South Wales Osteopathic Society

These case studies are drawn together under this heading from the other parts of the website. For more information please click on the particular topic on the A to Z. These cases help illustate the osteopathic approach to patient care. They have been much shortened and use non-technical terms to make them accessible to the general public.

Neck

Retired teacher Marjory felt her neck slowly getting achey and stiff, with difficulty turning her neck to look round in the car. She took herself off to the osteopath, who diagnosed spondylosis in the neck as part of her trouble. He explained that he thought things were made a little worse by Marjory's long history of asthma. Asthma sufferers often develop an increase in the kyphosis (convexity) in the middle of the back. To adjust to this,  the normal concavity (called the lordosis) in Marjory's neck had had to increase slightly over the years, leading to more pressure on the joints at the back of the neck.

Her osteopath worked on the neck, freeing the joints with gentle stretching techniques. He also worked on the muscles, not just at the back of the neck, but at the front, loosening the scalene muscles which attach to the upper ribs. He also attended to the middle of the back and gave her a few simple exercises to help her progress. Within a fortnight Marjory felt a lot better, with improved neck movement, and the osteopath told her to come back if she began to stiffen up again. 

Hamstrings

Keith was a professional football player who was sent to the osteopath by his club because he kept getting hamstring strains. Keith couldn,t understand why he kept getting them – he was dutifully doing his hamstring stretches .  The osteopath found areas of scar tissue in the muscle belly.  He also found the hamstrings were long and weak, whereas the quads were strong. Worse, the hamstrings on one side were longer than on the other. This had allowed the pelvis to tip forward , more on one side than the other, and caused a torsion in the pelvis and up into the low back.

In consultation with the team coach and physiotherapist, the osteopath modified Keith’s training to concentrate more on quads stretching and hamstring strength. The osteopath also treated the joints and soft tissues of the pelvis and spine so they could adapt well to the altered forces this would produce, He also used soft tissue and isolytic muscle energy techniques to improve the pliability of the scar tissue.

Hip arthritis

Tom, a retired farmer thought he had strained a muscle in the groin. It was getting more and more painful to walk any distance and he was having trouble getting his right shoe on. He decided to go to an osteopath whom his wife visited. The osteopath looked at his back and his legs muscles and moved his legs about. When his leg was twisted in cetain directions the pain in the groin came on. The osteopath told Tom he was pretty certain Tom had arthritis in the hip.

Tom was sceptical, becuse he had always thought hip pain would be in the buttock. But an x-ray confirmed he did have arthritis in the one hip. His doctor said he didn't think it was bad enough yet to warrant a hip replacement. The osteopath said he could keep Tom going till he needed a hip replacement. After a few visits Tom could walk quite a bit further without pain. He found visiting the osteopath for a treatment if the pain built up kept him pretty painfree 

Sleepless baby

Baby Carys.This 7 month old baby girl cried for about 4 to 5 hours a day and wouldn't sleep for more than an hour at a time. This was affecting the whole family as they were all sleep deprived and everyone was becoming increasingly irritable, they had tried many colic remedies and sleep training but nothing had made a difference. After speaking with a midwife carys's parents brought her to see an osteopath Her birth was quite easy but very fast, which caused her head to be cone-shaped. The osteopath found that due to this quick birth she had multiple areas of tension in her cranial base and pelvis. She worked to relieve this tension and within three treatments Carys was crying for less than two hours per day and sleeping through the night.

Recurrent low back pain

Paul This 53 year old electrician had suffered with recurrent episodes of low back pain as a result of a disc injury whilst playing rugby in his twenties. Back then it would only come every few years and last a couple of weeks but when Paul turned 35 it all started to go down hill. It was becoming more frequent and lasting longer so that by the time he came to see us he was having it 4 to 5 times a year with each episode lasting a month or more. He used to try and alleviate the symptoms by using a support belt and taking pain killers. When Paul turned 50 he had had enough, he came to see the osteopath three years ago. THey were able to alleviate his symptoms and give him exercises to help keep his back going. He now visits  two or three times a year for maintenance, to update his exercises and talk through any worries he may have. He has been free of pain now for two and a half years.

Whiplash

Emily was stationary at traffic lights, when a jeep drove into the back of her Fiesta with such force it shunted her into the car in front. She managed to get out of the car and exchange insurance details, then drove home, very shaken. Next day her neck felt very stiff and painful, and one arm felt a bit tingly. She went to work as usual, but through the day the pain got worse and she asked to leave early. Next day she went to the local hospital A& E. department. They took an x-ray, said it looked OK and that she probably had “soft tissue injury”, and sent her home with anti-inflammatory tablets and a soft collar.. The tablets seemed to help a bit, and she could return to work, but work was still very uncomfortable and her neck seemed as stiff as ever. She had been to an osteopath with low back troublesome years before, so she decided to seek his advice.

