Case Histories

Below are just a few of the actual case histories of people just like you that we have helped. For over twenty years, ARC Physical Therapy has helped nearly 10,000 people rediscover the simple joy of being able to sleep, work, and play without pain.

Patient: 63 year-old female hairdresser

Diagnosis: Bilateral elbow tendonitis (epicondylitis), bilateral shoulder pain, neck pain, and chronic low back pain.

Patient History: Patient owns a hair salon, and reports chronic low back pain (10 years) and severe bilateral elbow, shoulder, and neck pain (for several months) when working.

Significant Findings: Patient presented with painfully limited cervical rotation and side bending to the right. Bilateral elbow flexion and right shoulder abduction were also limited moderately and painful at the end ROM. Backward bending of the lumbar spine was also painfully limited. Muscular hypertonicity and tender points were present in the right posterior cervical spine, right shoulder and ribcage, both elbows, and right hip flexors.

Intervention: Patient was treated twice weekly for seven visits total. Treatment consisted of a neuromuscular treatment approach (Strain/Counterstrain) to eliminate the muscular hypertonicity and ROM limitations, followed by instruction in spinal stabilization exercises for the cervical and lumbar spine, and strengthening exercise for both upper extremities.

Outcome: Patient was discharged after seven visits with no complaint of pain in elbows, shoulders, neck, or low back, and she reported no difficulty with working. Patient did return for one follow up visit four weeks after discharge for minor low back stiffness, and correction of her technique with her lumbar stabilization home exercise. Patient reported four months later that she was still pain-free and working without restrictions.

Patient: 33 year-old female administrative assistant

Diagnosis: Headache, neck pain

Patient History: The patient reported that she turned her head and felt a “pop” in her neck which resulted in significant left sided neck and shoulder pain. Two days later, she went to an urgent care center and her X-Ray reported was negative for any cervical abnormality; she was seen for her initial evaluation at ARC. At the time, she was c/o 5 out of 10 constant pain, and she described pain as “a ton of bricks on my shoulder:. She reported sharp neck pain and shoulder pain when she turned her head. She was also c/o frequent sub-occipital headaches.

Significant Findings: The patient presented with significantly limited and painful cervical active movement in all directions, but especially while rotating her head to either right or left. With palpation, she presented with marked tenderness and increased tone at the sub-occipital region and left cervical musculature, including elevator scapula.

Intervention: The patient was seen for five total sessions over the course of two weeks. Treatment consisted of Strain/Counterstrain, myofasial release, manual cervical traction at her first two sessions, then mechanical cervical traction, PROM, scapula stabilization, and cervical isometric exercises, at her last three sessions.

Outcome: Patient contacted us two weeks later after her last session to report she has no complaint of pain.

Patient: 58 year-old, female, social worker

Diagnosis: Low back pain, piriformis spasms

Patient History: Patient began experiencing low back and left posterior thigh pain during her recovery period from bladder surgery. She reported severe pain after walking about 20 feet. She also reported pain with sitting, especially in a recliner chair. She had been prescribed an anti-inflammatory, but had no significant relief.

Significant Findings: Patient presented with severely limited lumbar flexion which caused low back pain and extreme cramping in hamstrings. Left hip ER was also moderately restricted and SLR was positive on the left. Severe hypertonicity and tenderness were noted in the left medial hamstrings and buttocks.

Intervention: Patient was treated three times a week for two weeks then weaned to two times a week for two more weeks. Treatment consisted of a neuromuscular treatment approach (Strain/Counterstrain) to hyper tonic areas of left hamstrings and buttocks, joint mobilizations to the sacrum, muscle energy techniques to improve spinal alignment, and a home exercise program of gentle stretching an isometric abdominal exercise.

Outcome: Patient was able to do some light gardening after four sessions and returned to work full-time after four weeks of treatment. Patient discharged after four weeks of treatment with no complaint of pain or loss of function.

Patient: 17 year-old female gymnast

Diagnosis: Status post left knee ACL reconstruction

Patient History: Patient was referred to clinic by her orthopedic surgeon, at 8 weeks post-op, after having received 8 weeks of physical therapy treatment at another provider. The surgeon reported displeasure with the lack of full knee extension.

Significant Findings: The patient presented with a 13º flexion contracture of her surgical knee. Passive knee extension was painfully restricted, with the patient reporting severe anterior joint line pain at the end of range. Palpation of the popliteal space revealed a 2cm diameter zone of dense, tender soft tissue, directly adjacent and medial to the posterior border of the lateral femoral condyle.

Intervention: A neuromuscular treatment approach was applied to the painful area, one visit only.

Outcome: After one visit, patient achieved an 80% reduction of the pain at end range extension, gaining 10º of knee extension (3º short of full extension). With the surgeon’s permission, the patient was referred back to the original physical therapy clinic she had been treated at.

