Client with back problems

[HurDelieui]

A regular client has got problems with his right shoulder and I'm not to sure what it is. He has broken his collar bone 4x but never went to the doctor or got any physiotherapy for it. He suffers more with it in colder weather. The symptoms are stabbing pain, spasms and tightness. I thought it may be frozen shoulder but have never dealt with this before.

I found that his right shoulder is much tighter than his left and tonight, bless him he did say that it hurt a bit, but didn't yell out - only told me at the end of the massage. Said that if its hurting then the masssage must be working.

He also has lower back problems. Lifts daily in his job, very physical. Doesn't follow proper manual handling procedures. Has pulled his lower back a couple of times. When working on the area I noted how tight the muscles were around there. Spent some time working down there but wonder whether anyone can recommend ;

1) any further massage moves or
2) recommend postural exercises whereby he can strengthen the lower back.

Thanks

 

[KBT]

Hi Heaven~Spirit,

Can you zero in on these symptoms for us please?... what part of the shoulder or elsewhere specifically do they occur, what movements cause them (both active and/or passive), which ranges of motion are abnormal, what areas are tender or sore to palpate etc etc?

In terms of his lower back, should he be strengthening or trying to release the tightness? Also, in terms of his posture, how is his pelvis? Would you say he's relatively well balanced or is there any anterior or posterior rotation (excessive lumbar lordosis or is it quite flat)?

Sorry for all the questions.

Regards

Henry

 

[wings]

Hi Henry,
I can't really answer these questions. I'd have to ask him about his shoulder etc and as to his lower back I think it is flat. However he did tell me that he walks quite hunched - like a gorilla, he said!

Whilst doing my Swedish Massage Level 3, we didn't even touch on these points so no complicated words.

Thanks

 

[hpsuabtvpli]

I think your client should be told he is doing himself no favours here and needs to be properly assessed by a back specialist! So he has a collar bone that breaks regularly, but won't get it seen - and wonders why he has shoulder pain? And the lower back problems - if he doesn't follow the proper lifting procedures, why does he (and you) seem surprised that things go wrong? Honestly! Some people need saving from themselves!

 

[Sam Anderson]

Chris

I have told him this and he is aware what he is doing wrong. He's his own worst enemy. He has been to a back clinic in the past but cannot afford there fees. I've recommended he see someone but he's not willing. Feels comfortable coming to me but I don't feel I have the skills or knowledge to assess him properly and am scared of injuring him even more.

 

[MikeL]

I've just called him to see how he is and he is ok but i've recommended that he see an Osteopath, whom I know in Grimsby just to diagnose and if possible rectify some of his problems then he can hopefully come to see me for relaxation and working out any tension spots.

 

[gintable]

If "walking like a gorilla" (love it!) means he's rather kyphotic (rounded shoulders, forward head posture) then you can't go far wrong if you try concentrating on the tight / facilitated muscles that cause that morphology, namely:
pec major / minor
upper traps
levator scapulae
sternocleidomastoid
anterior scalenes
suboccipitals
subscapularis
lats

If you're interested, there are 2 great articles on Forward Head Posture on Erik Dalton's site... http://erikdalton.com/articles.htm

Happy Easter

Henry

 

[pribefenesbit]

Thanks Henry, thats great! and I certainly did not keep a straight face when he admitted that he walked like a "gorilla"!

 

[MinPins]

Hi Heaven Spirit

Sorry, but I have been very busy and have only just picked up the thread of your post.

I am a Personal Trainer and back injury rehabilitation practitioner covering the Lincolnshire area. So far you have asked all the right questions and been offered some sound advice. However, there may still be many more questions that have not been tackled.

Firstly, very heroic of your client to 'soldier on' with his broken shoulder. However, the questions have to be asked 'WHY'? and 'WHO DIAGNOSED THE BROKEN SHOULDER'?

As for the lower back problems, if he is lifting incorrectly (that is, not following the normal health and safety rules) then who is in charge of him? (assuming he is an employee and not self employed), has he ever completed a lifting course?

As a general rule, our bodies (yours, mine and his) are designed to perform many many tasks at many different angles with varying loads - and this should not cause us a problem. However, as a species we are becoming more sedentary and are therefore less able to cope with the more demanding tasks.

So, the questions you need to ask your client are:

why is he not lifting properly (ignorance due to lack of instruction?)

What general exercising does he do on a regular basis?

What does he do to keep himself mobile?

The final consideration is to determine if he is over weight!

Good luck.

Best wishes

Martin

 

[cobcgcoa]

Hi Martin

I can answer most of those questions.

He's a Gas Engineer therefore lifts heavy boilers/radiators

He doesn't have time to do exercise as he works shifts, the job is exercise in itself as very physical.

He's not overweight, from what I can tell and

another thing is that he doesn't sleep well, partly due to pain in back. or lying still for a few hours.

 

[Ked misybeer]

Hello again

If your client is a gas fitter I would presume that he has been on a lifting course. If not, then perhaps he should (health and safety at work act 1986 I think is what he needs to quote to his employer - but the will know better than me!).

Unfortunately he and you seem to think that his job (being physical) provides enough exercise. Sadly, this is NOT the case. He needs to be performing a more 'rounded' exercise programme to help strengthen opposing muscle groups and fixators. You would think for instance, that being a personal trainer I would get all the exercise I need during a day at work to keep me fit and healthy. This is not the case. I work at the level that suits my client and as a result am not elevating my own heart rate (being fitter than the client) and as such am not receiving a workout for myself.

Thankfully he does not appear to be over weight. However, he may have poor muscle tone so you should encourage your client to make time to exercise. Everyone can fit in a 10 minute training session at least once a day. It has already been mentioned in this thread that you should check his pelvis alignment - from your most resent comment I would be inclined to think that this is sound advice and would go further to suggest that his hip flexors (illiopsoas) are too strong/tight and probably need stretching.

Alternatively, have you asked if he has spoken to his GP? Perhaps he may have a medical condition such as arthritis.

If you would like to take this further on behalf of your client then please feel free to ring me yourself or ask him to contact me - I will ask lots of questions and give him some ideas of the exercises I think he should be doing. I never charge for telephone consultations so please don't be afraid of running up a large bill. Please be sure to mention HEALTHYPAGES so that I know who I am talking to.

I hate to see or hear of people suffering (and I'm sure most of the people who visit this site will think the same) so lets fix him if we can.

Best wishes
Martin