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Case Studies

Case Study  – Irritable Bowell Syndrome

This is the case study of Mrs R a 38- year old fit and healthy woman, who presented with an chronic case of severe Ibs and lower back pain. She was diagnosed with IBS(irritable bowel syndrome) 15 years ago.

Subjective Questioning:

Aggravating factors: Symptoms get worse after eating but constant discomfort She complains of crampy abdominal pain, no bowel movements for several days. Problem: Onset of abdominal pain, bloating, gas, on occasion for about 15 years but more frequent for the past 12 years.

Easing factors: After bowell movement, eating ice cream seemed to calm the acid reflux in the stomach.

History of Problem: Diagnoised with IBS over 15 years ago. This condition has been chronic ever since. Diet and lifestyle has changed on the advice of doctors dietician etc.

She has seen her primary care provider as well as 2 local gastroenterologists who have performed routine lab studies, celiac serologies, colonoscopy with random biopsies – all of which were normal.
Blood tests came back as normal as well.
Due to the severity of  symptoms, her GP had prescribed strong multilaxin, imodium, colofac  and muscle relaxants.

Palpation: At lower a lot of pain and discomfort on palpation- with the patient supine. Local tenderness at the the gall baldder attatchment, stomach, asphosogus, colon and right kidney.


Visceral Manipulation is a gentle manual therapy that aids your body’s ability to release restrictions and unhealthy compensations that cause pain and dysfunction.

Restoring full range of movement of spinal joints through local mobilisation, manipulation, acupuncture, dry needling, cranial sacral fsm,  visceral manipulation and inversion therapy. Restoring normal movement in all the internal organs with mobilisations and local soft tissue techniques.


Following 5 weeks of treatment, Mrs I is now functioning properly with full bowel movements without pain. Mrs I still has mild acid reflux because of the lining of the stomach been inflamed for so long, but I am confident we will be able to eradicate this.

Case Study – Hip Pain

Eight months ago Mr H slipped whilst at work, landed on his left side and twisted his hip at the same time. This was very painful and a lot of bruising came out over the next few days. He could not put any weight on the leg, so he went to have an X-ray at A&E. They reported no fracture around the hip or pelvis just inflammation.

Subjective Questioning:

Problem: This patient had some physiotherapy at the local hospital. His symptoms were not improving and he still needed to take a high levels of pain killers. He cannot walk for longer than 2 minutes before the pain in his hip worsens. Movements of the hip are painful and restricted, particularly on movement.

Daily pattern – his symptoms seem worse first thing in the morning and at the end of the day.

Medication – strong painkillers and anti-inflammatories


On examination he presented with generally good posture and muscle tone. He had no pain at rest. No bruising or swelling noted.

Movement: Active hip flexion (knee to chest) and abduction (leg out to side) were restricted to half range due to pain over the anterior and lateral hip. His walking was relatively normal with no limp.

Nerve movement: No neural symptoms noted, full nerve mobility not tested due to restricted range of movement.

Joints: The hip joint did not appear restricted; however this was difficult to test due to pain.

My clinical diagnosis was of trauma/twisting type strain to the anterior and lateral hip structures, particularly the psoas and TFL muscles.

Treatment: I discussed the presentation with the patient to ensure he had a good understanding of the problem and the likely outcome of treatment which he had not had from his previous treatment. I treated the area with a range of techniques and a graduated strengthening programme and light cardio-vascular exercise. His rehabilitation programme concentrated on achieving full active movement first and we then progressed to strengthening once this was achieved.

Outcome: He was seen six times over three weeks and he regained full range of movement and near full muscular strength.  He was no longer taking pain killers and felt he “had his life back” following his treatment. The patient wished he had attended sooner rather than waiting eight months to see a specialist.

Case Study – Neck Pain and Headaches

This is the case study of Mr N a 54- year old fit and healthy man, who presented with severe pain in neck and severe headaches. He was involved a a head on collision 4 years previous but had neck complaints before accident.

Subjective Questioning:

Aggravating factors: Symptoms are constulisy bad even with no movement, even holding head feels heavy. Severe pain on rotation to left. Rotation 12 degrees to left 25 to right. Cannot side bend to either side without pain. Head is tilted approx 15 degrees to left and tilted back 10 degrees approx.

Easing factors: Lying down with his head on a high pillow to take the weight of head but still has the headache.

History of Problem: This patient was involved in a road traffic incident in June 2009. The car hit him head on and he was in the driver’s seat with his seat belt on.  That night he had pain on undressing and could not move his neck in either direction, could not look over his right shoulder or take/tilt head to the left. Mr N attended A& E later on that night and  was diagnosed with severe whiplash.

Palpation: All the shoulder and neck muscles were sensitive to touch but the upper trapezius and scalenes were hypersensitive  and very painful to touch.

Nerve movement: Pain limited some of the testing reliability. 

