Student
Susan Kaculis
Neuromuscular Therapy
19 September 2015
Case Study
I. The Client My client is my big sister, ______. She is a wife and also a mother of two girls; her youngest was born rather recently, on July 4th. She is currently on maternity leave, but when she is working she does so for a company that recruits special needs educators, spending most of her time at her desk. She rowed crew for four years at The Ohio State University, is a marathon runner, a triathlete, a yogi, and a lifter. She has had only one surgery: an ACL repair on her right knee back in 2008, but has had no trouble with it since. She also has a very slight case of scoliosis, almost unnoticeable until palpated. She sees a chiropractor, a massage therapist, and her little sister–me–for treatment when her busy schedule allows. ________ had no pain complaints before we began her assessment, putting her at a 0 on the pain scale. As a new mother, she is breastfeeding, which means that she has a substantial amount of relaxin in her system that will take another several months to work out. This relaxin makes my already super flexible sister–again she’s a yogi–a walking rubber band, so I didn’t push her range of motion assessments any further than what we would otherwise deem as “normal.” Her goals were to decrease tension, break up and release trigger points, and become more aware of her structural and muscular imbalances.

II. The Observations A) Standing: _________ had even weight distribution, though it was slightly forward. Her arches, malleoli, fibular heads, and patellas were even. Her right trochanter and right ASIS were higher than the left side; while her left acromion, left scapula, left occipital bone, and left temporal bone were higher than the right side. Her head was forward and offset to the right. She had quite a bit of lordosis, ~ a 13-degree angle from ASIS to PSIS. Her arms were slightly flexed, shoulders medially rotated with thumbs forward, no apparent thoracic rotation. Her legs were barely laterally rotated, feet everted. B) Reclining: This time, ________’s right medial malleolus and right fibular head were still even but her right patella joined her right trochanter and ASIS, in being higher than the left. The left acromion, left occipital and temporal bones remained higher than the right. Shoulders were still rotated medially, lateral rotation in the legs barely apparent, though eversion in the ankle was clear. C) Walking: ________ walks with feet slightly turned out, favoring the inside arches of both feet. Her left arm sticks a little as she swings it forward, while the right moves smoothly. D) Pictures: The before and after pictures for this case study were taken at the beginning and conclusion of two different sessions. Session 1 included hips and shoulder girdle, session 2 the neck. They are ordered respectively.

III. The Treatment Based on the above observations and assessments, I came up with a treatment plan for my sister. I would treat three areas, beginning with her QL and quadriceps since this was the area closest to her center of gravity that needed the most work. I chose this area due to the obvious tilt in her pelvis (right side up), likely from years of competitively rowing on the left hand side of the boat. Then I would move to her shoulder girdle to work on her pectoralis major and minor, deltoids, and supra- and infraspinati. She’s carrying around a newborn all day long, generally in her left arm, and breastfeeding, explaining her medial rotation in the shoulders and thoracic tilt (right side down). I would finish with her neck, working scalenes and SEM, to help with her forward and offset head (to the right), which again can be attributed to looking down at the baby a lot and more than likely an secondary effect of her shoulder girdle tilt. We did the treatment in two sessions. The hips and shoulders were worked on for two and half hours in our first meeting, the neck for an hour in our second.

IV. The Results After my three treatments (which are all documented in my SOAP notes and the three individual NMT treatment forms), ______ felt a great release of tension. Her fascia wasn’t very tight, but I was able to release it a little bit before applying Swedish and then NMT techniques. I was able to release many of the trigger points I found in her QL and greatly reduce the size of the ones I found in her scalenes, supraspinatus, and pectoralis majors. I was also able to work out a lot of hypertension found in her quads and deltoids. Structurally, the tilt in her shoulders and pelvis evened out slightly, though there is still a lot of work left to be done in these areas. Her head moved more in line with the center of her body, away from the right offset seen earlier. Her ears became in line with the string after I had worked on her neck, which was the most noticeable change post-treatment. Also, her shoulders lost some medial rotation. I can’t say there was a change to her range of motion, mostly because I didn’t push her relaxin-filled body past a “normal” range. She was able to comfortably go to the same, ROM before and after each treatment (i.e. bent to the side the same distance, could fully bind arms behind back each time, etc.). She started and ended with a 0 pain scale. My sister may be tense but she’s tough. Her pain threshold is above average, in my opinion.

V. The Plan My recommendation for my sister is additional massage, especially NMT work. I also asked her to call her chiropractor immediately, due to the severity of tilt I found in her shoulder girdle and neck. One of her goals was to learn about her muscular and structural imbalances, which she was able to do just by looking at her before pictures. She and I were able to come to realizations about her every day activities and how her habits have shaped her body, like carrying the baby on her left side 95% of the time. Now, not only is she able to tell her chiropractor and LMT which areas she needs work on, but she is also educated enough and therefore able to make necessary adjustments at home.

VI. The Conclusion If I were to do anything differently, it would be to do work on ________’s abs and psoas to help with her lordosis. She was uncomfortable having these areas worked on in this study because she is self-conscious of her changing body, so this will be something to educate her on and ease her into, because I think it would benefit her greatly.