Personal Details



This case study was done while I was a student.

Personal Details

Client is a 36 year old male with a spinal cord injury of 18 years. The injury is between C4-C5. The vertebrae of C3-C7 are fused together. Client is diagnosed as a quadriplegic. He can move his neck and has feeling in his neck. He can move his arms, but his hands do not open. He does not have control over his trunk and lower extremities.

Client has frequent, painful, and uncontrollable muscle spasms that travel through out his entire body. He has some muscle atrophy and a lot of muscle tightness. He is not on any medications at this time, but does take Dr. Schulze Super food daily.

He is of medium build and 6’2”. He is wheelchair bound for 14 hours of the day which 6 of them are spent at the computer for his job. When in bed he sleeps 5-6 hours on his left side before being turned.

Condition 4/28/2017

Client presenting problem is frequent muscle spasms and overall muscle tightness. There is some flexion in the right knee and lower limb edema is present.

Treatment Plan

The aim was to calm the muscle spasm and loosen muscles overall with special attention to the hip flexors. I used hydrotherapy; warm bath with essential oil and coconut oil (organic and unrefined) with cypress oil for 25 minutes. I followed this by 30 minutes of warming and stretching the muscles. I avoided any deep techniques due to the loss of feeling.

Details and Results

With client on his left side I stretched the hip flexors by gently pulling the right leg back until I found his point of resistance. I held this for 30 seconds, returned the leg to resting position for 15 seconds then repeated this 2 more times. I then rolled client and repeated this for the other side. With client in supine position I then warmed serratus anterior followed by vibration followed by effleurage to clear the area of waste and sooth the muscle. I then put client back in the side laying position (client can not lay prone) to access the hamstrings. I warmed the muscle group by effleurage then kneading then back to effleurage. All this was done from insertion to origin for the right leg to shorten the hamstring muscle fibers to decrease the knee flexion. Lastly I released the psoas major on both sides by palpating two fingers over and two fingers down from the belly button. I held this until I felt the release of the muscle fibers. I then palpated the lesser trochanter of the femur by passively flexing and laterally rotating the thigh to slacken iliopsoas. I then guide my way by finding the distal tendon of iliopsoas and following it deep to the lesser trochanter to release the psoas major Golgi tendon organ. When I stimulate the Golgi tendon organ it causes the muscle to relax by interrupting the contraction.

After Care Advice

I suggested trying to do the side stretches for the hip flexors before bed. This would help keep those muscles flexible since he sits in the wheelchair most of the time.

Conclusion

Client was very satisfied with the treatment. The frequency of the muscle spasms decreased. Extension of the knee improved a little. The tightness in his chest that he was experiencing during inhalation is now gone.

Condition 4/29/17

Client presented the problem of left shoulder and neck pain that is throbbing. On a pain scale (1 being the least and 10 being the worst) the pain is an 8. He had slept on the left side all night for 10 hours. He is also experiencing frequent spasms.

Treatment Plan

The aim was to relieve the shoulder and neck pain and to calm the spasms. I used plant therapy essential oil (for achy joints and muscles) with certified organic olive oil.

Details and results

With client laying on his right side I warmed the shoulder and neck region with effleurage, I then kneaded the entire area to increase circulation followed by effleurage to flush out the area. I then returned client to the supine position and I loosened the fascia of the deltoid and trapezius. By doing this I am creating fascia traction, relieving tension. Next I did traction on the neck followed by an active resistive neck stretch. I then put client into side laying position to stretch the hip flexors. I did this by gently pulling the leg on top back until I found his point of resistance. I held this for 30 seconds then returned the leg to resting position for 15 seconds. I repeated this 2 more times. I rolled client to repeat for the other side. With client in supine, I then located psoas major by palpating two fingers over then down from the belly button. I released this on both sides. I then moved to the hamstrings. I stretched these on each leg by placing his leg on my shoulder, locking the knee and gently rising until I found his point of resistance. I held this for 30 seconds and then returned the leg to resting position.

Conclusion

Client felt better after the treatment. His shoulder and neck pain is almost gone now. Spasm frequency had decreased and he felt very relaxed.

Condition 5/1/2017

Client presented the problem of frequent spasms. He had been in bed on his left side for the last 10 hours.

Treatment Plan

The aim was to use hydrotherapy bath at 97.5 degrees F with organic cypress oil and organic unrefined coconut oil for 20 minutes to calm the frequency of the spasms. I then did 45 minutes of stretching to loosen the hip flexors and lower limb muscles.

Details and Results

Hydrotherapy bath of 97.5 degrees F with essential oil used was used. Then I began the stretching with GF in the supine position, I warmed the musculature of the foot, using classic massage movements of effleurage and then kneading the soft tissue. I started with the bottom of the foot by palpating the plantar aponeurosis and then the flexor digitorum brevis. I found some micro trauma, so I used trigger point. This was done by holding my thumb 30-60 seconds on the area. I then used effleurage to clear the area of waste. The area surrounding the ankle felt tight so I rotated the foot in both directions for several minutes. I then progressed up the leg. I used effleurage in the centripetal direction to move the fluid from the leg. I then progressed to the thigh where I palpated the quadriceps and adductors. I warmed these muscle groups with effleurage. I kneaded them to improve circulation followed by jostling to relax the involved muscles. I then separated the quadriceps from the adductor muscle group. This helps create space for the femoral artery, nerve, and vein, and also helps with the edema. Then the inguinal ligament was released. This should help with the psoas major being so tight because the inguinal ligament originates on anterior superior iliac crest and inserts on the pubic tubercle in essence strapping psoas into place.

Conclusion

Client was very pleased with this treatment. It appears the lower limb edema is already going down. The spasms have decreased and he feels very relaxed.

Condition 5/3/2017

Client has frequent spasms he would like to calm. He has been lying in bed on his left side for the last 10 hours.

Treatment Plan

The aim is to calm the spasms to make client more comfortable.

Details and Results

I started with client in the side laying position to stretch his hip flexors. I did this my pulling his top leg back until I found his point of resistance. I held this position for 30 seconds and then returned the leg to a resting position for 15 seconds. I repeated this 2 more times. I then loosened the Achilles’ tendon by jostling. The calves were loosened by effleurage in to kneading and then jostling to sooth the muscle. The hamstrings were warmed and kneading insertion to origin. This was done to shorten the hamstrings to help with the knee flexion. I progressed to the quadriceps to address the issue of edema. I warmed the muscle group with effleurage. I then separated the quadriceps from the adductor muscle group. I worked my way to the psoas Golgi tendon to release it. Finally I released the inguinal ligament to help with psoas being so tight.

Conclusion

Client said he felt more relaxed. The muscle spasms have decreased. Edema decreased.

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