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May 2016 Myotherapy Newsletter

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18 May 2016  |  1 Comment

Alison Smith

Case Study 1

Subject:   Female, 46yrs

Occupation:   Hairdresser

Activities: Walking - Daily

Stretching - Daily

Gardening - Weekly

History:  Client has experienced Mid Tx pain described as burning and stabbing in excess of five (5) yrs. For the past two (2) yrs client has suffered a similar burning/stabbing pain and loss of ROM in the right shoulder.  Client also suffers from consistent Orbital and Sub-Occipital headaches. The client has sporadically sought out treatment; Chiropractic, Osteopathic, Physiotherapy and occasionally massage.

Agg:  Occupation and sleeping on side

Ease: Stretching

VAS:  5-6


Cx:    Flexion: SMCD

Extension: FP

Rotation: DN

C1-2 Rot: JMD/TED

LRF: Right – pain

MRE: Right – pain

UE1: Tx Ext/Rot JMD/TED

UE2: Elbow Flexion SMCD

Shoulder Girdle SMCD

SOT: Neer's Impingement +ve

Hawkin's Kennedy +ve

Subjective Examination:

Subject displays classic upper crossed syndrome pattern and 'painful arc' on abduction indicative of shoulder impingement.

Treatment Protocol:

Frequency:   4 treatments over 28 days

The client was treated with a combination of Dry Needling to the Rotator Cuff, Latissimus Dorsi, Trapezius, Rhomboids, Sub-Occipitals, Deltoid, Tricep and Pec Major. Mobilisation of the Tx &Cx spine and 1st Rib.  Active Release of Sub-Occipitals.   Trigger Point  SCM, Subscapularis, Pec minor.  MET: SCM.  MFR  of Latissimus Dorsi – seated and side lying.

Over the course of treatment the client reported the cessation of headaches, a VAS reduction of TX pain to 1-2 on working days and 0 on all other days.  ROM of the right shoulder improved significantly, however it still registered a 2-3 VAS at the upper range of the arc preceding a treatment.  At the conclusion of the final treatment shoulder ROM VAS was reported as a 1.

Exercise Prescription:

For the first 14 days the client was instructed to spend 2-5 minutes daily, preferably at the end of the day, lying supine with legs elevated up against a wall with arms abducted to a compfortable range and if needed a pillow to support the head.  After this 2-5 minutes to be spend lying supine with a rolled up towel positioned just beneath the scapula in order to self mobilise the Tx.

At the third and final treatment the client was instructed in the t-spine rib grab and the wall sit.  Additionally the client was provided with a simple yoga program for wrists and shoulders (see attached).

Self-Treatment & Education:

At the initial consultation the client was taught to self-treat SCM to aid with her headaches and also the use of a Trigger Point (smooth) Ball.  In discussing with the client the relationship between her occupation, the effect it has on her body, in particular the position of her shoulder and therefore her pain the aim was to empower and impress upon her the need for daily self-treatment and commitment to the exercise prescription.


After three treatments and good compliance with EP and self care techniques the client reported nil headaches in the (7) days between 2nd and 3rd treatment.  There was an overall reduction in the VAS reportage – from 5-6 to 2-3/1-2.

Each treatment was preceded by the SFMA, the most consistent element was DP on LRF & MRE and DN on Cx rotation.  At the conclusion of each treatment these elements were re-tested and showed significant improvement, however these gains were eroded between sessions.  This is indicative of the impact that repetitive work such as hair dressing has on the clients physiology.  Overall the client did enjoy significant improvement but without consistent follow up treatment and a commitment to EP and self-treatment undoubtedly the client will return to her original presenting condition.

My treatment strategy was greatly informed by my research for Exercise Prescription PBL 2 – First Rib Dysfunction and PBL 3 – Shoulder Impingement Syndrome.

For anyone interested we have new myotherapy courses starting on the Sunshine Coast Mondays 9-4pm & Tuesdays 9-1pm, commencing July 25, 2016. Call Hannah Eacott on 07 5443 2553 to discuss further.

Our Gold Coast campus will be accepting late 2016 intake for Myotherapy August/September. This will run for 9 months but please check with the Gold Coast campus closer to that date.

The Brisbane campus still has places available for intake toward the back end of the year so hurry while there are still places, they fill quick! Their last Myo for the year commences next Tuesday, 24th May 2016.  It will run Tuesday night and Thursday day for 53 weeks.

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