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Case Study: Aaron Dienger

Onset and History:  33 year old male with sudden flare up of bilateral calf tightness and pain which began August 2015. History: right achilles ruptured in Feb 2012 playing basketball. Brastrum technique to tighten up lateral ankle ligaments.

Initial Evaluation (9-15-15) Patient presented with pain, tightness, and trigger points to right more than left lower leg muscles and decreased bilateral hip ROM.

Treatment: The patient received a total of 4 treatment sessions from 9-15-15 to 10-8-15. He reported feeling less muscle tension and improved flexibility in the ankle following the first session. Treatment consisted of a combination of techniques including Dry Needling Technique, Kinesio taping, Therapeutic Exercise, and Education on proper Self Care and Management Strategies.

Discharge: (10-8-15) Patient demonstrated significant improvement with physical therapy including minimal to no limitation with walking, toe raises, and going up and down stairs. He is now able to be physically active without pain or tightness in legs.

Outcome: (11-13-15) Over a month post physical therapy the patient reports he continues to be doing well. He is able to play basketball without pain and his calves remain flexible. He is pleased with treatment results.

Conclusion: Patient met all of his goals, he is even playing basketball without pain after only 4 sessions of physical therapy. His level of success was due to the comprehensive care he received at Burkhardt Physical Therapy Center. If you are having pain or discomfort that is affecting your quality of life don’t wait to seek treatment.

Case Study: Audrey L.

Onset and History:  Mid-January 2015 this 9 year old young lady was at school playing tag and running and she tripped over her feet and fell. Then another kid tripped and landed on her left foot. 2 weeks after the initial injury she was still having pain and limping so her mom mentioned it to her family doctor during a well check.  The doctor referred her to podiatry due to her history of breaking her foot. She was diagnosed with plantar-fasciitis and treated with tape to her foot, ice, and Ibuprofen for several weeks with no change.  Then trial of crutches for 3 weeks with no change. She was now having constant pain even at rest in sitting and lying down. She was referred to Dr. Wintersteen in Pediatric Orthopedics where X-rays were performed that indicated no visible fracture. She was immobilized with a cast, non-weight bearing for 3 weeks progressing to  crutches with a gradual increase in weight bearing. She was then referred to a pediatric physical therapist and after 3 visits she still had no change. Dr. Wintersteen was questioning a diagnosis of reflex sympathetic dystrophy due to inconsistent discoloration, swelling, and sensitivity to touch. Due to improper gait mechanics,  physical therapy wanted to restart crutches but the parents and doctor did not want to move backwards. Therefore she was referred to this clinic for hands on advanced physical therapy strategies.Initial Evaluation at Burkhardt Physical Therapy Center: 6-19-15 Six months after the initial injury she was unable to run, ride bike, or jump. She experienced moderate to severe pain and difficulty with walking and using the stairs.  She was unable to participate in physical education classes at school or gymnastics.  She presented with very painful and altered gait mechanics.   She rated the pain from 2/10 at its best to 6/10 at its worst with some level of pain constantly present. Fascial Counterstrain screening indicated she was positive for neuromuscular dysfunction in the nervous, visceral, dural, and periosteal fascial systems.Treatment: The patient received a total of 12 treatment sessions from 6-19-15 to 8-28-15 including a primary technique of Fascial Counterstrain (a skilled manipulation of the body’s deep fascial receptors with the goal of normalizing associated pain and spinal cord reflexes that maintain spinal cord central sensitization. The observable clinical results include: decreased pain and inflammation, improved flexibility, improved proprioception, normalization of muscle tone and improved functional performance.); Kinesio taping (designed to gently create forces on the surface of the skin which elevate the tissue, relieving the pressures beneath the skin surface, thereby promoting increased circulation to the tissues and structures beneath the area taped); and Therapeutic Exercise to improve flexibility, balance, stability, & strength of the ankle, knee, hip, and core.

Discharge: 8-28-15 At the time of discharge this 9 year old was able to walk normal, jog, run, go up and down the stairs, and play without pain. She was able to stand on her left leg without pain or losing her balance.  She was instructed to continue her home exercise program to progress strength and stability of her ankles, knees, hips, and core to prevent future injury.

