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PHYSIO GROUP
370 Steeles Ave W
Thornhill, Ontario
L4J 6X1

Tel: (647) 707-7000
physiogroup@hotmail.ca

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Case Studies

Physiotherapy Case Studies

Headaches
Low Back Pain Radiating into L-Buttock
R-Sided Neck and Shoulder Pain
Scoliosis
TMJ Pain

Osteopathy Case Studies

Constipation And Abdominal Cramps
Diarrhea (Baby)
Ear Infections
Nose Bleeds
Unresolving Infections

Physiotherapy Case Studies

Headaches

Patient Info	Girl, 15 years
History	Patient started to have headaches 3 years ago. She complains of pain above her eyes that usually comes on in the afternoon and lasts up until bedtime. She generally has headaches 2-4 times per week.
Observation Evaluation	On evaluation patient was found to have very restricted mobility of cranial bones. There was a restriction around the third ventricle, almost in the center of the head. In addition, the 1st vertebra position was too far forward compressing vessels passing from the neck to the head.
Anatomical and Physiological Relevance	Cranial bones mobility helps to pump fluid inside the brain. Decreased mobility means decreased nutrition and decreased blood flow to the brain. The third ventricle helps to produce and distribute cerebrospinal fluid, which nourishes and cushions the brain. Poor position of the first vertebra affects the greater occipital nerve causing headaches, and also prevents normal blood supply/outflow from the brain.
Course of Treatment	Patient had 4 weekly sessions of therapy with focus on mobility of the skull and blood supply to the brain. A month later she was given another session and was scheduled for a follow-up in 6 months.
Outcome	At the end of the first month patient reported feeling 80-90% better. She said that over the last week she only had 1 mild headache. During follow-up a month later she felt great and only had 2 headaches during previous month. Her condition continued to improve and she was headache-free half a year later.

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Low Back Pain Radiating into L-Buttock

Patient Info	Female, 56 years
History	Low back pain that has been getting worse over the past 6 months. Currently pain is really bad, especially in sitting. Patient works at a computer and has to sit for prolonged periods of time at work every day. She also complains of pain at night when she falls asleep, or when she has to turn over.
Observation Evaluation	Patient was found to have a very hard and restricted sacrum. The lumbar spine had a number of vertebral lesions. R kidney was found to be in a poor position, and some areas of low back were found to have severe muscle atrophy.
Anatomical and Physiological Relevance	The lumbar (lower back) spine and sacrum lesions corresponded to patient's location of pain. Poor kidney position contributed to paraspinal muscles spasm and affected Psoas (the muscle that connects low back to the leg and passes through the groin). Poor low back and hip position put tension onto nerve rootlets, which likely contributed to the L buttock pain. Lack of muscle support compounded it further
Course of Treatment	Patient was given a total of 13 sessions. Initially she was seen twice a week for 3 weeks. During the first two sessions treatment focused on her sacrum and lumbar spine. The following week kidney was corrected, and then spinal (dural) membranes and neural rootlets were decompressed. Each osteopathic treatment was conducted in conjunction with a massage to release muscle tension and allow for quicker healing. After the 6-th session she reported that the pain was improved almost 50%. She continued weekly treatments for another 6 sessions and came for a follow-up two months later.
Outcome	2 months later patient reported being totally pain-free.

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R-Sided Neck and Shoulder Pain

Patient Info	Female, 46 years
History	Patient presented with complaint of R neck and shoulder pain that keeps getting progressively worse over the last year. Recently she started to have difficulty lifting R arm up.
Observation Evaluation	On evaluation patient was found to have restriction in the left lung, ribs and neck area.
Anatomical and Physiological Relevance	Lung restriction pulls on the neck. Neck lesion causes neural tension towards the shoulder and results in shoulder pain. Restriction in the ribs compounds the problem and creates more tension towards the armpit, which results in decreased arm mobility.
Course of Treatment	Patient had 9 sessions of therapy with focus on the position and mobility of ribs, heart and lungs. Patient was also given exercises to improve shoulder mobility and strength.
Outcome	After 3 sessions patient reported improvement in pain. After 9 sessions patient reported that her pain improved 95% and she was able to fully use her shoulder.

