How Multi-Layered Approaches to Patient Care Can Be Effective: A Case Study

32Let’s look at a patient case study to examine the way hybrid healthcare can work towards providing the best possible care for patients.

Low Back Pain Case Study

John is a patient who complains of low back pain. He has had a history of back pain, but his present pain was made worse by a vehicular accident a month ago in which the car he was a passenger in was rear-ended. He works in marketing and sits at his desk on a computer for several hours on end. By the end of the day he says he experiences radiating pain down his legs. He presents with a pelvic rotation, poor posture and lack of core control.

1. Chiropractic Care: In this case, the Chiropractor would address the patient’s pelvic rotation with a manual adjustment. This manipulation would help move the pelvis back into its correct articulation. Additionally, the patient may be placed on a traction table to help alleviate some of the pressure and subsequently pain on the lower back disks.

2. Physical Therapy: The physical therapist would address the pelvic rotation also with mobilizations and manual therapy. Additionally, therapeutic exercise will be used to strengthen the core to add support to the low back. Pain relieving modalities will also be used such as: ultrasound, low-level laser therapy and TENS units.

3. Acupuncture: This non-traditional therapy is gaining popularity in treating back and neck pain. In a study posted in the Clinical Journal of Pain, Acupuncture was found to be effective in reducing pain and the reduction was effective for up to 6 months. Needles are placed at specific points along the body and stimulated with electrical stimulation for short periods of time. Participants reported reduced back pain and increased relaxation.

4. Massage: This adjunct therapy will be used to address specific issues or injuries, in this case radiating sciatic pain. Trigger point release and deep tissue massage will be used to help release the sciatic nerve and inhibit the experience of radiating pain.

5. Pilates: Another great adjunct therapy, Pilates will address the lack of core strength using mat exercises as well as modified work on the Reformer and Cadillac machines. Core strengthening is an essential component in this case study to help lower the risk of reoccurring back pain.

Healthcare and patients choices with how to approach their health needs are evolving. Using a multi-layered approach is a wonderful way to offer patient’s cutting edge care that addresses their unique set of needs.

How Physical Therapy Can Treat Thoracic Outlet Syndrome

suSymptoms can start out somewhat vague. Pain may be felt in the neck and shoulder accompanied by tingling in the hand, particularly if a lot of time is spent at a computer. Hand and shoulder pain may worsen, while patients may begin to feel coldness in their fingers. Thoracic outlet syndrome may start out benign enough, but if left untreated, patients conditions may deteriorate to the point of decreased ability to work and participate in their day-to-day life.

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) is a condition which symptoms include:

  • Numbness in fingers
  • Pain in shoulder, neck and arm
  • Impaired and sometimes discoloration of the extremities

TOS is caused by compression of nerves and/or blood vessels in the upper chest. The thoracic outlet(TO) refers to the exiting passage for those nerves and blood vessels out of the chest into the upper extremities. The TO is bordered by muscles, bone and other tissues and any issue that results in muscle, bone, and other tissues border the thoracic outlet. Any condition that results in swelling of these tissues can cause thoracic outlet syndrome. Thoracic outlet can be caused by poor posture, extensive computer work, weightlifting, however it must be noted that sometimes no sometimes there is no detectable cause.

How to Treat Thoracic Outlet Syndrome

  1. Posture Training: The first protocol in treating TOS is assessing postural problems in day-to-day activities, work and at rest to reset the posture as needed in order to decrease the pressure on the thoracic passage.
  2. Manual Therapy: The focus of manual therapy is increasing range of motion in the shoulder girdle and the 1/2 ribs. This will also aid in the patient’s ability to maintain the postural adjustments of the posture training.
  3. Transcutaneous Electrical Nerve Stimulation or TENS: TENS or EMS is a pain treatment modality that uses low voltage electric current which causes the local release of neurotransmitters such as serotonin which block pain signals in the brain.
  4. Kinesio Tape: In addition to the useful benefits Kinesio tape have in pain relief, swelling reduction and improvement in lymph function; Kinesio tape is also useful for helping patients maintain proper posture.
  5. Therapeutic Exercise: In order for patients to be able to maintain proper posture to relieve the pressure, they must have the strength and flexibility to do so. In addition to exercises done in a physical therapy session, home exercise programs using exercises such as thoracic extension and rowing are necessary for successfully treating thoracic outlet syndrome.