Patient Testimony: 8-31-15
Before Physical Therapy I couldn’t: 1. Walk properly 2. Put all of my weight on my left foot 3. Run 4. Stand on tip-toes.
Now I can: 1. Walk normal 2. Put all of my weight on my left foot 3. Run 4. Stand on tip-toes 5. Jump

Conclusion: Although this patient received prior pediatric physical therapy, podiatry, and pediatric orthopedic consultation without change it was evident that something was still wrong as she was reporting pain all of the time and was unable to walk correctly or enjoy the normal play of a 9 year old.  Due to comprehensive evaluation and treatment using Fascial Counterstrain (even though it was 6 months post injury), she was able to fully recover. The effects of Fascial Counterstrain result in decreased pain, improved strength, improved range of motion, and decreased parasthesis and weakness due to the release of fascial tension which compress associated neural tissues.  The treatment is gentle and very effective.  It treats the whole body and identifies restrictions throughout all your systems that affect pain, immobility, and muscle strength.  It is quite amazing.   If you have unexplained symptoms of pain and weakness please don’t hesitate to call us at Burkhardt Physical Therapy Center with questions.


Onset and History
59 year old female with left lower back, hip, and buttock pain that came on with unknown reason or injury. All movement exacerbated symptoms. With first onset of symptoms she tried chiropractic care for one month with minimal relief. Patient started physical therapy about one month after onset of pain and disability. Prior to this incident of back pain patient was typically very active walking 3 miles, biking 4 miles, and doing Zumba class 3 times per week.

Initial Evaluation (4-15-15)
Patient presented with pain, tightness, and limited movement throughout her lower back and hips. She demonstrated with signs and symptoms consistent with neuromuscular, mechanical, and myofascial dysfunction.  Patient rated her pain as an 8/10 on the first visit. Pain was so severe she could not sit, stand, or lie down for more than a few minutes in any position. “The car ride from La Crosse to West Salem was almost unbearable.”

Treatment
The patient received a total of 5 treatment sessions from 4-15-15 to 4-28-15. She reported feeling significantly better even after the first session. Treatment consisted of a combination of techniques including Muscle Energy Technique (to improve muscle balance and joint movement), Fascial Counterstrain, Kinesio taping, Therapeutic Exercise, Intramuscular Trigger Point Release, and Education on proper Self-Care and Self-Management Strategies.

Outcome: (
7-30-15) 3 months following the patient’s last visit she reported she continues to be doing much better. She is able to attend Yoga classes.  Pain is occasional and is 2/10 at its worst.

Conclusion
Because this patient was able to receive comprehensive treatment including Muscle Energy Technique within a month after onset of symptoms she was able to decrease her pain significantly, improve function, and return to Yoga classes. If you are having pain or discomfort that is affecting your quality of life don’t wait to seek treatment. And if you have tried other methods of treatment with minimal results or temporary relief it is best to give yourself another option- including Burkhardt Physical Therapy Center. Call us with any questions or concerns you may have. 608-786-4989

Case Study:
11 year old female

Diagnosis:
Bilateral leg pain and weakness

Onset and History
January 2015. Right foot pain that started while playing basketball. She went to the doctor a few days later. Feet and ankle X-rays- Normal. It was thought to be overuse of muscles and she was recommended to keep using legs. In about 2 weeks she was walking with a limp. Then she tried volley ball practice that included bumping and squatting motions which flared her up. The pain was so intense she started to use a walker, then a wheel chair. She was in the hospital due to pain and disability. She had several tests including an MRI- which were inconclusive.

Initial Evaluation at Burkhardt Physical Therapy Center: 3-12-15
She was unable to stand independently or fully weight bear on her legs and her legs were tight and painful to the touch. She used a wheel chair and walker for mobility. She rated the pain from 7/10 to 10/10. Fascial Counterstrain screening indicated she was positive for neuromuscular dysfunction in the nervous, visceral, venous-lymphatic, arterial, dural, and periosteal fascial systems.

