We held our 2nd Upper Extremity module in Paris for 2016 the 1st to the 4th of December. The course was held at l’IFEC, Institut Franco-Européen de Chiropraxie, Ivry Sur Seine. The course participants were very eager and dedicated throughout the whole course. 90% of the participants passed their practical exam although the course was very intensive and demanding. Thank you so much to all participants for their overwhelming feedback. Good luck with your patients and athletes! Course Instructors: Nicolai van der Lagen and Ole R. Johansen (both from Norway, but teaching in French).
Male patient aged 44 with pain on the medial side of the right elbow and on the ulnar side of the forearm. The problem has been present for a couple of years, but it always gets worse during the summer. Last winter was also painful, but symptoms were not constant, more following the activity level. Loss of strength in the forearm and grasping followed the pain. Symptoms started to present on the left side this year. Very active person who competes on high level endurance races cross country.
During examination we quickly found out that the ulnar nerve was very tight and that the nerve itself bounced anteriorly and posteriorly during extension and flexion of the elbow. Increased tightness of the ulnar nerve was palpated by the medial elbow/forearm when shoulder external rotation and abduction were introduced (more stretching of the nerve). Patient reported increased symptoms when ulnar nerve was tested. Patient presents restrictions in shoulder external rotation and abduction (more active than passive).
The ART Lower Extremity level 1 course in Moss – Norway was a great success. Participants from The Netherlands, USA, Canada and Norway worked together for 4 intensive days at HQ Europe seminar room. Participant backgrounds: Chiropractors, Physiotherapists and Osteopaths.
During the Lower Extremity course participants work hands on with clinical approaches for a variety of diagnoses and cumulative soft tissue problems. Accurate handling with our tools of preference (our fingers and hands) are demonstrated and reviewed throughout the entire course.
Male patient aged 60 with pain in the left groin and testicle. GP referred the patient after relevant examinations had been carried out to exclude pathology. Patient has complained about intense and almost constant pain for several years. Symptoms get slightly better after 15 to 20 min of exercises. Symptoms get worse and intense as he stands up from a seated position. The longer he sits the more intense the pain during standing up.
Male golfer aged 44 was told he had «Tennis elbow» and tendinitis by his GP. He was given NSAIDs. His symptoms were intense pain on the lateral side of the right elbow with some radiation distally on the extensor side of the forearm and superiorly along the lateral aspect of the arm. Pain starts as he starts to grasp, and gets worse after activity. Symptoms might be milder during the activity itself. He was a bit surprised with the definition of the problem. He has played golf for almost 30 years and he has previously had the same problem at more occasions. He knew that the tendinitis diagnose was wrong and he took contact with our clinic. He never started on the NSAID’s.
Male patient aged 44 referred by the GP with impingement diagnosis of the left shoulder. He had already tried physiotherapy and rehabilitation, this without positive results. He is now up for surgery (MRI showed bursitis and changes of the supraspinatus tendon). The patient works as a carpenter, which has been difficult the last year. He feels that he does not have any force left, its painful almost at all times and he can only abduct the shoulder 20 to 30 degrees and has extreme limited external rotation. He experiences sharp local pain by the acromion and some more diffuse pain on the posterior and lateral side of the upper humerus. Difficult to sleep due to pain. Classic impingement syndrome.
Football player aged 27 with edema problems in the left knee. He plays at high level club. Huge problem for the club as the player is very important for the team’s defense. After playing 30 to 40 min. his knee get swollen, very badly. He has to stop playing because of the intense pain followed by the pressure in the knee. Problem has been present for more than one year. All examinations you can think of have been done without finding anything explaining the swelling. I quickly began to think about the Hiatus of the Adductors (canal for our femoral artery and vein, becoming popliteal artery and vein).
Female patient with minor scoliosis complaining about pain and dysfunction in the jaw left side. Patient is also experiencing intense tension headaches and irregularities with the heart rhythm. Muscles of the trapezius and the neck in general are very tight and tense. She has been examined by GP, Cardiologists and neurologists. Pathology has been ruled out and different medications have been tested.
Female patient aged 46 with symptoms indicating Thoracic Outlet Syndrome and/or Carpal Tunnel Syndrome on both sides. Symptoms have been severe to mild and vice versa for more than 2 years. She has tried most forms of treatment without any results. Specialists were considering surgical intervention of the Transverse Carpal ligaments both sides for her problems. She works as an accountant and trains at the gym 2 to 3 times a week. She keeps busy with 3 kids and more…
Our initial examination indicated secondary compression on the plexus between her middle and anterior scalene, secondary tension/pressure/friction from the coracopectoral gate and along the neurovascular sleeve in the upper arm. Palpation and neurovascular tension tests for these structures reproduces/elevated the patient’s symptoms in the arms and hands. Median nerve tests by the flexors of the forearm did slightly reproduce symptoms, but not as distinct as for the earlier mentioned higher up the tracts. Test of breathing pattern indicating secondary breathing activation at rest, and slightly lesser activation of Diaphragm.
Active Release Treatment was performed 4 times over a period of 4 weeks, including specific gliding/flossing exercises for the particular tract involved. At the 5th visit, the patient explains that she has not experienced any of the symptoms since the last treatment.
Patient was given correcting breathing exercises and specific gliding exercises for maintenance after 5th visit. At the evaluation 3 months later patient had no complaints and she had not experience any setbacks during the period.
Saved from the knife. ART – When results matter!
Female alpine skier on professional level came to the clinic with problems in her right and left thighs. Symptoms were burning, loss of strength and cramping on the anteromedial side. She has not been able to train correctly nor compete. Her training and skiing only worsens the symptoms. A lot of specialists and physios had previously tried to help her without any luck. No pathology and tests for lactic acid were negative at all times tested. Problems have been present for several years and it now looks like she has to put her career. (Case from 2012).