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開院10周年の感謝をこめて

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  2. 症例報告
  3. 9.English case report

開院10周年の感謝をこめて

症例報告

9.English case report

32-year-old male with wright forearm and hand pain and numbness


【Clinical features】

32-year-old male had had pain and numbness at wright forearm to hand pain and numbness for 6 months, and had been unable to work at best. He told me that he had been required to use of computer 10 hours per day, especially this 2 months. The symptom started his hand, then forearm. Without use of computer, the symptom tend to decrease. He had no other history of medical problems or injury.


【Clinical findings】

・MMT - right grip was weak. right forearm pronation was weak.
・Tinel's sign - negative. Pronator teres tapping induce patient's symptom.
・Phalen's sign- negative.


【Treatment and outcome】

Treatment plan consisted of Active Release Technic and Graston Instrument Technic applied to his pronator teres and entire anterior forearm. In addition, ergonomic advice about the use of computer and the use of Prossage Massage Gel to help reduce tension of soft tissue is offered. Within 5 visits, his symptom began to subside gradually. He had a total of 10 visits (1 months), after which his symptoms were 90% recovered. The patient was advised to have continued care once per 2 months in order to maintain his good condition.


【Conclusion】

This case study suggest that advanced soft tissue technic such as Active Release and Graston Instrument tool can relieve overuse muscle tension and entrapment of nerve caused by chronic overuse of computer. Management including Active Release Technic, and Graston Instrument tool and daily use of prossage gel were effective in this case.


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20-year-old male with right ankle sprain


20-year-old male with right ankle sprain

Clinical Features:

A 20-year-old male, who has been playing football, had suffered from right ankle
sprain yesterday. He went to see a medical doctor and radiographs didn't indicate
any sign of fracture. Pharmaceutical procedures was given to him in order to
reduce inflammation, and referred to our clinic.


Clinical findings:

・Observation - Swelling was found on the symptomatic site.
・ Palpation - Pain was located anteriorly over the anterior tibiofibular ligament
and lateral aspect of ankle soft tissue (peroneus tertius muscle)
・ Orthopedic exam - Pain was elicited through a variety of tests designed to
stress ankle articulation through diastatic forces.


Intervention and Outcome

Treatment plan included chiropractic manipulation, active release technic,
physiotherapy modalities, and rehabilitation was offerd. Care must be taken to
avoid stressing the supporting ligaments during the early course of therapy. Initial
treatment is aimed at reducing pain and inflammation using modalities such as
microcurrent and P.R.I.C.E. principles. Treatment over subsequent weeks
involves progressive resistance exercises, proprioceptive challenges, plyometric
exercises and sport-specific agility drills, while maintaining cardiovascular fitness.


Conclusion
The most common mechanism of ankle sprain is forced external rotation in a
dorsiflexed foot. Practitioner should also be cognizant of the indolent nature of
this injury and possibility for sequelae. Anterior ankle pain and pain with a deep
squat or during the push-off phase of gait are typical of this injury. Radiographs
to rule out fracture and evaluate the extent of the injury may be necessary.
Conservative therapy involving chiropractic manipulation, active release technic,
physiotherapy modalities, and rehabilitation was effective for this case of Grade I
and II injuries, while Grade III injuries require a surgical intervention.

Symptom information

Piriformis syndrome



Forty-year old male with right lower extremities pain ( Piriformis syndrome )


Clinical feature:
A 40-year-old male works as an executive business person. The patient has experienced chronic pain for the past few months. Pain is experienced in the right gluteal/buttock region; the pain travels inferior along the lateral side of the leg and down along the fibula to ankle. This is experienced with a verbal numerical rating scale at an intensity level of 8, often as a dull, throbbing ache that can travel distally to heal.


Clinical findings:
・ Hip joint ROM - elevation & internal rotation revealed the symptom.
・Palpation - Piriformis muscle became tight and tender. Trigger point were found.
・Neurological examination - Within normal findings.


Treatment and outcome:
Treatment plan consisted of chiropractic manipulation, stretching, and deep soft tissue massage. Intensively ,The patient was treated 8 times over 2 months period during which time he experienced progressive 90% relief. At the end of 10 visits the patient's symptoms had resolved, and released from chiropractic care. Instead, self-exercise care was commenced at home continually. 