Treatment
 The patient received a total of 9 treatment sessions from 3-12-15 to 6-23-15 including a primary technique of Fascial Counterstrain (a skilled manipulation of the body’s deep fascial receptors with the goal of normalizing associated pain and spinal cord reflexes that maintain spinal cord central sensitization). The observable clinical results include: decreased pain and inflammation, improved flexibility, improved proprioception, normalization of muscle tone and improved functional performance.; Kinesio taping ( designed to gently create forces on the surface of the skin which elevate the tissue, relieving the pressures beneath the skin surface, thereby promoting increased circulation to the tissues and structures beneath the area taped); and Therapeutic Exercise to improve flexibility, balance, and strength.

Discharge: 6-23-15
At the time of discharge the patient no longer had limitations with walking and moving. She no longer needed a walker or wheelchair. She was able to run and play and her pain was significantly reduced. At discharge she reported 2/10 pain occasionally with sprinting and no pain 90% of the time.

Conclusion
Although this patient received prior physical therapy, had undergone an MRI and several tests without conclusive results it was evident that something was wrong. Because this 11 year old was able to receive comprehensive treatment including Fascial Counterstrain in a reasonable amount of time following symptom onset, she was able to fully recover. The effects of Fascial Counterstrain result in decreased pain, improved strength, improved range of motion, and decreased parasthesis and weakness due to the release of fascial tension which compress associated neural tissues. If you have unexplained symptoms of pain and weakness please don’t hesitate to call us at Burkhardt Physical Therapy Center with questions.

Onset and History
This 72 year old female had neck and low back pain “for years”, since she was 10 y.o. April of 2013 arms and back began hurting and motion was limited. Pain started with worsening shoulder pain and restriction, and then worsening hip pain and restriction.
Previous treatment: Prior physical therapy at another clinic-Dec to January 2014, chiropractic care about once per month, massage therapy over 2 years ago, medications, and exercise instruction

Symptoms
Bilateral neck,shoulder, arm, and hip/groin pain. Symptoms were on and off and varied from day to day with intermittent numbness and tingling in bilateral hands. Pain was rated at 0/10 at its best and 7/10 at its worst.
Initial Function: Symptoms interfered or affected  to a significant degree  with work, sleep, daily routine, recreational and social activities. Reports with significant pain and difficulty with  any amount of walking, sitting, standing, outdoor work, vacuuming, housework, shopping, bending, lying down, reaching, lifting, carrying, overhead activities, dressing, driving, computer work, and reading.
Occupational History: retired, from police department- administrative.

Initial Evaluation at Burkhardt Physical Therapy Center
8-19-14 She demonstrated with slight forward head and shoulders, scapular protraction, thoracic spine kyphosis, flexed lumbar spine, and bilateral knee hyper- extension; positive bilateral median and radial nerve upper limb neural tension test; severe tenderness and tightness to upper and lower quadrant muscles; hypomobility of the cervical,thoracic, and lumbar spine; hypermobility of the sacral spine; decreased bilateral cervical, shoulder,hip, and hamstring range of motion; dizziness with cervical extension or going to lie down; Fascial Counterstrain Screening indicates dysfunction present in the fascia of the viscera, nervous, dura, lymphatic, and arterial systems.

First treatment: 8-19-14 
Fascial Counterstrain (FCS) was performed to the dura. Patient was instructed to diaphragmatic breathing and proper posture and alignment. She reported neck pain and dizziness were was not bothering her anymore after first visit

Subsequent treatments
The following treatment sessions focused on decreasing neuromuscular, myofascial, and mechanical dysfunction by using Fascial Counterstrain to the dura, lymphatic, nervous, and visceral system; deep and superficial myofascial release to the neck, shoulders, back, chest wall, and rib cage; joint mobilizations to the spine, glenohumeral joint, scapula, and right hip; intramuscular trigger point release/dry needling technique to the neck, shoulders, and arms; cervical traction; therapeutic exercise including diaphragmatic breathing, upper body stretching, and scapular re-training; Muscle Energy Technique to the pelvis, sacrum, and lumbar spine; Kinesio taping to the bilateral neck and shoulders; patient education/self care management including postural re-training, self occipital release,  thoracic  and lumbar mobilization, decompression of TMJ, and nerve glides to the bilateral median, radial, and ulnar nerves, and proper sleeping positions .