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Scoliosis

Patient Info	Boy, 9 years
History	Patient first discovered that he had a mild thoracic scoliosis 3 years ago, when he had an X-ray for a pneumonia. He has been followed by an orthopaedic surgeon, and apparently the curve has not progressed over the past three years. Recently he started to spend a lot of time on the computer and his parents noticed that in addition to scoliosis, he now started to develop a forward-curved posture with elevated shoulders and caved-in chest.
Observation Evaluation	On evaluation patient was found to have mild scoliosis and poor posture. The anterior ribs and diaphragm were restricted. There were a number of vertebral lesions in his thoracic spine, and overall flexibility of the spine was restricted.
Anatomical and Physiological Relevance	The vertebral lesions and reduced flexibility of membranes around spinal cord likely contributed to his scoliosis. Ribs restriction and habitual lumped posture at the computer compounded the problem and he ended up developing a forward curvature.
Course of Treatment	Parents were educated regarding the position at the computer. They were advised to elevate the screen and not allow their child to play computer games on a laptop on the couch, but rather on a table. Patient had 4 weekly treatments aimed to improve spine flexibility and correct vertebral position. He was treated with manual therapy, ribs stretches to open up the chest and breathing exercises. Afterwards he was followed monthly for 4 months to maintain and augment the progress.
Outcome	Noticeable difference in his posture was visible after the third session. One month later parents reported that their son's teachers commented on the improvement of his posture. The improvement was maintained during the three months of follow-up, after which patient was discharged and given an instruction to come back in one year for a follow-up.

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TMJ Pain

Patient Info	Female, 26 years
History	Patient presented with pain and clicking over the left TMJ joint that has been there for at least half a year. Patient reported not being able to fully open her mouth. She took 4-6 extra strength tylenos per day for pain and wore a bite guard at night. Pain was described as sharp, constant and evoking headaches.
Observation Evaluation	Patient's jaw mobility was found to be about half of normal. The L TMJ and temporal muscle (muscle over the joint) was very tender. The joint felt swollen. The mobility of membranes inside the skull was restricted. L temporal (ear bone) mobility was restricted the most. In addition, the trigeminal ganglion (a collection of nerve cells under the left temporal bone) was blocked. The vitality of mandible was severely restricted with multiple sites of density possibly due to extensive orthodontic/teeth work.
Anatomical and Physiological Relevance	The TMJ joint and muscles were inflamed. The skull membranes limit normal mobility of the skull bones and affect nutrition to the brain and compliance of brain and ganglia. The trigeminal ganglion is heavily implicated in oral and facial pain. Previous history of extensive orthodontic work may explain lack of vitality of the mandible, and would create further tension on the trigeminal nerve.
Course of Treatment	Patient was given 5 weekly sessions with the focus on releasing the mandible (jaw) and the trigeminal ganglion. Membranous tension inside the skull was corrected, and normal blood supply to and from the TMJ joint was restored.
Outcome	Patient reported significant improvement after the 3rd session. During the 5th session her mouth opening was measured to be almost twice of the initial, however she complained of a recent onset of headaches. She was seen 4 more times after that and reported full resolution of both the headaches and her TMJ pain at the end of treatment.

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Osteopathy Case Studies

Constipation and Abdominal Cramps

Patient Info	Boy, 12 years
History	Frequent upset stomach with bouts of constipation and diarrhea for as long as he can remember. The last bout of constipation was so bad, that he had to miss 2 days of school.
Observation Evaluation	Patient was found to have a very hard and restricted sacrum. The lumbar spine had a number of vertebral lesions. The sympathetic neural chain of the lumbar spine was very restricted. In addition there were a number of lesions in the neck and suboccipital spine (i.e. neck just under the head).
Anatomical and Physiological Relevance	The rectum, which is responsible for collection and expulsion of waste, is situated right in the front of the sacrum. Poor mobility/position of sacrum would compromise rectum and its innervation. In addition low back lesions and sympathetic neural trunks (which run the full length of the spine) would compound the problem by restricting the normal neural supply to the area.
Course of Treatment	Patient was given a total of 11 sessions. Initially he was seen 5 times with a weekly interval. Treatment focused on releasing colon mobility and innervation. Neck and Lumbar lesions were corrected, and sympathetic trunks were released. Patient reported significant improvement at the end of the first month, and was put on a biweekly schedule for the second moth, after which treatment was continued monthly 4 more times.
Outcome	Patient was reporting improvement throughout the course of treatment. At discharge he stated that the problem was 80-90% resolved. He was very happy with the outcome. Patient was advised to continue maintenance treatment of 1-2 sessions every 6-8 months to maintain his status.

