Top 5 Fridays! 5 Interesting Cases of 2014 | Modern Manual Therapy Blog

Top 5 Fridays! 5 Interesting Cases of 2014


Ok, I am at a loss for a coherent topic for today's Top 5 Fridays! Here are 5 of my more interesting cases this year.


Ok - it's not her, but if you missed this on my social media, that's amazing! - Guinness Record Holder for oldest Gymnast, 86 yo!

1) Move it or Lose It
  • 85 year old female, who volunteers at the senior center "to help out the old folk"
  • she practices getting up off of the floor 10 times/day knowing that is a severe risk at her age
  • 3 visits of cervical retractions, mild postural correction and cervical dissociation exercises and she was asking if she could just continue on her own, of course she could!
2) Hip flexor "pulling"
  • chronic pain patient who I train when the pain is under control, and I treat when she needs it
  • she was complaining of severe hip flexor pulling with squats and deadlifts
  • took a baseline with kettlebell deadlifts and end range trunk flexion caused severe "pulling" in her left hip flexors
  • Capnotrainer baselines showed great ETCO2 at rest and in sitting, she has been working on the rhythm of her breathing to keep her CO2 levels optimal
  • at end range trunk flexion, holding onto the bell, she was told to close her eyes and concentrate on her breathing pattern
  • after obtaining the breathing pattern than normalized her ETCO2 levels the "hip flexor pull" was completely eliminated
  • it was a learned breathing pattern that started with exercise - not after prolonged exercise
    • in other words, more O2 was not needed within the first 1-2 reps, it was a habit
From a Yale study on hyperventilation
O2 levels brain scan after only 30 seconds of overbreathing
3) Unexplained Compliants
  • 11 yo female, with bilateral arm paraesthesia, weakness, mood swings, severe fatigue
  • her lumbar pain I previously wrote about here, seemed mechanical in nature
  • no cervical or general UQ treatment affected her other complaints
  • Capnotrainer results: severe hyperventilation, average ETCO2 levels at 20 mmHg, the normal levels to balance pH should be between 35 mmHg and 45 mmHg
  • her BPM was 40 with extremely short inhalation and aborted exhalation
  • attempting to coach her on slower, more rhythmic breathing, she felt like she could not breath appropriately and rushed and forcefully exhaled
  • on the 3-4 breaths a minute she was able to slow down to 19 BPM, her ETCO2 levels were 35 mmHg, the lowest level needed to buffer pH
  • her mother was instructed on practicing with her 20-30 minutes a day and they will follow up in 2 weeks
  • taking the above into account, you can see why the patient is fatigued, has mood swings, and any other number of her complaints
  • research shows up to 50% of unexplained complaints that go undiagnosed have patients that are overbreathing

4) Anxiety and Performance
  • 38 yo fitness competitor and marathoner
  • recently started a huge new business, and told me she has had anxiety for years - I did not know despite having known her as a close friend for more than 10 years
  • cervical pain after two head traumas during hockey
  • she improved mechanically with cervical retraction, IASTM to cervical patterns, RockTape to cervical patterns and kettlebell carries to improve scapular stability
  • what clinched the recurrent "tightness" in her cervical spine, while also greatly relieving her anxiety was some learning on the Capnotrainer and working on her thoracic rotation
  • upon first using the Capnotrainer, she was really upset, asking if her average levels of ETCO2 of 26-27 mmHg, was "accurate" because she was so fit.... 
    • my response "Being fit gives makes it ok that your pH is too high?"
  • Watching the visual feedback capnograph only frustrated her
  • upon closing her eyes in supine she was able to raise her PECO2 levels to 40 mmHg, which she could replicate by closing her eyes and focusing on her rhythm in sitting as well
  • after some IASTM to her thoracic patterns and instruction on open book, plus cervical disassociation in the TGU triangle position, she felt much better
  • after two weeks, she returned with improved thoracic rotation, decreasing the intensity of most of her resistance training and taking time to close her eyes and reset her breathing patterns any time she feels tension or anxiety, which relieves it in 1-2 minutes
That's not a WB joint!

5) Pushing it Back
  • 22 yo female with TMD after two basketball accidents (both getting elbowed in right inframandibular area)
  • chronic HA and cervical pain for 5 years
  • after posture correction, facial and cervical complaints decreased 50%
  • she responded rapidly to TMJ mobilization, light IASTM to mandible and cervical patterns, plus postural correction and cervical retraction for HEP
  • after 2 visits, her Sx started around 3-4 pm instead of upon waking
  • I told her to double down on her HEP and perform twice as many reps or do them more often between 2-3 pm - before the onset
  • next visit, Sx onset was between 5:30-6:00 - her commute home
  • reminded her to use her lumbar roll in the car, and actually use the head rest
  • this pushed her complaints back to about 7:00 pm
    • my constant positive reinforcement was "If we keep pushing it back -regardless of the intensity pretty soon, it won't come back"
    • I often state this for onset that occurs later and later, even if the intensity is not changing, in this case, intensity was still 80% improved
  • upon questioning her about what occurs between 6-7 pm, it was studying... and often on the involved (right) side
  • she is also a frequent nail biter, which also starts more when she gets home because she avoids it during the day as a teacher's aide
  • these are both parafunctional habits that can trigger onset of TMD complaints, be mindful for them or other small seemingly minor things that are adding up to bring the patient past the pain threshold
Hope you found these cases as interesting as I did! Keeping it Eclectic...

P.S. May not have regular blog posts for next week, wife and I are expecting our 4th baby any day now!

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