Discharge: 12-31-14
The patient made significant improvements with physical therapy. She reported with a rating of 0/10 at its best and 1/10 at its worst on a consistent basis! The pain decreased in intensity, frequency, and duration. She was no longer limited with walking and moving in her environment. Symptoms only interfered or affected daily activities occasionally and minimally and no longer interfered with sitting, standing, outdoor work, vacuuming, housework, shopping, bending, or lying down. Patient demonstrated improved shoulder range of motion to put hands behind low back and improved neck and hip range of motion.

Patient testimonial
On 8-29-14 the patient reported that prior to beginning physical therapy and depending on the day she had 7-8/10 pain. “It was hard to go for a walk, do normal household chores without pain or discomfort”.  After 4 visits she reports, “Pain level is down to a 1-2 and muscles are more relaxed and it is easier to do normal things”. On 9-25-14 the patient reported, after two intramuscular trigger point release treatments, “I feel better than I have in a year and a half! These treatments have released the knots in my shoulders and neck.”

Conclusion
This case study demonstrates the effectiveness of utilizing a combination of techniques including Fascial Counterstrain, Kinesio taping, Therapeutic Exercise, Myofascial Release, Intramuscular Trigger Point Release, and Patient Education/Self-management to relieve pain and dysfunction. This patient not only had significantly reduced pain (1/10 pain rating at the worst) but improved sleep and daily functioning. This patient responded very well to a team approach including two Physical Therapists and a Physical Therapist Assistant at Burkhardt Physical Therapy Center, LLC.

Onset and History
The symptoms gradually came on in the beginning of August 2014. She is in a flexed position for prolonged periods of time at work.

Previous treatment
chiropractic care and massage therapy without lasting relief

Symptoms
This 28 year old female complained of left lower back pain which was constant and aching. It became sharp with certain movements.  Pain was rated a 4/10 at its best and a 7/10 at its worst.

Initial Function
Prior to coming to Burkhardt Physical Therapy Center, LLC the patient’s sleep quality was poor. She woke up 7-8 times per night due to pain. She experienced moderate pain and difficulty with normal daily activities including moving from sit to and from stand, getting in and out of car, walking, standing still, making meals, housekeeping, and laundry.

Occupation
Full time Dental Assistant

Initial Evaluation at Burkhardt Physical Therapy Center: 9-29-14
She demonstrated increased pain with lumbar flexion and extension. Trunk side bending and rotation to the left was also bothersome. She demonstrated with forward head and shoulders, increased lumbar lordosis, bilateral knee hyper-extension, thoracic spine severe hypo mobility, sacral spine hypo mobility, pubic bone misalignment, and lumbar spine mechanical dysfunction. She demonstrated with severe tightness and tenderness to the occipitals, cervical spinalis, thoracic paraspinals, upper trapezius, levator scapula, rhomboids, intercostal muscles, diaphragm, lumbar paraspinals, quadratus lumborum, iliopsoas, sacral sulci, gluteus maximus, medius, minimus, piriformis, and TFL. Strain Counter-strain screening demonstrated neuromuscular dysfunction present in the fascia of the visceral system, nervous, anterior and posterior lumbar spine, pelvis, hips, and thoracic spine.

First treatment: 9-29-14
Strain Counter-strain was performed to the nervous system including the vagus nerve 1-3; the visceral system including the ureter, inferior kidney, superior kidney, duodenum, sigmoid colon, and cecum; and the anterior lumbar spine; Kinesio taping was applied to the left gluteus medius and the lower back; Muscle Energy Technique was performed to improve alignment of pelvis, sacrum, and lumbar spine; Joint Mobilizations were performed the lower thoracic, lumbar, and sacral spine; and Therapeutic Exercise instruction for improved spinal alignment. Following the first treatment the patient reports decreased pain and symptoms for 5 days!