Conclusion:
This study demonstrates the application of chiropractic manipulation with a stretching program to ameliorate chronic piriformis syndrome. This protocol was greatly improved with the addition of a daily self-stretching exercise. 


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Migraine headache

26-years-old female with chronic migraine headache


Clinical features:

A 26-year-old woman had chronic migraine headache for 5 years. She had no history of trauma and the symptom persisted despite taking several prescribed medicine. Her symptom were accompanied by nausea and visual aura of "spots" when severe.


Clinical findings:

・ROM - Cervical rotation and lateral flexion was slightly restricted.

・Palpation - Several tenderness point was found in Suboccipital musculature.


Treatment and outcome:

Treatment plan included chiropractic manipulation, patient education in nutrition, and an in-office stretching program progressing to home therapy was reviewed with the patient. Within 5 visits, her symptom began to subside. She had a total of 10 visits (2 months), after which her symptoms were 80% recovered. The patient was advised to have chiropractic care once per 1 months in order to maintain her good condition.


Conclusion:

In this case, the chronic recurrent migraine almost resolved over a 24-week period with use of chiropractic manipulation, lifestyle modification, and rehabilitation in this patient.


Symptom information

28-years-old male with neck pain and dizziness / vertigo after vehicular collision Clinical features.



【Clinical features】
A twenty-one year old male presented with complaints of upper neck pain and dizziness /vertigo subsequent to a vehicular collision that occurred 5 days prior. While driving a mountain bike , a car crossed into his lane of traffic. The symptom has nothing changed since he got this accident.

【Clinical findings】
・Cervical ROM was restricted and revealed chief complaint.
・Complete neurologic examination revealed no apparent abnormalities.
・Cervical compression makes chief complaint worse.
・Post-traumatic spinal dysfunction at C0/1 and C1/2,
・Traumatic strain injuries of the sub-occipital musculature 

【Treatment and outcome】
Chiropractic care was initiated utilizing chiropractic spinal manipulation targeted to vertebral dysfunction and soft tissues of the upper cervical spine. In addition, Active Range of Motion and proprioceptive ball exercises of the cervical spine that incorporated vestibulo-occular activities were provided to the patient from the 4th visits of care. Through 8 weeks of care(within 10 visits), the patient reported progressive improvement to more than 80%.   

【Conclusion】
This case study suggest that chiropractic care can relieve neck pain with dizziness / vertigo caused by traffic accident. Management including chiropractic spinal manipulation, active soft tissue release technic, and proprioceptive rehabilitative exercise were effective in this case.




25-years-old female with cervicogenic headache



【Clinical features】
A 25-years-old female, who has been working as a typist, had a headache of approximately 3-years duration that were located on the left upper cervical region. Prior medical intervention included pharmaceutical procedures without improvement of symptoms.

【Clinical findings】
・Static palpation with diffused tenderness to complaint area . 
・Seated cervical spine range of motion was limited by an increase of her symptom.
・Cervical compresson test made her symptom worse.
 
【Treatment and outcome】
Treatment plan included patient education in posture and an in-office stretching program progressing to home therapy was reviewed with the patient. She noticed an increase in signs and symptoms after her first 2 visits followed by a decrease in her primary signs and symptoms during visits 3-5.  She was released to home therapy and supportive chiropractic manipulation with continued positive response.

【Conclusion】
?Management of cervicogenic headaches with chiropractic manipulation and rehabilitation is discussed. Management strategies including education of proper biomechanics, rehabilitation and chiropractic manipulation were effective in this case.



A 60-years-old male with low back pain and right hip pain.


【Clinical features】
A 60-years-old male has been suffering from increasing pain in his lower back and right hip for a year. When he was asked about past injuries, he explained how, about 30 years ago, he had several injuries on his low back and sprained his joint on playing football. At first, the pain in his low back and right hip was spontaneously improved, but since last year the pain came back again and gradually getting worse.

【Clinical findings】
・X-rays showed mild degenerative changes in his L5/S1 segment.
・The range of motion in his low back and right hip were slightly restricted.
・Tightness and sensitivity of piriformis, gluteus minimus, and multifidus muscles. 

【Treatment and outcome】
Treatment plan consisted of chiropractic manipulation and sof tissue technics to his low back spine. Within 3 visits, he experienced increasing improvement. She had a total of 6 visits (1 months), after which her symptoms were 90% recovered. The patient was advised to have chiropractic care once per 2 months in order to maintain his painless condition.