Patient: 67 year-old retired but active Grandmother

Diagnosis: Scoliosis and LBP

Patient History: Patient with chronic history of recurrent LBP which she relates to her scoliosis persented to ARC physical therapy after a sudden increase in the low back pain over the last three weeks which limited her ability to perform any sustained weight brearing activities especially while standing and walking.

Significant Findings: She was found to have significant limitation in her lumbar flexion and left sidebending ROM. Her left hip and right lumbar musculature were hypertonic and tender to palpation.

Intervention: Patient was treated predominantly with (Strain/Counsterstrain) for her first six sessions and reported the resolution of the majority of her pain complaints after the first four sessions. She was seen for a total of ten sessions and was instructed in a follow-up exercise program with emphasis on core strengthening and lower extremity felxibility.

Outcome: Patient reported the resolution of her acute LBP as well as most of her chronic low back discomfort and had resumed all of her normal ADLs without limitations.

Patient: 52 year-old female

Diagnosis: Right hip trochanteric bursitis

Patient History: This patient reports falling on two separate occasions in December of 2008 and January of 2009 in which she landed directly on her right hip. Her X-rays were normal and she was diagnosed with a contusion and trochanteric bursitis. After receiving an injection to the trochanteric bursa and taking anti-inflammatories for several months, she was referred to ARC physical therapy.

Significant Findings: Patient presented with limited and painful lumbar and right hip ROM in all planes of motion. She was unable to tolerance sustained periods of standing or sitting secondary to pain and had stopped many of her normal ADLs such as lifting her grandchildren and gardening secondary to the pain. The pain was also disrupting her sleep and made it impossible to climb stairs reciprocally. Upon clinical exam, she was found to have a right sided pelvic obliquity which was most likely a result of her fall with significant muscle quarding in her right lower quadrant muscles.

Intervention: Patient was treated two to three times a week, receiving (Strain/Counsterstrain) and muscle energy and was demonstrating a resolution of her pelvic obliquity as well as 70% reduction in her pain complaints after only four sessions. She was seen for a total of twenty sessions over the next two months to help restore her normal core strength as well as restore her normal lower extremity flexibility.

Outcome: Patient recovered fully while reporting the total resolution of her pain and had returned to all her normal activities, including gardening.

Patient: 50 year-old male electrician

Diagnosis: Left shoulder pain status post left shoulder arthroscopy and subacromial decompression.

Patient History: The patient was involved in a motorcycle accident nearly two years prior to surgery from which he suffered a fractured left clavicle and scapula as well as a collapsed left lung. He was treated for the collapsed lung and the fractures were left to heal. Over the following two years the patient continued to complain of left shoulder and scapular pain as well as pain and tingling in the left forearm. All symptoms were worsened with overhead activity. Throughout this time the patient continued to work full duty as an electrician. He received ultrasound treatments and cortisone injections prior to undergoing surgery on 3/26/09. Following surgery he was referred to therapy for ongoing left shoulder pain with movement. At the time the patient began therapy at Advanced Rehabilitation Clinics on 4/9/09, he was off work due to his recent surgery and continued complaints of signs and symptoms.

Significant Findings: Patient presented with moderately limited left shoulder range of motion that was moderately uncomfortable at the end ranges. Forearm symptoms (numbness and tingling) could be reproduced with left shoulder flexion and left scapular retraction. The arthroscopic portals were healing well and there was minimal swelling present. The patient exhibited hypertonicity and tenderness to palpation in the left pectoralis minor muscle as well as the intercostal muscles of ribs 3-5.

Intervention: Patient was treated three times per week for eight weeks at which time he returned to work full duty. He was seen two times per week for an additional three weeks after his return to work. In total the patient completed thirty-one sessions of therapy over a four month period. Treatment consisted of (Strain/Counsterstrain) to address hypertonicity in the left upper quadrant, patient education regarding posture and body mechanics and strengthening for the left rotator cuff and scapular musculature. At the end of eight weeks, the patient no longer complained of distal symptoms with overhead activity or scapular retraction, had regained full active range of motion and strength of the left shoulder and scapular region, and was independent in a home exercise/stretching program. Upon return to work (at full duty), the patient experienced a mild increase in left upper quadrant signs and symptoms as well as a minor decrease in left shoulder range of motion. His remaining two weeks of therapy focused on the resolution of neuromuscular dysfunction in the upper quadrant using (Strain/Counsterstrain) and range of motion was restored to within normal limits (despite working eight or more hours per day that included a significant amount of overhead activity). Pain upon discharge was minimal and patient was able to self manage symptoms.

Outcome: Patient was returned to work full duty and without restrictions. He was discharged from therapy (to self management of symptoms) reporting 80% reduction in his original symptoms.