Subsequent treatments:
The following treatment sessions consisted of decreasing remaining dysfunction through Strain Counter-strain of the anterior lumbar spine; Myofascial Release to the neck, shoulders, back, gluteus maximus, piriformis, gluteus medius, and quadratus lumborum using neuromuscular principles; Intramuscular Trigger Point Release to the bilateral upper trapezius, piriformis, tensor fascia latae, gluteus medius, L5 paraspinals, quadriceps, external obliques; Kinesio taping to the bilateral upper trapezius, levator scapulae, interscapular border, and across low back/SI; Therapeutic Exercise including inner core re-training, scapular mobility exercises, and scapular re-training into retraction and depression to promote improved posture; Patient Education/Self Care Management included instruction to proper sleeping positions, pain relieving strategies, proper bending and lifting mechanics and instruction to patient and patient’s spouse on application of self Kinesio taping.

Discharge: 10-22-14
The patient was discharged after 6 visits with significantly decreased pain rating a 0/10 at its best and 2/10 at its worst! The pain has decreased in intensity, frequency, and duration. She now has minimal to no pain  with work, sleep, daily routine, recreational and social activities, moving from sit to and from stand, getting in and out of car, walking, standing still, making meals, housekeeping, and laundry. Sleep quality has improved significantly.

Conclusion
This case study demonstrates the effectiveness of listening to the patient and thereby utilizing a combination of techniques including Strain Counter-strain, Kinesio taping, Therapeutic Exercise, Myofascial Release, Intramuscular Trigger Point Release, and Patient Education/Self-management to relieve pain and dysfunction. This patient not only had reduced pain significantly (down to NO pain at times) but improved sleep and well-being. This patient responded very well to a team approach including a Physical Therapist and a Physical Therapist Assistant at Burkhardt Physical Therapy Center, LLC.

Onset and History
Symptoms began 7-8 years ago for this 71 year old male. He went through several tests at local medical center without significant results or findings to determine a treatable diagnosis.  He was referred to the dentist for possible Botox. The dentist recommended intramuscular trigger point release instead of Botox
.
Previous Treatment
teeth pulled, Xrays, Nose surgery – pulp removed, double sinus surgery.
Symptoms: Prior to coming to Burkhardt Physical Therapy Center, LLC the patient had constant pain in the left side of face, jaw, eye area, forehead, cheek bone and into nose and sinuses. Symptoms were eased temporarily by nasal saline washes  but only a small change. He rated his best pain at a 7/10 and a worst pain at a 10/10 on the pain scale.

Initial Function
Symptoms affected his sleep, daily routine, recreational and social activities. All activities were difficult to perform including eating and drinking. Occupation: semi-retired – painter (buildings)

Initial Evaluation at Burkhardt Physical Therapy Center
3-21-14 He demonstrated with forward head and shoulders, reduced cervical lordosis, scapular protraction; severe tightness and tenderness in the neck, shoulders, and face; and hypomobility in the cervical and thoracic spine. Strain Counterstrain screening indicated neuromuscular dysfunction of the fascial structures of the visceral,  venous-lymphatic, arterial,  neural, dural, cranial, and musculoskeletal systems. He demonstrated with 58% impairment on the Neck index.

First Treatment
3-21-14 Fascial Counterstrain to the lymphatic, visceral, and nervous system including the bilateral thoracic/lymphatic duct, internal jugular vein, medial transverse cervical lymphatics, external jugular vein, Sibson’s fascia, tentorium cerebelli, trigeminal nerve I, II, II,temporal nerve, and facial nerve. Kinesio taping was applied to the left TMJ/masseters, over left nose and zygoma. Myofascial, diaphragm, and thoracic releases were performed. Patient  and patient’s wife were instructed on how to apply Kinesio tape to the face for pain relief; was educated and issued information about Strain Counterstrain, Intramuscular Trigger Point Release, and Neck Saver Tips.

Subsequent Treatments
The following treatment sessions focused on decreasing remaining dysfunction through Fascial Strain Counterstrain of the dura, nervous, and lymphatic systems; Kinesio taping to the affected left side of the face; Therapeutic Exercise including inner core re-training, cervical mobility,  and posture re-training; Instruction on proper bed mobility to decrease strain on the neck and face muscles; and Intramuscular trigger point release to the affected face, head, and neck muscles.