【Conclusion】
This case study suggest that chiropractic care can relieve chronic low back and hip pain  caused by previous repetitive injuries. Spinal dysfunction and a tightness of the hip stabilization muscles appeared to be the cause of patient's symptoms and previous injuries often has negative impact on normal neuromuscloskeletal function.  Management including chiropractic manipulation and soft tissue technics were effective in this case.



A 38-years-old female with headaches, right arm and neck pain


【Clinical features】
A 38-years-old female visited us because she had pain and tightness in her neck and right arm. When she was asked about past injuries, she explained how, about 20 years ago, she had a traffic accident and hit on her right shoulder. At first, the pain in her right shoulder was spontaneously improved, but over the years she developed neck and arm pain on the same side. By the time of her first visit,  She had seen several MDs for treatment on her neck and arm in the past, and she was taking non-steroidal anti-inflammatory drugs prescribed by her GP.

【Clinical findings】
・blood pressure, pulse, sensation, reflex and muscle tests. All were normal.
・The range of motion in her neck and right shoulder were restricted.
・Trigger points are found in muscles of scalene and deltoid. 

【Treatment and outcome】
Treatment plan consisted of chiropractic manipulation to her entire spine, trigger point therapy and rehabilitative exercise program. Within 5 visits, she experienced increasing improvement. She had a total of 8 visits(2 months), after which her symptoms were 80% recovered. The patient was advised to have chiropractic care once per 1 month in order to maintain her painless condition.

【ConclusionTreatment and outcome】
This case study suggest that chiropractic and rehabilitative care can relieve neck pain, 
neck/shoulder stiffness and arm pain caused by trigger point. Spinal dysfunction and a weakness of the inner spinal stabilization muscles appeared to be the cause of patient's symptoms and if it becomes chronic, the situation is likely to produce trigger point. Management including , trigger point therapy, core and spinal stabilization exercises, and chiropractic manipulation were effective in this case.



Chiropractic in Tokyo (Setagaya)
Spinal care center

A 35-years-old male with 2 years history of lower back pain and left sciatic pain.


【Objective】
This case study discusses management of lumbar disc herniation with degenerative disc disease and facet dysfunction using a program of chiropractic manipulation and an active rehabilitation program.

【Clinical features】?
A 35-year-old male presented with a chronic 2 years duration of low back pain. The patient was diagnosed with lumbar disc herniation with facet arthropathy. He complained of pain that originated in his lower back region and radiated all the way down his left buttock region and into the back of his left posterior thigh and lateral calf. He reported his original injury occurred 2 years ago while at gym. The day prior to his injury he had performed an entire day of heavy bending and lifting at gym. The following day, he felt an immediate explosion of pain, originating in his low back and radiating down his left leg. He stated initially his pain levels were 8 or 9 on the visual analog scale, and the pain ran from his low back and radiated all the way down to his left foot. Initially he had numbness that encompassed his entire right lower extremity to the foot. The patient was prescribed pain killer medicines.

【Intervention and outcome】
?Treatment plan and intervention consisted of patient education on proper posture and ergonomics, such as proper bending and lifting techniques, for both the home and at gym. An in-office chiropractic and rehabilitative exercise treatment program was commenced, with eventual transition from office based into home based therapy and exercises. The patient was instructed in and placed on McKenzie exercises, to be performed at home 3 times per day at 10 repetitions each session. Within 5 times visits, the patient showed good response ( 30% improvement ) to treatment, reporting a decrease in his signs and symptoms. Active rehabilitation was continued with the goal of restoring normal range of motion, improving core and spinal stability and strength, and returning the patient to original life and work. Upon reaching these goals he was released to home therapy and supportive chiropractic care with continued positive response. It took 20 visits until achieving these goals.

【Conclusion】
This study does suggest that chiropractic and rehabilitative care can relieve lower back and leg pain. Spinal deconditioning and a weakness of the core and spinal stabilization muscles appeared to be the cause of patient's symptoms and reduced physical capacities in this particular case. Management including patient education on proper posture, proper ergonomic lifting techniques, core and spinal stabilization exercises, and chiropractic manipulation were effective in this case.