TOS is one of those diagnoses that start out more as an annoyance. However, if left untreated, it can become a source of disability and need for surgical intervention. In our computer and technology driven lifestyles, patient’s posture continue to degrade putting most patient populations at risk for developing TOS. It’s important for patients to understand that treatment is available and early intervention is key.

How Physical Therapy Can Treat Sciatica Caused by Low Back Pain

vBack pain is the second most common symptom-related reason for physical therapy in the United States. Up to 84% of adults have low back pain at some time in their lives, with sciatica affecting up to 40% of those with low back pain. The long-term outcome of low back pain is generally favorable, but persistent symptoms affect millions of individuals. Sciatica accounts for approximately 5% of people with back pain who go on disability, and for up to 75% of the costs associated with low back pain. Noninvasive intervention, such as physical therapy is an important tool that can play a significant role in reducing healthcare costs.

What is Sciatica?

The term sciatica describes the symptoms of leg pain-and possibly tingling, numbness or weakness-that originate in the lower back and travel through the buttock and down the large sciatic nerve in the back of the leg.

Sciatica is not a medical diagnosis-it is a symptom of an underlying medical condition, such as a lumbar herniated disc, degenerative disc disease, or spinal stenosis. Sciatica is often characterized by one or a combination of the following symptoms:

  • Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
  • Pain that is worse when sitting
  • Leg pain that is often described as burning, tingling or searing (vs. a dull ache)
  • Weakness, numbness or difficulty moving the leg or foot
  • A sharp pain that may make it difficult to stand up or to walk

How to treat Sciatica Symptoms caused by Low Back Pain

    1. Ultrasound: Ultrasound is often recommended before stretching of the piriformis muscle. Ultrasound is a form of deep heating in which sound waves are applied to the skin and penetrate into the soft tissues. Ultrasound is especially useful in relieving acute episodes of pain and may enhance tissue healing.


    1. TENS: TENS, or transcutaneous electrical nerve stimulation, is a back treatment modality that uses low voltage electric current to relieve pain. TENS is effective for treatment because it causes the local release of neurotransmitters such as serotonin to block the pain signals in the brain.


    1. Iontophoresis: Iontophoresis provides a means of administering medication transdermally using a low, direct electrical current to drive it to the involved tissues of the low back. Frequently, it is used to administer anti-inflammatory medications to local tissues. A secondary benefit for iontophoresis is the electrical current itself that can immediately reduce symptoms by blocking pain receptors.


    1. Traction table: Lumbar traction using a traction table operates under the theory that separation of the lumbar vertebrae will decrease impingement of the spinal nerves as well as decrease pressure between the discs.


  1. Low Level Laser Therapy: Low Level Laser Therapy helps relieve muscle tension, spasms, inflammation, fluid retention, aches, stiffness, and pain. Other benefits of LLLT include improved circulation (blood and lymph), general flexibility, range of motion, and increased tissue elasticity (ex: scar tissue). In a study published in The Australian Journal of Physiotherapy, results showed that Low Level Laser Therapy combined with exercise drastically reduced pain and increased lumbar range of motion in patients complaining of severe low back pain.

Low back pain is an expensive drain on healthcare and individuals. When left untreated low back pain can go on to cause further problems, such as sciatica, thus increasing its detrimental effect. Physical therapy is a time and cost-effective way to combat the effects of sciatica and low back pain, helping patients get back to the task of living their lives pain-free.