! CASE STUDY Student name School Course code Submission date Ian Jenkin London School of Sports Massage LS29B Case study number - 1, 2 or 3 2 Category - from list of 6 - each case study must be from a different category Athlete (recreational or competitive) Physical disability Aged over 70 Post-acute injury or surgery Chronic injury Medical condition Post-Surgery General information - first name only, age, gender - do NOT include any personal identity information Carla, 43, Female Occupation - describe the physical aspects of their job and also their level of occupational stress or other relevant factors Production Controller - office-based role, largely sedentary. Sport - in detail if this is in the Athlete category Previously: Snowboarding, Swimming, Running, Yoga Currently: CrossFit (Recreationally) Medical history - in detail if this is in the medical condition, physical disability or over 70 category Benign Tumour found behind mandible - below the ear on the right side. Surgically removed. Injury history - in detail if this is in one of the injury categories No broken bones Injured neck in Snowboarding accident some years ago - crash resulting in impact to C6-T2 area of spine - not diagnosed or treated but some resulting restriction to movement. Lifestyle - family, hobbies, activities, lack of activity, diet, smoking, social life, etc 1 young child, healthy eater, non-smoker, occasional drinker, takes part in structured exercise 3-4 times per week. Treatment goals
Client - what the client hopes to achieve Primary (eg treat the main injury) Secondary (eg treat another problem, get back to playing sport, lose weight and get fitter Primary goal is to restore any lost range of movement and to reduce/remove any resulting muscular tension. Secondary goal is to reduce the visibility of the scar as much as possible using myofascial techniques. Therapist Are client s goals achievable? How many sessions may be needed and over what timescale? If/when you would consider referring the client to a medical practitioner If/when you would consider referring client to another discipline such as Pilates, sports coach, podiatrist Yes, there was very little muscle interference. Any restriction in movement is likely residual. If symptoms were to worsen or were to change and any pain arose, then referral to a medical practitioner would be sought. Assessment Current symptoms - client s account of their symptoms - pain, restricted movement etc Slightly restricted movement on lateral neck flexion to the left and slight restriction on rotation to the left Posture - neutral, lordotic/kyphotic, flat-back, sway-back or other noticeable features Posture fairly good - having done yoga for some years, Carla has very good posture. Slight posterior pelvic tilt but only missing a couple of degrees. Very minor rounding of the shoulders but negligible. Spine - either normal or describe the degree of excessive lordotic/kyphotic curvature (cervical, thoracic, lumbar, sacral) Slightly flat-backed due to the posterior tilt mentioned above, but generally fairly good. Pelvis - either normal or describe the degree of excessive anterior/posterior alignment (left and right sides) and lateral alignment (one side higher than the other) Posterior tilt - even on both sides and only missing 1-2 degrees. Shoulders - either normal or describe the degree of protraction/retraction, elevation/depression (right and left sides) All pretty good. Nothing to report - slightly protracted but very minor. Leg/arm alignment - either normal or describe any features such as hyper-extended knees, overpronation or other foot issues All seems ok - very mobile through squat assessment. I coach Carla in CrossFit classes and she has very good mobility. Mobility - which joints or spinal sections appear to have a restricted range of movement or are hyper-mobile As mentioned above, very good mobility. Slight lack of stability overhead but this may be due to lack of familiarity with overhead movements, so more of a skill acquisition issue than musculoskeletal. Range of movement (ROM) tests The joints or spinal sections you apply active, passive and/or resistive ROM tests (or any other tests) to Conclusions
Assessed the neck as this is the area of focus for treatment. Shoulders Flexion and extension - all ok Rotation - Right ok, Left missing about 15 degrees Lateral flexion - right ok, left missing about 20-25 degrees. Able to fully elevate and depress evenly. Can protract and retract evenly Flexion even and full range Extension - full range Abduction - full range Horizontal Abduction & Adduction - full range Palpation and observation - which muscle areas look and/or feel hyper/hypo-tonic Nothing really appears to be particularly unusual - some slight pulling showing in the right side of the neck during lateral flexion to the left and on rotation to the left. Appears to be through the upper trapezius. Assessment summary - describe what you think the problem is, based on the above assessments I assume there is some residual tension presenting due to the disruption to the skin and fascia in the right side of the neck. Treatment plan What measurable improvements are you hoping to make to the symptoms? Hoping to restore full range of movement and to reduce the visibility of the scar. SESSION 1 General massage - effleurage & pétrissage to the upper traps and deep stroking to the scalenes. STR to Scalenes, NMT pinch technique to the upper trapezius followed by MET (PIR) for lateral neck flexors with client in supine. Fascial techniques to the scar itself to lift & apply friction to mobilise the scar. Range of movement in the side of neck has returned. Lateral flexion and rotation back to full range. Scar feels softer and less rigid.
Advised to stretch lateral neck flexors using self-met technique. Keep working manually on the scar and keep stretching the tissue and moving it around to reduce the scar. SESSION 2 How long after Session 1? 3 weeks Client feedback - what client says about their condition since the last treatment Client reports range of movement still feeling good and scar still continuing to soften up a bit. Reassessment - describe any changes that have occurred since last treatment Scar is a little fainter now in appearance and the tight skin around the scar is starting to flatten out and become less obvious Friction applied to the scar but no general massage used in this session. No other techniques used in this session. Scar still reducing in visibility. Still advising to stretch lateral neck flexors and upper trapezius. Also advised to keep mobilising the scar and to ask her husband to lift it and apply some friction. SESSION 3 How long after Session 2? 4 weeks Client feedback - what client says about their condition since the last treatment Client feels that the scar is becoming less of a thought and they are not as self-conscious about it as it is reducing nicely. Reassessment - describe any changes that have occurred since last treatment
The line of the incision is less distinguishable and the scars from the stitches have pretty much disappeared. Upper trapezius again - this was mainly due to general stress and accumulation of training/exercise stress. Friction used on and around the scar itself to continue reducing it. None used in this session - Carla has no movement restrictions or muscular injuries/aches to address so we focused on the scar again and will continue to until we no longer see any improvement. The scar is still decreasing in visibility although I doubt that we will get it completely gone, it is becoming easier for Carla to live with as it is far less visible than it was and she has more confidence wearing her hair up again. As above really - keep working into the areas of the scar that feel tight and thick and try to massage them out - I showed her husband some techniques to use on the scar itself to continue treating it. Conclusion - summarise results and future plans (if any) with the client We will continue to work on the scar and will monitor movement patterns in the neck and shoulders whilst exercising to ensure that things aren t tightening up. ISRM use only Marker initials % mark for this case study Comments Average % for three Case Studies