Patient: 75 year-old retired female

Diagnosis: Chronic low back pain

Patient History: Patient reported history of chronic low back pain (LBP) over the last five years which had progressively worsened to a 5-7 out of 10 (on a 0-10 scale) over the last four months. Patient complained of severe difficulty with rising in the morning and could not tolerate any prolonged standing or walking for more than 5-10 minutes. This was particularly frustrating for the patient as she just moved into a retirement community a couple of years ago and could no longer go on many of the planned day trips that she used to enjoy. She also reported pain in both knees which hindered her ability to climb stairs or get in or out of the bus, and required her to use a walker when walking outside her apartment.

Significant Findings: Upon evaluation the patient exhibited painful restrictions in both lumbar flexion and extension as well as restricted right knee extension and flexion which caused her to ambulate with a limp. Patient also exhibited significant hypertonicity in the left lower quadrant musculature with tenderness to palpation of the left hip flexors, and lumbar paraspinals as well as tenderness over the posterior knee musculature. The core musculature was significantly weak with limited function fo the deep stabilizers (transverse abdominals and multifidus).

Intervention: A neuromuscular technique (Strain/Counsterstrain) was applied to the hypertonic left lower quadrant and right posterior knee musculature and the patient reported significant reduction in the severity of her low back pain after 2-3 visits. The techniques were continued to the right posterior knee and the patient was able to wean from her walker after four weeks of physical therapy. The patient continued physical therapy for an additional four weeks, emphasizing core strengthening and flexibility and strength of the lower extremities.

Outcome: The patient was discharged to an independent home program after two months of physical therapy, reporting only an occasional aching in her low back with prolonged standing. Functionally, she was very excited because she has resumed taking the many day trips offered by her retirement community, without any significant side affects.

Patient: 49 year-old male stock broker

Diagnosis: C7 Radiculopathy

Patient History: Radiculopathy noted in fourth and fifth digits after serving a tennis ball approximately one year ago. Patient continued to have symptoms after undergoing ulnar nerve release surgery and C7 epidural injection seven months ago.

Significant Findings: Patient presented with a 10 degree elbow flexion contraction and 15 degree wrist supination contracture as well as fourth and fifth digit numbness when performing the combinaiton movement of end range elbow flexion and wrist pronation. Dense fibrous tender tissue noted in cubital fossa as well as moderate fascial restrictions in proximal wrist felxors and surgical incision scar tissue. Strength was within normal limits. No change in symptoms was noted when patient returned to spot.

Intervention: Augmented soft tissue mobilization of wrist flexors and biceps, myofascial release of the distal biceps and ulnar nerve stretches.

Outcome: After two visits patient reported only rare occurances of finger numbness and was able to achieve normal supination, active range of motion and improved elbow extension. Physical therapist recommends ergonomic workstation set up consultation, tennis serving lessons as well as continued neural stretching to maintain current reduction in nerve tension.

Patient: 35 year-old male businessman

Diagnosis: Hallux Limitus RIght Foot S/P Total Joint Implant

Patient History: The patient is a marathon runner who injured his right foot three years prior. He began experiencing dull, ahcy pain with occasional shooting pain in his right big toe during long runs. The severity and frequency of his symptoms increased significantly, limiting his runs to no more than 3 to 4 miles. Surgical correction was recommended. The patient was referred to Advanced Rehabilitation Clinics post-op Total Joint Implant of the first toe.

Significant Findings: The patient presented with moderate edema right foot and toes. Passive toe extension was painfully restricted. The patient was not weight bearing through the first toe during level walking and he was unable to run.

Intervention: A musculskeletal treatment approach was initiated including joint mobilization, massage, range of motion and strengthening exercises, and gait training. A progressive running program was designed to return the patient to his marathon training regimen.

Outcome: The patient successfully returned to pain free running three months post-op. He was discharged with a self directed training program to allow for completion of a marathon five months post-op.

Patient: 47 year-old female

Diagnosis: Cervical Degenerative Joint Disorder and Chronic Headaches

Patient History: Patient with chronic history of recurrent headaches since being in a motor vehicle accident in 1979. Reported several trials of physical therapy over the last fifteen years with no substantial change in symptoms, and in one trial of physical therapy, the symptoms had actually worsened. Patient is diagnosed with cervical degenerative joint disorder and cervicogenic headaches and referred to physical therapy with complaints of daily headaches and pain throughout her neck and upper back.

Significant Findings: Patient exhibits grossly normal ROM with end range pain in all directions of movement. There were multiple tender points throughout the left upper quadrant musculature with asymmetrical posturing of the left scapula and upper rib cage, with an elevated and protracted prosture (forward and depressed shoulder).

Intervention: The patient was treated with (Strain/Counsterstrain) two sessions for eight weeks after which she reported a reduction of the frequency of her headaches to once a week. Patient also reports no pain with end range crevical motion. The intensity of her headaches had been reduced by 50%. She was weaned to one session a week for two months during which postural exercises were introduced. At the end of the two months, the patient was experiencing infrequent headaches whose intensity were only 20% of her original symptoms.

Outcome: The patient stopped by our office two months after her last visit and reported that she has been headache free for the prior month.

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