Michelle

Michelle

Michelle is a 23-year-old student studying a Masters Degree at University. She was referred to the Body Genius Institute by her Chiropractor for a second opinion on her bilateral shoulder pain.

Michelle has always been an active person and participates in a gym-based strengthening program four to five times per week along with Yoga, running and Muay Thai training.

Michelle received her ‘Welcome Pack’ via email from the Body Genius Institute. She completed the relevant client history and medical information before returning it to Body Genius.

Client History

bursitis / impingement in both shoulders.body diagram

Left shoulder cortisone injection.

Chiropractic care every 6-8 weeks.

Physiotherapy treatment when shoulders ‘flare-up’

Basic rehab program designed and implemented.

Left scapular winging. Previous left clavicle injury – break or dislocation?

Regular neck pain and tension.

Have been referred for an MRI and for orthopedic review for surgical options.

When flared-up all daily activities hurt. When good, only overhead activities are painful.

General Health – Do you have any medical conditions or symptoms
Cancer Depression Hoshimoto’s Grave’s
Diabetes Celiac Gluten Sensitive Psoriasis
Eczema Dandruff Chronic acne Ostoarthritis
Rheumatoid Arthritis Gout Smoker? Hypertension
High Cholesterol Stroke Heart Attack Asthma
Sleep Apnea Gallbladder disease Food Sensitivities Urinary Tract Infect.
Previous Smoker Athlete’s Foot Toe nail fungus Finger nail fungus
Poor diet Sedentary Lifestyle Chronic lethargy Bloating
Diarrhea Constipation Heartburn / reflux Cavities/dental work
Grinding Teeth Surgeries Poor sleep patterns C-sections
Medication – do you take medication for any reason?
I was prescribed antibiotics 2 weeks ago for my skin. My face and back have come up in what appears to be a rash or reaction to something.

 

Based on the information provided, a Body Genius Physiotherapist called Michelle to clarify the information provided and to gain greater insight into both her history and the nature of her pain. An initial consult was scheduled at this time.

Two days later Michelle attended the Body Genius Institute for her initial consultation. Since all of the subjective questions had been covered during the initial phone call, the Body Genius physiotherapist immediately began to explain the assessment process to Michelle.

Step 1 – Neural Dynamic Testing and treatment

Neural dynamic testing

Neurodynamic testing utilizes the latest in neurophysiology research to objectively and accurately assess neural dysfunction. The aim is to accurately test whether a client has neural dysfunction or not. If neural dysfunction is present the aim is to provide treatment until resolution occurs. This allows the treating practitioner to determine what percentage of the client’s condition is from mechanical nerve gliding problems.

This testing takes approximately 5 minutes to perform and is completely safe and pain free. Clearing neural dysfunction in clients can take as little as 60 seconds in simple cases and may take up to 2-3 sessions in more complex cases. Clearing neural tension is an essential first step in the healing process.

Step 2 – Whole body examination (Joints, muscles, ligaments, tendons, discs)

knee examinination
Once Neural Tension (NDT) has been cleared, a full body evaluation is undertaken. This assessment occurs in a systematic fashion (check list) so that every important factor is uncovered and recorded.

Although the client’s pain may be present in the upper body, structures in the lower body may be contributing to or even causing this pain. This is one key reason why the Body Genius physiotherapist will assess the client from head to toe.

back examination

Step 3 – Summary Chart

A summary chart is generated from the testing performed in Step 2, which will provide significant guidance throughout the treatment process.

Step 4 – Treatment Direction Testing

Every client is unique and the strategies used to help each client heal will be different for everyone. Treatment direction testing (TDT) is a system that is client focused. The treating therapist will use the Summary Chart for the individual client to determine which structures in the client’s body will improve restricted movement patterns. This form of treatment yields immediate results that can be demonstrated to both the client and therapist.treatment direction testing

For example, a stiff thoracic (middle back) segment may improve right neck turning in one client while tight shoulder muscles in another client may improve right neck turning when released. Each client is unique and TDT allows the Body Genius therapist to immediately determine what treatment strategies will work best for the individual client.

Step 5 – Determine the primary contributing factors (PCFs)

For most clients there will be one or two structures in the body that yield significant improvements when corrected. This may include joints, ligaments, tendons, muscles and/or fascia. When these factors are found they are labeled the primary contributing factor(s).