Joints: The shoulder joint did not appear restricted however the lower neck joints were stiff on both sides and painful. Particularly the bottom three levels C4-7. These joints did not like being compressed together. The atlas and axis were compressed together so this is my conclusion for the head aches.

Neurological Tests: Reflex testing, sensory and motor testing passed. There was  no evidence of nerve irritation when tested

Analysis of Pathology: I diagnoised Mr N with cervical distonia( Spasmodic torticollis) this is when the muscles go into spasm  causing the neck to involuntarily turn to the left, right, upwards, and/or downwards

TREATMENT: Mr N received 3 sessions of cranial sacral therapy and mobilization- because I felt this is the only way his body will relax and let me do the work that he needs.

Having this problem for over 4 years so this is why I did not treat as I would for an acute injury.

Outcome: Following 6 weeks of treatment, Mr N is now functioning properly with full movements without pain. The headaches have ceased with just an occasional one after a night out.

Case Study – Shoulder / Ribs

This case study involves a 28 year old lady who had a 7 year history of right sided pain half way up her back and under the right shoulder blade.  The pain was not becoming worse or improving but she recently realised that she was fed up with it and wanted to see if anything could be done.

Subjective Questioning:

Agravating factors: The pain was a diffuse ache, present most of the time under the shoulder blade.  It was aggravated by sustained postures, i.e. sitting or standing for any length of time.

Pain 2 was an intermittent sharp pain approximately 1 inch to the right of her spine.  It was a brief pain brought on by twisting, reaching up or lifting.

Easing Factors: Keeping moving or lying down would ease it.

Past Medical History: Usual from giving birth etc

Medication: Pain  killers and anti-inflammatory tablets as required.

Social History: Teacher. Tries to Swim 3 times a week and uses a gym once a week.

Initial Examination: This showed no observable scoliosis or other spinal deformity.  The muscles to the right of the spine were more tense than they should be and there were a few tender places in them.

Movement testing showed no restrictions in the cervical (neck) and lumbar (lower back) spine movements.  Thoracic spine (mid back) movements were painful, especially backward bending, twisting right and side-bending either left or right.  The most restricted movement was twisting to the left.

Arm movements caused both pains when nearing full elevation.  A deep breath in caused pain.


Treatment initially was the muscles on the right side of her back.  This eased the ache and allowed a more thorough spinal assessment.  The further findings were that accessory movements of the 4th, 5th and 6th thoracic vertebrae (T4-6) and the right 5th rib gave pain.  Also, T5 was in a right subluxaited position.

After treatment 5  was delighted with her progress and both pains were 60-70% better.  There was no pain on breathing or reaching up anymore  and she described her back as “much freer”.

After treatment 8 she reported being “95% or more” better with no ache and had only felt a few hints of pain near the spine. The treatment was repeated a further time and she was checked to make sure no other problems were present.  We did not book a further appointment because I expected the remaining discomfort to disappear over the following 2 weeks.  She was to rebook if any symptoms remained but has not needed to.

Case Study – Back Pain

This is the case study of a 34- year old fit and healthy man, who presented with an chronic onset of severe lower back pain, an extremely common injury.

Subjective Questioning:

Problem: Constant, unremitting lower back pain, with shooting pain into left leg from buttock to heel, also reported the presence of pins and needles in leg and heel.

Aggravating factors: Any static position aggravated his back and leg pain if sustained for over 1-2 minutes.

Easing factors: There was nothing to do to ease these symptoms.
24hrs: reported difficulty sleeping, standing driving but no significant difference pattern to his symptoms.

History of Problem: A head on collission which resulted in sudden episode of lower back pain and leg pain, that 2 years ago. He reported a history of 1-2 episodes of localised lower back pain and occasional low-grade leg pain, but nothing ever of this magnitude.

Past Medical History: No medical problems of note. Due to the severity of his symptoms, his GP had prescribed strong pain-killers and muscle relaxants.

Palpation: Local tenderness at the distal two joints of the Lumbar spine (L4/5), with widespread muscular spasm. Palpation of l5/S1 elicited left leg symptoms.

Neurological Tests: Reflex testing, sensory and motor testing failed. There was evidence of significant sciatic nerve irritation when tested

Analysis of Pathology: His symptoms led me to believe that he had intervertebral disc prolapse at L5/S1, causing compression to the sciatic nerve root and leg symptoms.

Following an MRI our suspicion was confirmed Buldging disc with nerve root impingement.


Restoring full range of movement of spinal joints through local mobilisation, manipulation acupuncture dry needling cranial sacral fsm and inversion therapy.

Restoring normal nerve movement along the length of the sciatic nerve, with nerve mobilisations and local soft tissue techniques.

Outcome: Following six weeks of therapy, this gentleman is now resuming a running program, back playing football and enjoying life.

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