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Physiotherapy Case Studies

by Wendy Emberson(more info)

listed in physiotherapy, originally published in issue 36 - January 1999

The following series of case studies were all carried out by members of Physiofirst (the Organisation of Chartered Physiotherapists in Private Practice).

Acupuncture for Pain Relief
Acupuncture for Pain Relief

Don’t miss the painfully obvious

This gentleman had a 9-month history of waking at 2am with intense pain and tingling in both arms and hands – every night. He could not sleep when these symptoms came on and spent each night walking about the house. These symptoms were gone by 8am and did not recur during the day. No drugs eased his pain.

He was seen by his GP and 3 consultants – an orthopaedic surgeon, a neurologist and a neurosurgeon, and was admitted to hospital for tests to check for a brain tumour and various neurological diseases. He also had nerve conduction tests carried out on his arms. All these tests were negative and he was having even more tests done when he went to see Francis Taft MCSP, privately.

By this stage he was understandably anxious, depressed and suffering from chronic fatigue.

Francis started by simply asking him how he lay in bed. He slept lying on his front with 4 pillows! As no-one else had asked this simple question, she thought it would be advisable to correct this sleeping pattern first and suggested he try and sleep on his back with just one pillow. This was all that was needed to cure his condition and he has slept soundly every night since.

Keep your tongue between your teeth!

This 28-year-old lady with two small children had a 10 month history of neck pain, headaches, and wasting of the right side of her tongue. This all started when she moved her head suddenly and heard a noise under her right ear.

Her GP refused to refer her for physiotherapy and instead sent her to the Dental Hospital who checked the cranial and dental nerves. They found no problem with these nerves but told her she had a “trapped nerve”. No treatment was offered, just observation at 3 monthly visits.

She went to see Sue Lewis MCSP after finding her name in the Yellow Pages. Sue made a clinical diagnosis of neuropraxia – nerve root compression, of the topmost nerve of the spine that comes out from between the skull and the first vertebra. This was causing the wasting in the tongue and headaches. The compensatory inflammation and muscle spasm in the rest of the cervical spine caused the other symptoms.

The first three treatments included manipulation, acupuncture and exercises to correct the posture. Together with education and advice for managing her work situation, the whole problem was addressed. The headache resolved in 2 sessions. Her sleep improved after the first session and her tongue began to fill out from the first session.

At the second visit to the Dental Hospital, she was told that she needed to see a Specialist, and have an operation. She was also told that the wasting could spread to the whole of her tongue! She went back to Sue Lewis instead and after 7 more treatments she had full, pain-free movement of the neck and her tongue was almost normal. She didn’t want to go back to the Dental Hospital, but felt she should, if only to prove them wrong in this instance!

Manipulation of the Neck
Manipulation of the Neck
Respiratory Treatment for Help with Breathing
Respiratory Treatment for Help with Breathing
Ultrasound for a swollen knee
Ultrasound for a swollen knee

The cost of back pain?

This labourer felt something “go” in his back whilst lifting kerbstones. This resulted in severe low back pain and referred pain to the left side of his penis.

His GP referred him to an Orthopaedic Surgeon who found nothing wrong, and referred him to a Urologist, who said he could find nothing wrong. He referred him to a Neurologist who said he could find nothing wrong and referred him to a Psychiatrist who said he was quite sane, and referred him back to his GP who kept him off work for 2 years! The only relief from his pain was to lie on his back!

By this stage he had chronic persistent pain in the left side of his penis which prevented him from doing virtually anything non-essential for life.

So he went to see Neville Greaves MCSP who reasoned that there was possibly muscle spasm and scarring in and around the nerve supply to the penis resulting from the original low back injury which was still having an effect on the nerve from the spine.

2 treatments of ultrasound resolved all the signs and symptoms – 1 week and 2 years after the original injury!

Take the Load off the NHS!

This 66-year-old lady had an 8-month history of increasing pain in the left knee joint. This was made worse by her weight, which was 13 stone. She also had raised blood pressure for which she was taking medication from her GP. Her GP had prescribed non steroidal anti-inflammatory drugs and recommended referral to an Orthopaedic Surgeon with a view to replacing the joint. She asked for physiotherapy instead and went to see Rosemary Payne MCSP. When she saw Rosemary she was unable to walk more than a few hundred yards and had to rearrange her life so that she only had to climb the stairs once a day.