Step 6 – Restore full movement to all patterns and pain resolution

These primary contributing factors are used to restore full movement to the client’s restricted joints and patterns of movement. Clients are often amazed at how using the Primary Contributing Factor (PCF) to correct one movement pattern ‘spontaneously’ corrects several other movement patterns at the same time. Anatomically this may not make sense, however from a neurological perspective this emphasizes the old saying “the entire body is connected.”

Step 7 – Functional testing and generating a Risk Profile

Once the client is pain free and ‘clinically clear’ from any dysfunction, it is important to go through a Risk Profile screen. The Body Genius Institute is one of the only organizations in Australia to utilize the powerful Move2Perform software. This powerful screening tool is now used in over 10 different countries and by thousands of teams and organizations including professional sporting teams.

y balance testing

The Risk Profile may include:

Functional Movement Screen

Lower Quarter Y-Balance Test

Upper Quarter Y-Balance Test

Dorsiflexion (ankle movement)

Functional Hop Testing

y testing

Each client will be taken through a series of functional tests and outcomes are recorded in the Move2Perform software. A risk profile is then generated that indicates whether the client is ‘optimal’ or whether they have a slight, moderate, or substantial risk of injury.y balance iq chart

Step 8 – Corrective exercises and return to activity / sport plan

The risk profile that is generated from the Move2Perform software clearly demonstrates where each individual client needs improvement. The Body Genius physiotherapist can then design and implement corrective exercises specifically to meet the needs of the client.

 corrective exercise

Are the corrective exercises working?

Repeating segments of the risk profile testing can demonstrate clearly to both the client and therapist that the corrective exercises are resulting in improvements in functional movement patterns and reducing the client’s risk of injury in the future.

Michelle’s Goals

Michelle was asked to express in her own words what a “Good Outcome” would mean for her. Michelle provided the following answer:

“I would first like to be pain free on a day to day basis and be confident that my shoulders will not flare up again. Ideally, I would like to then return to all my sporting activities including Muay Thai training.”

Step 1: Neuro Dynamic Testing (NDT)

The Body Genius physiotherapist performed Neuro Dynamic Testing (NDT) and determined that Michelle had a positive test for her upper cervical spine and also both lower limbs. A ‘positive’ test means that neural tension is present and therefore needs to be cleared. The results were explained clearly to Michelle and she was allowed to feel through her own muscles what a positive test involves.

The treating therapist first treated Michelle’s upper cervical spine to clear neural tension at this level. Michelle commented on how gentle the process was and could feel the difference immediately. The therapist then proceeded to clear Michelle’s right leg by working gently on her lumbar spinal segments. Upon retesting, the work to clear Michelle’s right leg also cleared her left leg. Once again this demonstrates the interconnectedness of the body.

Now that Michelle’s NDT was clear (negative) they could move on to Step 2 and performing a full body evaluation. Michelle was impressed by how quickly her neural tension was resolved and how gentle the treatment was.

Step 2 and Step 3 – Full body evaluation

Michelle’s physiotherapist followed a detailed checklist and performed a head to toe evaluation of every joint, muscle, ligament, tendon and other soft tissues.

The findings were then recorded in a Summary Chart.

 Example – SUMMARY TABLE
Movement Asterisk Signs   Palpation Asterisk Signs TDT
1 Shoulder flexion 180 deg. pain 1 Right distal tib / fib joint stiff
2 Shoulder abd. 180 deg. pain 2 C2, 3, 4 stiff left
3 Knee to wall test: left 11, right 9 3 C4, 5, 6 stiff right
4 Cervical flexion -10cm 4 Right proximal tib/fib stiff
5 Cervical left / right rotation 60 deg 5 T4 to T12 stiff
6 Cx lateral flexion left/right 30 deg 6 T7, 8, 9 were reactive
7 Tx rotation left/right 30 deg 7 Masseter
8 Hip flexion right 110 deg 8 UT
9 Hip ext. rotation right 55 deg 9 Deltoids
10 Hamstring length L/R 100 deg 10 Biceps
11 Shoulder int. rotation left 30 deg 11 Brachialis
12 Shoulder int. rotation right 20 deg 12 Brachioradialis
13 13 Forearm extensors – ECRL/ECRB
14 Squat 70 deg 14 Hand Intrinsics
15 Thomas Test positive bilateral 15 TFL
16 16 RF
17 17 VM
18 18 VL
19 19 Adductors
20 20 Foot Intrinsics
Hamstrings
Cx = Cervical Gluteus medius and minimus
Tx = Thoracic IS
Lx = Lumbar SS
Teres
Latissimus dorsi and subscpaularis
Psycho-emotional factors present Ö
Consider posture, sleep, diet, stress, exercise/activity & other perpetuating factors that may aggravate their condition or increase “system wind-up.” Discuss with client.

