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Lower Back Pain

Lower Back Pain

NECK AND SHOULDER PAIN

NECK AND SHOULDER PAIN

KNEE PAIN

KNEE PAIN

Interesting case using NKT protocol

I seldom share case studies of patients but I thought I would share this one because it was very interesting to me. I got this patient just after taking my first course in Neurokinetic Therapy which is an excellent tool in deciphering muscle imbalances and movement dysfunction.

This is a case of the pectoralis minor muscle not functioning he way I would normally expect. This muscle tends to be short and weak bringing people into that illustrious forward head posture that you see many times with people who sit at a desk all day. When it is tight it will also cause the bottom of the shoulder blade to tilt upwards. This is conventional thinking but look what I found with the following case study! :

45 year old squash player presents with 6 months history of pain in his right coracoid process, insidious onset. Patient has repeatedly had therapy which primarily consisted of pec minor release and rotator cuff exercise. Patient states that none of the therapy really helped and the exercises only help him temporarily. Objective findings included internally rotated shoulders, pain at end range of abduction, flexion and horizontal adduction. Impingement tests (neers and Hawkins-kennedy) were both positive. The coracoid process was tender on palpation and the patient stated he has had a constant dull ache for approximately 1 week. Muscle testing… Rotator cuff muscles were all strong and relational testing to pec minor revealed nothing. I tested coracobrachialis and short head biceps due to their attachments to the coracoid and both were strong. When testing Serratus anterior in a seated position – The upper fibers were weak. So I asked the patient to therapy localize pec minor and the upper fibers of serratus were strong. I fired up the pec minor and tested the upper fibers of serratus again and found a neural lock! So serratus anterior was facilitated and pec minor was inhibited! I then continued to release the serratus anterior with a functional release technique and the pain in the coracoid was 100% gone on palpation and special tests!

For the practitioners out there reading this... make sure you assess and don't guess. I was totally shocked in this case but I am glad I learned a new way to assess these muscle imbalances and I could put a smile on my patient's face! That's why I am a physiotherapist - such a reward!

For the lay person reading this. I know I used a lot of jargon in this article, but the point is... it is very easy to find out WHAT hurts, but the WHY it hurts takes a lot more detective work. That is why I love working with my colleagues at MOBO Physio, we are all interested and passionate about the WHY!

Make sure you come to Mobo Physio to get assessed orthopedically and functionally to get to the true cause of pain! 

Thanks for reading!

Morris Senior, PT, CSCS, FMS, GAMP

 Owner of Mobo Physio, Physiotherapists in North York