Simple exercises for both the quadriceps (thigh) muscles, with dietary advice to reduce sugar, saturated fats and salt has meant that she has lost a stone in weight. She can now walk a mile without pain, has minimal swelling in the knee, can climb the stairs several times a day – and her GP has stopped her medication because her blood pressure has returned to normal.

Nursing a Bad Back?

This 37 year old psychiatric nurse was diagnosed as having a lumbar (low back) disc lesion 10 years ago following a lifting injury. She had recurrent episodes of low back pain with pain in the thoracic spine (between the shoulder blades). She also had high anxiety levels because of the recurrent nature of the pain and disability.

She had a number of physiotherapy sessions at the hospital and injections into the small joints of the spine at the Pain Clinic. All of which achieved only moderate temporary relief. Any physical work increased the pain. She had disturbed sleep, painful periods and frequency of micturition (passing water). She generally felt stiff and had never been without pain over the preceding 10 years.

She eventually went to see Paula Clark MCSP who made a clinical diagnosis of a spinal dysfunction together with an imbalance in the autonomic nervous system (the nervous system that controls the activities in the body that we don’t have to think about e.g. circulation, heart rate, breathing etc).

Paula treated her with a very specialised technique called “connective tissue massage”. This coupled with specific exercises and ergonomic advice completely relieved all the signs and symptoms. The 7 treatments given over a 6 week period meant that this lady could finally say that she felt better than she had for years and that life feels normal again.

Not all Physiotherapists are the same!

Sylvia has come a long way since her stroke 4 years ago, which left her unable to even sit up on her own. She was under the impression that because the stroke was such a severe one that she was a ‘hopeless case’. Her husband took her to see Wendy Penwill MCSP who specialises in neurophysiotherapy. 19 months later, Sylvia is able to sit completely unsupported, walk with only one person and can now get from the chair to the toilet on her own. This means that her devoted husband, Jim, is now able to get back to playing golf every now and again! Physiotherapy in this area is very highly specialised and requires a high degree of post graduate training, skill and experience to be able to achieve such results.

“Medicine by Physical Means” – Drug Free Therapy

This publican had been suffering with pain in his neck and arm which was getting worse and interfering with his work. He did not see his GP because he thought he would only be offered painkillers and anti-inflammatory pills. So, on the advice of one of his customers he went to Wendy Emberson MCSP. With manipulation, Interferential Therapy, and the all-essential rehabilitation programme, the mechanical problem with the small joints in his neck was fully resolved in 4 treatments. On his last visit, he mentioned that he had been suffering from chronic sinusitis for the last 5 years which meant he had been using a nasal spray at least 5 times a day across this time. Long term use of this spray had possible side effects, which could affect his heart and eyesight. Wendy offered him treatment using Interferential Therapy, and after 3 sessions he no longer needed the spray, he was sleeping better (which helped his neck condition) and was “amazed with his progress”! After his 4th session he had no signs and symptoms at all.

Further Information

Chartered Physiotherapy is the third largest medical profession in the UK. Accurate diagnosis followed by treatment regimes designed specifically for the individual patient mean a cost-effective alternative. Couple this with rehabilitation techniques to gain maximum possible fitness means that the recurrence rate is significantly reduced. Only Chartered Physiotherapy can offer this complete package based in sound, extensive medical knowledge and expertise.

PhysioFirst represents independent Chartered Physiotherapists in the UK. It is the Occupational Group of our professional body, the Chartered Society of Physiotherapy and is the physiotherapy equivalent of the BMA for doctors. Chartered Physiotherapy is the only state recognised qualification for physiotherapy in the UK that carries a 3 year BSc honours degree in Physiotherapy. There are 2800 members of PhysioFirst UK wide and they will have the letters MCSP after their names. They also have full professional indemnity cover for the safety and security of you, the patient.

If you want to know where your local practitioners are then either look in the Yellow Pages for the OCPPP block advert under “physiotherapist”, or telephone the Administrative Office on 01702 392124.

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About Wendy Emberson

Wendy Emberson is a chartered physiotherapist who has been working in her private practice for 20 years specialising in orthopaedic medical and musculo-skeletal conditions. She can be reached at her clinic on Tel: 01279 654020.

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