Step 4 – Treatment Direction Testing (TDT)

treatment direction testing backThe BG physiotherapist then used this summary table to guide the treatment process. Both Michelle and the therapist agreed that thoracic rotation was the most heavily restricted movement pattern. As such this was used as the ‘test’ movement pattern.

The structures on the right hand side of the summary chart (joints, trigger points, tight fascia, etc) were then used to determine which one(s) would yield the greatest improvement to thoracic rotation.

This process took about 30 minutes and through a process of elimination the physiotherapist was able to determine that thoracic segment 9 (T9) and the right gluteus minimus/medius muscles improved thoracic rotation to the greatest extent. All other structures were eliminated from the list as they did not yield improvements in movement when manipulated.


Step 5 – Primary Contributing Factor (PCF)

The Body Genius physiotherapist worked continuously with both the T9 segment and the right gluteal muscles to restore thoracic rotation left and right to full range – 65 degrees both directions. Once this was achieved the therapist reassessed the other movement patterns to determine if they had improved as well.

  • Right shoulder movement patterns were now full range and pain free
  • Knee to wall test measuring ankle movement was now 13cm on both sides
  • Cervical (neck) flexion had improved to full range and left and right rotation was 90 degrees.
  • Right hip flexion was now 130 degrees and external rotation was 60 degrees
  • Hamstring length on both sides had improved from 100 degrees to 160 degrees
  • Shoulder internal rotation on both sides had improved from 30 degrees to 60 degrees.
  • The Thomas Test had been cleared demonstrating no muscle tightness around the hip joints.

Step 6 – Symptom resolution and full movement patterns

Michelle’s pain had now completely resolved on a daily basis and all of her movement patterns had been restored to full range. The primary contributing factors appeared to be thoracic segment (T9) and the right gluteal muscles. Michelle was studying for long hours as a student, which was likely stressing this part of her back. She was guided through the best way to set up her home workstation and how to restore posture to protect her thoracic spine. Michelle was also provided with mobility exercises for her spinal segments and hip fascia.

It is also worth noting that Michelle was continuing to experience bloating and abdominal pain on most days of the week. This is an important factor to consider because not only can subluxations of the spinal segments cause dysfunction of the internal organs and systems but the reverse can occur as well. In other words, gastrointestinal inflammation can lead to pain and dysfunction within the spinal column. Consider this chart below and the influence the gallbladder, liver, stomach, pancreas, spleen, kidneys and small intestine can have on the T9 region of the spine.

 spine diagram

Michelle was keen to resolve these issues and was therefore referred to the Integrative Health Practitioner (IHP) at the Body Genius Institute for further evaluation.

At the Body Genius Institute the practitioners make clinical decisions based upon ‘The Performance Pyramid’, a concept they have developed through clinical experience, scientific evidence and observation. Thousands of Body Genius (BG) clients have benefitted from the Performance Pyramid and the simple concepts it represents. Each practitioner on the BG team has a copy of the pyramid on their desk and clients are walked through the basic strategy and where they sit within the pyramid.

 Performance Pyramid
The Body Genius Institute ‘Performance Pyramid’

Michelle was continuing to experience a wide range of symptoms suggesting that one or more underlying ‘systems’ within her body may be stressed.

Endocrine System Gastrointestinal System Lymphatic System
Cardiovascular System Respiratory System Central Nervous System

This meant that she had not satisfied the ‘HEALTH’ level of the pyramid and therefore her treating physiotherapist recognized that they should not move upwards through the pyramid too quickly until she was evaluated.  Over the next few months Michelle worked with the Body Genius Integrative Health Practitioner (IHP) and made significant improvements in her health.

Step 7 – Functional testing and generating a Risk Profile

Michelle was keen to get back to full participation in all of her activities – running, cycling, weight training and Muay Thai.

