Case Studies

Jeff was referred to me by his sister who I was treating at the time. Jeff is a 42 year old male who has had numerous injuries from bar fights, jet skiing, and MVAs, etc. He slid off his truck while washing it and landing in a straddle position on to his front porch six months prior. Initially he could not sit and the pain was localized to his tailbone. His pain progressed to the point where he was getting B leg pain and symptoms from the pelvis to the cranium. All his ADL were affected. I followed the recommended FMLQ sequence (I started with the coccyx) and worked through the lumbo/pelvic/hip complex and progresses to his knees.

I taught him BET concepts to improve his postural alignment (the elevated sternum correction and LE weight acceptance were very important for him to master). He had both ACL reconstructed and stopped utilizing his legs as an efficient base of support. I trained his gait, push/pull, lift and carrying tasks with BET/PNF techniques. Jeff was not big into exercising so I integrated exercises in to his functional activities. By this time his only symptoms were his chronic L subscapular pain that occurred when he has repeatedly stomped on the mid back during a bar fight. I called the MD and extended treatment to this region.

I followed the FMUQ sequence and integrated CTI techniques to correct the anterior subluxations in his 6th and 7th ribs and thoracic dysfunction. By discharge, his pain in this area decreased from a constant 6/10 to 1-2/10 and only after a stressful day on the job. Jeff still keeps in touch with me on his progress. I would have been overwhelmed with a case like this without my IPA training. I am so grateful that FO I was my first CE out of PT school.

I had a patient who was s/p tibial fx. And ORIF. She had only trace strength when starting PT. My treatment over six months included PNF, which was guidance only for a month, weight bearing, gait training, PRE's, Cybex isometrics and isokinetics, and therex for her LE's. After FMLQ, I initiated manual resistance with irradiation into the four quadrants with the contralateral LE. I got almost instant and dramatic results from this treatment. This was documented by the peak torque and total work that the Cybex recorded. When asked what protocol helped her the most, the patient stated, without hesitation, the manual resistance with irradiation.

I am currently treating a 44-year old woman who sustained a Shoulder injury in January of this year. She received physical therapy at another practice unsuccessfully and underwent surgery in July that included an Acromioplasty and Debridement of the GH joint. At the time of the initial evaluation, she had significant loss in her ROM in all planes. Using Functional Mobilization techniques and neuromuscular re-education made tremendous gains immediately that far exceeded the physician's expectations. The treatment now focuses on continued neuromuscular re-education of the shoulder girdle and strength training. She is now able to perform most of her ADL and work activities with little to no pain or noticeable dysfunction.

An example of a patient that benefited nicely from the IPA approach was a 20 year old athlete with a recurrent hamstring strain. He plays football for a Division I-AA program, and was initially injured two years before his first session with me. He had dozens of prior treatments from two other physical therapists and from the athletic training staff at his school, consisting primarily of pain and inflammation relief modalities including heat/ice, ES, US, massage, and stretching. At initial evaluation he presented not with hamstring flexibility issues, but significant myofascial mobility and play restrictions mid belly. This was assessed and treated using soft tissue mobilization, myofascial release and functional mobilization techniques from FOI and FOII. The patient began to note decreased pain and improved mobility throughout his lower extremity following several treatments. He was also assessed to have an anterior inominate dysfunction on the same side that was restricted into posterior inominate rotation and causing a functional leg length discrepancy. This appeared to be a driving force for the recidivism of his injury over the two years. Following soft tissue work and functional stretching, MET and mobilizations from LPI were used to correct the inominate dysfunction, and then a combination of prescriptive exercise and hip/pelvic PNF stabilization techniques were utilized to maintain the correction and new mobility. The patient was pain free following seven or eight treatments for the first time in 2 years, and following strengthening and functional exercises, returned to running and playing within another several weeks. Patient reported during and following his season that he played the entire year pain free for the first time since high school, and with the best mobility and speed of his career. I definitely feel that if it wasn't for the training, knowledge and treatment ideology that I learned from the IPA I would have most likely treated this patient the same way that his other two therapists had. With traditional modalities and exercises that would have alleviated his symptoms and not addressed and corrected the core problem that was driving his recurrent strain.

I recently had a patient who has been seen by multiple PTs over the past six years (S/P MVA with three pelvic fractures) for recurrent low back pain. She also required a splenectomy after the accident, which was followed by an infection in her abdominal scar area. Not one PT who saw her prior to me had ever looked at her abdomen/anterior chest to see how horrific her scarring/adhesions had become and the potential for posterior pain as a result of these. I am embarrassed to say that prior to taking IPA courses, I wouldn't have paid much attention there either. Now, I look there first. With three treatments of desensitization, soft tissue mobilization and functional mobs, I have already seen improvement (as has the patient.) I know that after increased neuro re-education and education as well as continued manual therapy, the patient will be much improved and able to return to ADLs she though would never be possible again. Restoring hope to patients has been an unexpected bonus.

I have a 20 y/o male that I saw for two visits before the FMLQ course with LBP, radicular pain and numbness into groin and L foot, L2 rotation with L5 mild anterolisthesis on S1. I have been mobilizing hips, inominates, sacrum, coccyx, treated L2 in sitting extension quadrant FM, following up with abdominal series. After three additional visits, he has no radicular pain, good abdominal facilitation, absent L2 rotation and a normalized forward bend, (was limited by 50%, now he is able to touch toes!). Thanks again, my confidence continues to grow!