Mr A was presented to the clinic with acute left upper back pain near to the medial border of his shoulder blade. Pain was aggravated due to a sudden quick overhead lifting during work. On examination, patient had full range of shoulder range of motions with mild pain at the back particularly during flexion and abduction. The left scapula was observed and palpated to have delayed upward rotation and winging pattern. Scapular assistance and retraction tests both reduced his pain during arm elevation. Shockwave, soft tissue release and exercises were provided. Shockwave therapy was used to revascularize the injured axioscapular muscles to promote healing and reduce pain. Exercises with an emphasis to promote scapular control and scapulohumeral rhythm such as scapular setting, supine punching and wall push up were incorporated. The patient had shown significant improvement after the treatment and was able to return to lifting activities at work.
Acute low back pain - Derangement syndrome
Mr R was presented with bilateral low back pain aggravated by sudden twisting and turning of his back during reaching. Disc bulge was shown on imaging and on examination repeated lower back extension resulted in centralization and reduce back pain. Shockwave, soft tissue release and McKenzie exercises were provided to promote recovery. Shockwave was utilized to increase vascularization around the injured soft tissues to promote healing. McKenzie exercises such as prone elbow extension was prescribed to target at the posterior disc bulge. The patient had shown significant reduction in pain and increased in lumbar flexion after several sessions.
Plantar fasciitis
Ms M was presented with right foot pain that got aggravated during walking especially the first few steps early in the morning. Pain was elicited during passive big toe extension and tenderness was localized to the medial calcaneal tubercle. She was treated with shockwave, ultrasound, soft tissue massage and stretching exercises to relieve her symptoms. The use of shockwave promotes the revascularization around the inflamed plantar fascia, thereby enhancing the recovery of the tissue. Foam rolling of the sole of the foot was also encouraged to reduce the tightness of the fascia. Pain was significantly reduced after several sessions of interventions and the patient reported less pain during walking.
Lateral Epicondylitis
Mr M was presented to the clinic with bilateral lateral elbow pain after an intense obstacle course. He complained acute pain over the sides of his elbow and had difficulty gripping and carrying heavy objects. One of his goals was to return to his sports and obstacle course. His pain and swelling was improved significantly in 2 weeks after the use of shockwave therapy. Since his sports require fair amount of gripping, climbing and flexibility, stretching and strengthening exercises were introduced to further enhance the function of the wrist extensor muscles. Sports-specific skills and education to prevent recurrence of elbow pain were provided to help him return to his sports.
Post ACL Reconstruction
Ms J is a young woman who sustained an ACL injury around 3 years ago during her basketball. She was treated surgically with hamstring graft and continued to receive rehabilitation in our clinic to improve her physical function. One of her goals was to return to basketball practice and competition. Shockwave was used to improve her pain and healing of the ligament after surgery. Since basketball requires high level of fitness, neuromuscular control, power and agility, stretching, lower limb strengthening, balance exercises and sports-specific drills were included to help her return to her sports.
Ankle Sprain
Ms A was presented to clinic with Grade II right lateral ankle sprain and was walking with a canadian crutch. She complained of pain, stiffness and reduced mobility after the injury. She was unable to work for a few weeks after the injury as her work as a nurse involves a lot of standing, walking, squatting and lifting. Her main goal would be to return to work as soon as possible without functional limitations. She was treated with shockwave and ultrasound to promote the healing of the sprained ligament. Joint mobilisation was utilized to improve the ankle stiffness and range of motion. Exercises such as knee to wall stretch, calf raises and balance training were provided to further improve her strength and balance to assist her return to work. She is progressing well in the past few weeks and is returning to her work in 2 weeks time.
Cervical Nerve Root Compromise
Mr S was presented to the clinic with right neck and shoulder pain as well as constant numbness over his ring and little finger. He also complained of gradual onset of weakness on the right hand. The clinical presentations were identical to the nerve root compression over the exit of his lower cervical spine. The patient was treated with shockwave therapy, passive physiological joint mobilisation and exercise therapy. Patient reported the effectiveness of shockwave in reducing his pain over his neck and shoulder. Joint mobilisation and sustained rotation home exercise were effective in reducing the compression at his cervical spine, thereby reducing his numbness in his arm. The patient is showing gradual improvement and has greater physical capacity to continue his current work.