Michelle was booked for a Risk Profile evaluation and asked to wear comfortable clothing. The evaluation included the following tests:

  • Functional Movement Screen®
  • Upper quarter Y-Balance Test®
  • Lower quarter Y-Balance Test®
  • Dorsiflexion (ankle) range of motion testing
  • Functional Hop Testing
 functional movement testing
Functional Hop Test

Involved side: Left Left Right Difference (cm) Difference (%) Standard
Single Hop (cm): 90 100 10 10% Below
Triple Hop (cm): 300 310 10 3.2% Pass
Triple Crossover Hop (cm): 250 230 20 8.7% Below

The results from these tests were then entered into the Move2Perform software and a Risk Profile was generated for Michelle.

 y balance iq chart move2perform

The results clearly demonstrated that Michelle’s scores for the Functional Hop Testing and ‘Overhead Squat’ were below standard. Although her scores for the Upper and Lower quarter Y-Balance Tests were scored a ‘pass’, this is likely not sufficient for the level of participation in her chosen activities.

The ‘moderate deficit’ Risk Profile rating would suggest that Michelle has a 30% chance of sustaining an injury during sport participation in the next six months.

Step 8 – Corrective exercises and return to activity / sport plan

thoracic extension foam rolling

Foam rolling to enhance thoracic extension

The outcome measures from the Risk Profile clearly highlighted that Michelle’s overhead squat pattern was dysfunctional. This is a significant finding considering that Michelle was loading this dysfunctional movement pattern in her gym routine and a squat is a significant pattern of movement for the sport of Muay Thai. Likewise, her below standard scores on the Functional Hop testing reveal a significant deficit that is directly relevant to her chosen activities.

calf extension stretch

Prolonged calf stretching for up to 10 minutes

These findings may reveal why Michelle continually reinjures her shoulders when she returns to sport and activity.

Based on these findings the Body Genius physiotherapist planned a list of exercises that may improve her overhead squat pattern and lead to improvements in functional hop testing. During the course of a 30-minute session, six (6) exercises were performed to determine which ones had the most dramatic affect on Michelle’s overhead squat pattern. The results showed that there were two exercises that significantly impacted on her squat:

Within one week of performing these exercises on a daily basis, Michelle’s overhead squat pattern improved from a dysfunctional score (1) to a minimally functional score (2). Upon resting the lower quarter Y-Balance Test there was a significant improvement in Michelle’s scores and she moved from a ‘pass’ score to ‘optimal’. It was amazing to see the effect that correcting the dysfunctional squat pattern had on Michelle’s performance in the Y-Balance Test.

Michelle’s risk profile had improved from substantial (30%) to slight (16%) and she was cleared to begin running, cycling, swimming, and weight training. Michelle really wanted to begin Muay Thai training however with the dynamic nature of the sport (punching, kicking, hopping) and her ‘below’ standard scores on the hop testing, she was advised to hold off for another 1-2 weeks.

Michelle was then provided with one hip stability movement pattern and one agility pattern to perfect. Again with daily practice she had improved significantly after only one week and her scores on the functional hop testing had improved to the optimal range. Michelle was cleared for full sport participation.

Two months later Michelle returned to the Body Genius Institute for a clinical assessment. She had been completely pain free for the last two months. The Body Genius physiotherapist cleared her neural tension (NDT), used treatment direction testing with T9 and the gluteal muscles to restore full movement to the neck, upper back, hips and hamstring length and reminded Michelle about how to protect her primary contributing factors (PCFs).

Michelle was asked to return to the Body Genius Institute again in another two (2) months for a repeat Risk Profile to ensure her body continued to move well while training at a high level of intensity.

Michelle was so pleased with the outcome. She had suffered with pain in both shoulders and pain in her upper back for nearly 18 months. She had seen multiple health professionals who were able to clear some of her pain only to have it return weeks later with activity. Michelle could clearly see why this was happening and the process that was needed to restore her body back to balance and prepare her for the demands of Muay Thai.

To book an appointment with a Body Genius Physiotherapist or to book an Athletic Screen (Risk Profile), simply give us a call on 9227 6277. We look forward to finding the ‘Genius’ in your ‘Body’.

Results may vary.

 

2018-03-29T17:38:21+00:00
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