After asking lots of questions about the circumstances of the crash and her symptoms, the osteopath examined her neck and low back and tested the nerves in her arms. He said that the whiplash had strained some of the ligaments in the neck and also a few of the “Z” joints. He said that the vague pins and needles in her arm appeared to be coming from spasm of the scalene muscles at the front of the neck. The osteopath also found areas of the spine lower down, between the shoulder blades, that were not working well. At the first treatment the osteopath used gentle movements to reduce the muscle spasm and free tight joints in the neck. He also worked lower down the back. After two or three visits, Emily started to feel better. As she made progress, the osteopath added other forms of treatment to restore joint mobility. He also gave her some simple exercises to do at home. Emily’s solicitor asked her osteopath to prepare a report in support of her legal claim

Baby with ear troubles

Alice This two year old baby girl suffered from hearing loss. She consistently failed hearing tests from the age of eight months and suffered from nasal congestion. Osteopathic examination found tightness through the base of her skull, face and upper neck. This was leading to a reduction of drainage of the naso-pharynx and poor functioning of the Eustachian tube. Osteopathic treatment reduced this compression and improved the mechanical functioning of the upper neck. Alice's hearing improved significantly after only four treatment sessions.

 Low back and leg pain

John This 46 year old businessman suffered from constant low level back pain for about 4 years prior to visiting the osteopath. He said that he could never find the time and as a result it had recently become much worse and was starting to affect his leg. He also told us that he was a very light sleeper and generally get about four hours of sleep a night. John was in a bad way, because he had left it to go on for so long it was affecting not only his back but his pelvis and this was affecting his gait. After the first session John reported that his pain had diminished significantly but the best news of all was that he was now sleeping for eight hours a night and his wife was ecstatic because she was no longer disturbed by his irregular sleep pattern. John was seen a further four times as the problem had been so long standing but we are pleased to report that he no longer needs to come and he keeps himself going by doing the exercises that given  him on his final visit

Bursitis around the hip

A lady with  trochanteric bursitis ('hip bursitis') was  referred by a GP  to an orthopaedic surgeon where she underwent a number of corticosteroid injections.As the symptoms of the bursitis were still not resolving to a satisfactory level, she was then referred  for an osteopath's  opinion .After examination, the osteopath  had found a number of dysfunctional areas:

Hypomobile upper lumbar spine Hypermobile lower lumbar spine Chronic buttock tightness Localised trochanteric tenderness

This lady had lower back joints, which were either very stiff or very loose and consequently her loose joints worked harder and were over-used and fatigued more quickly. To combat this, the buttock muscles were working harder to try to stabilise and aid the painful spinal joints, which in turn made the muscles tighter and decreased blood flow. These tighter buttock muscles then pressed harder on thebursa... and created the bursitis.

The findings were simple enough in this case, as the cause of the bursitis was the chronic buttock muscle tension and its relation to the bursawith a predisposition from the lower back. Osteopathic treatment followed to all of the affected areas. As the symptoms had been persisting for two years,there was a great deal of work to be done, often meaning that the chronic tissues were very sore initially after treatment. Within six sessions, there was a significant improvement for the patient for the first time in two years.

Spondylolisthesis causing low back pain in early twenties

In her early twenties Sally started a job that meant long hours on her feet. She started getting severe low back pain that worsened as the day went on. She visited an osteopath a friend recommended. She told the osteopath that she had not had back pain before, although lying on her back had never been comfortable unless she had support under her knees.

 The osteopath examined Sally and noted that she had a slight "shelf" in her lower spine. When he felt Sally's back he could feel the "shelf" and from the history and examination suspected a spondylolisthesis. He arranged x-rays, which showed a grade I forward slip of the L4 vertebra on the one below. He gave treatment, working on areas away from the site of the slip, to improve the overall mechanics of the spine.  He also gave her some exercises to flatten the spine and improve the ability of the muscles to brace the area. Sally found this all helped a lot, thast she could stand for longer and with much less pain. She found a three monthly visit to the osteopath kept her back pain at bay.

Knee

John was a fit thirty five year old who decided to take up jogging. As he got fitter and started running further and faster, he noticed a pain on the inside of the knee. As it got worse, he went to see his GP, who referred him to the local hospital. Blood tests, x-rays and an MRI scan all drew a blank.

He visited his local osteopath, who asked him about the whether he recalled any particular incident bringing the problem on.  John said that he couldn't recall any incident that might have damaged the knee, although he did remember straining his ankle on the same side some years before, but that was no longer troubling him. When the osteopath examined the knee, he found no sign of arthritis and the meniscii (“cartilages”) appeared OK. The only positive finding was some pain on stressing medial collateral ligament on the inner side.

So the osteopath got John to turn up at the clinic in his running gear and watched him running in the nearby park. He noticed that John was not bending his right knee in a straight line as he ran, but bringing it out to the side with each forward stride. Back at the practice, he examined the ankle joints and found that the right one had a significant loss of mobility at the talo-crural (ankle joint). John was unable to bend  the foot up sufficiently when running, and so couldn’t clear the foot from the ground quickly enough, so was repeatedly having to put a strain on the inside of the knee. Until he started running, this had been no problem, but now the results of the old ankle injury were not allowing his body to respond to the extra demands on it. The osteopathic treatment was not to treat the knee, but to restore normal mobility to the ankle. Within a few treatments, John was running as far as he liked without pain.

Low back pain - sacro-ilaic joint

Susan was a keen golfer but she was finding increasing pain on the right side of the pelvis and low back each time she played. She had previously seen an osteopath about another complaint, so went along to see what they thought. They found a  hypermobile (overmobile) right sacro-ilac joint.

The osteopath said that although the right SIJ was too mobile, the left was not flexible enough. On top of thast, the dorso-lumbar area of the spine, which normally rotates well, was limited in its mobility. Both these factors were placing more stress on the right SIJ when Susan turned and walked.