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Diarrhea (Baby)

Patient Info	Boy, 1.5 years (infant)
History	Patient's mother brought him in because she was unable to stop his diarrhea over the past few days. She said that they are trying some new foods, and apparently the baby is not reacting well to beans/sweet peas. They stopped the peas, but he has a loose green bowel movement after every feeding/bottle.
Observation Evaluation	On evaluation baby's liver was found to be in a restricted position. The tummy was swollen with poor circulation of lymphatics.
Anatomical and Physiological Relevance	Liver is a key organ in digestion. When liver function is decreased, small and large intestine receive food that is not ready to be assimilated. The digestive organs have to work harder to break down pieces that should have been pre-digested before arriving there. In addition, poor lymphatic supply and fluid stagnation around the small intestine affect digestion and the ability to fight infection.
Course of Treatment	Patient was given 1 session targeting liver position and function, and circulation of lymph around the smaller intestine.
Outcome	Parents reported that the next day after treatment baby's diarrhea stopped. The colour and texture of stool normalized over the next 4-5 days.

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Ear Infections

Patient Info	Boy, 2.5 years
History	Patient's mother brought him to our office for recurrent ear infections. Patient had 3 ear infections during preceding 2 months. Each time he was treated with a course of antibiotics.
Observation Evaluation	Patient was found to have poor vitality of the small intestine, decreased lymphatic activity, restriction of membranes inside the head and restricted mobility of L temporal bone (the bone that hosts the ear).
Anatomical Relevance	Small intestine pouch contains a lot of lymphatic nodules and fluid. Lymphatic system hosts cells that fight infection and provide the first line of defence against infections. Restricted and/or stagnant lymphatic system puts body at a disadvantage when facing an infection. This combined with decreased mobility of the ear bones sets the stage for ear infections.
Course of Treatment	Patient was given 3 manual treatments 1-2 weeks apart. The goal of treatment was to improve circulation and lymphatic function of the whole body, and especially head and neck. A month later he was given another session targeted to maintain his improvement and augmentcirculation and lymphatic delivery to the ear area.
Outcome	One week after the first session, patient had the last ear infection, which resolved within a week. Half a year later patient's mother reported that the child is doing very well, and did not have another infection over the last 6 months.

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Nose Bleeds

Patient Info	Boy, 14 years
History	Patient has 1-2 severe nose bleeds per week. He says that he loses a significant amount of blood every time and his shirt and Kleenexes are covered in blood during each episode.
Observation Evaluation	On evaluation patient was found to have a restriction in his neck just under the head. The head felt congested. Neck was tight with compression around carotid sheaths.
Anatomical and Physiological Relevance	Neck allows blood delivery and outflow from the head. Tight neck and restricted suboccipital spine predispose to congestion in the head. The increased intra-arterial pressure has a tendency to release through nose bleeds.
Course of Treatment	Patient had 4 sessions of therapy over 6 week period with focus on releasing the neck and head structures, including connective tissue, intracranial membranes and passageways of arteries and veins in and out of the skull.
Outcome	At the end of treatment patient reported 1 nosebleed over the last month. 4 months later he stated that he only had one more nosebleed after finishing his treatment.

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Unresolving Infection

Patient Info	Female, 38 years
History	Patient has been sick for almost 4 weeks. Initially she had a high fever, which came down after about a week. However she continued to have congested sinuses with headaches, a general feeling of malaise and a dry hacking cough, which would not go away.
Observation Evaluation	Restricted diaphragm Upper lumbar lesion Decreased mobility of cranial bones
Anatomical and Physiological Relevance	The diaphragm affects the ability to inspire and lung ventilation. Decreased ventilation predisposes to prolonged infections and cough. Upper lumbar vertebrae put pressure on the lymphatic reservoir, which hosts cells and fluid for fighting infections. Lack of proper lymphatics equate with decreased immunity. Decreased mobility of cranial bones compounds the problem.
Course of Treatment	Patient had a total of 2 treatments one week apart.
Outcome	Patient reported that 2 days after the first session her sinuses cleared and she slept through the night for the first time in weeks. One week later she was back to her normal self with no symptoms of congestion or cough.

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