Case Studies 

Overview

A lay-up operator at a wood products plant, told his boss he had pain in the left wrist at the ulno-carpal joint and up into the forearm. He had a past history of bilateral carpal tunnel release surgery approximately two years before with full recovery. 

The pain started about seven weeks prior to our meeting with him and steadily got worse. The pain was focused in the wrist but radiated up his arm as it increased. He showed a decrease in grip strength on the affected side. His supervisor took him off of his regular job and had him doing clean up. 

Solution

At our initial visit we went over proper stretching technique and started him on a routine of seven stretches targeting particular muscles in the forearm and hand. 

Results

We saw him again in 10 days and he reported a 50% improvement in his pain and demonstrated an improved range of motion in wrist extension. We reviewed his stretches and made corrections on his form. We also started him on four active range-of-motion exercises at 8–10 repetitions each.

We then went out on the floor and observed him at his regular position on lay-up. There were ergonomic concerns with the height of the work surface in relation to his height but no way to adjust without a major redesign of the line. His height caused him to have to bend over the work surface creating an extreme angle at his wrists. This was likely the root of the problem. The only solution here was to increase his flexibility and range of motion at the wrists. 

Conclusion

We saw him again in two weeks and he was starting his third full-time shift back on his regular job and was having almost no pain in the wrist. He would get an occasional twinge but was able to use the stretches to take care of the pain. He was continuing with his stretches and exercises and showed significant improvement in his wrist ROM in all directions.

Overview

A young office worker was reaching and twisting under her desk for a wastebasket and had immediate onset of lower back pain with radiation into the left buttock and left leg. Pain was most significant in the left sacro-iliac (SI) joint. We saw her for a first appointment five days after the initial injury. Because of her symptoms, there was an initial concern of lumbar disc injury with nerve impingement. Her gait was altered and uncomfortable. In addition, she could not sit comfortably for any length of time. Hip and leg measurement showed a rotational pelvic obliquity. 

Solution

We taught her a pelvic self-mobilization routine and she was able to correct the obliquity on the first try. We went over proper stretching technique with her and started her on a routine to address tightness in muscle groups about the lower back and hips. She showed significant tightness and unusual range-of-motion restriction in the hip flexor and quadriceps muscles.

Results

We saw her again in one week. Her pelvic alignment was still good, her gait was improved, and she could sit more comfortably. But there was still pain in the SI joint and new pain in the anterior hip and deep buttock. We modified her hip flexor stretch and added a stretch for a lateral hip rotator muscle, which seemed to be an improvement immediately. We also evaluated her workstation for ergonomic factors and recommended a lift under her monitor as well as adjustments for her chair. 

Conclusion

We saw her for a final time two weeks later. Her back pain was gone with only tightness remaining and she was having no trouble sitting at all. She was doing the stretches as needed when her back started to feel tight. Stretches were reviewed a final time and we discussed body mechanics alternatives for reaching her wastebasket that did not involve reaching and twisting. The initial concern about disc injury turned out to unfounded. She was well on her way to a full recovery and no further appointments were necessary.

Overview

A forklift driver had acute onset of right shoulder pain that was preventing him from raising his arm beyond 40 degrees. There was no incident that seemed to precede the pain as it came on suddenly. 

He reported no previous history of pain in the shoulder. He is right handed and uses the right arm to operate the controls on his forklift. He initially wanted to see a doctor for the problem but agreed to try the ergoFLEX approach to see if it would work. 

We saw him the next day after the problem started for an initial appointment. He showed an elevated right shoulder girdle with the arm bone high and forward in the shoulder socket. He had tenderness in the sub-acromial bursa of the shoulder, a likely early bursitis. 

Solution 

We went over proper stretching technique with Mr. Shouldersocket and started him on a stretching routine to address tightness about the shoulder joint. A stretch was modified to provide a traction effect on the arm to draw the arm bone down in the socket. Stretches for the chest muscles were designed to relax the arm from its anterior position back to a normal one.

We also did an ergonomic evaluation of his forklift. As it turned out, the controls were set above his shoulder level. This was likely the root cause of his shoulder problem. Since moving the controls was not possible, we spoke with his supervisor and with the safety manager and recommended adding an armrest that would support the weight of his arm and take pressure off of the shoulder. 

Results

We saw him again in one week. His shoulder pain was completely gone. He had been doing his stretches 2-3 times per day or more and figured out a way to do a couple of them right in his forklift. He had a return to full range of motion in the right shoulder. The armrest was already in place and seemed to be helping. No further appointments were necessary and the company avoided a soft tissue, recordable claim.