Discharge
6-18-14 The patient was seen 15 times from 3-21-14 to 6-18-14. During this time the patient experienced a significant improvement in function. His sleep improved 80%. Daily routine improved 80-90%. He now has minimal difficulty with eating and is able to eat popcorn, nuts, and cheese with ease 80% of the time. His worst pain is now a 2/10 and his best pain is a 0/10! He demonstrates with 26% impairment on the neck index which is a significant improvement.

Patient Testimonial
8-10-14 About a year ago, I went to my regular dentist in La Crosse for my annual checkup. We were discussing my awful pain I always had in my face near my left nostril. I had double sinusitis surgery about five years ago. It stopped the pain for a while and then it returned. I was told it was Trigeminal Neuralgia. Since I refused surgery because of the medications I was on, my dentist told me to check with Chris Welch in West Salem at Waterloo Heights about Botox. We then went to a meeting with Mr. Welch. He told us about Burkhardt Therapy. He thought we should try this. So I went to Burkhardt Therapy and had 15 treatments of Strain Counterstrain and Dry Needling. It helped me so much as to relieving the pain and allowing me to sleep better and eat better. As it bothered me when chewing food too. I highly recommend Burkhardt Therapy to all who are having chronic pain, headaches, fibromyalgia, jaw pain, past surgical back pain, joint pain, vertigo, dizziness, sport injuries, etc. The people at Burkhardt Physical Therapy are very caring and they treat each person very good.  Thanks to all of you who helped me to relieve my pain. If I need to return, I surely will and will spread the word about how it helped me.   May God bless you all.
Sincerely, Lyle Helke- Stoddard, WI
Conclusion
This case study demonstrates the effectiveness of listening to the patient and thereby utilizing a combination of techniques including Strain Counterstrain, Kinesio taping, Therapeutic Exercise, Myofascial Release, Intramuscular Trigger Point Release, and Patient Education/Self-management to relieve pain and dysfunction. This patient not only reduced his pain significantly (down to NO pain at times) but improved his overall function 80-90%! This patient responded very well to a team approach including a physical therapist and a physical therapist assistant at Burkhardt Physical Therapy Center, LLC.

Diagnosis
Neck and upper back pain with frequent headaches

History
Date of Onset: 6/25/2013. This 30 year female was injured on the job as a CNA 10 months prior to coming to Burkhardt Physical Therapy Center, LLC for treatment. She received several other treatments including prior physical therapy consisting of exercise instruction, dry needling, and mobilizations, relaxation strategies, cortisone injections and biofeedback, all of which helped temporarily.

Symptoms
Prior to coming to Burkhardt Physical Therapy Center, LLC, the patient experienced daily headaches of 5/10 pain or greater with medication three times per day. She also experienced occasional numbness into 5th finger on the left. These symptoms were aggravated by sitting or standing prolonged, bending, computer work, sleeping, and upper extremity exercises. The symptoms were eased temporarily by previous physical therapy, repositioning, relaxation exercises, stretching techniques, rest, and slightly by ice and heat. Pain scale: best in the past week 5/10, worst in the past week 9/10.

Function
Patient reported that her symptoms affected her ability to walk around and play with her kids, perform her job tasks, sleep for more than 3-4 hours at a time, and participate in normal daily, social and recreational activities. Daily tasks such as walking, outdoor work, house work, shopping, bending, lying down, reaching, lifting, carrying, overhead activities, dressing and driving were all painful or difficult for her. Her main functional concern was that she was unable to pick up her 3 year old daughter without significant aggravation of symptoms. Prior to her injury, she was pain free and independent with all activities of daily living and recreation. Occupation: works as a CNA, full time, light duty. Transitioning to department secretary.
Evaluation: 4-9-14 (10 months post injury) Patient presented with decreased neck, back, shoulder and lower extremity range of motion, hypo-mobility of the cervical, thoracic and lumbar spine, hypermobility of the pelvis and sacrum and severe tight and tender upper and lower quadrant muscles. Palpation demonstrated dysfunction of the visceral, venous-lymphatic, arterial, neural, dural, cranial, musculoskeletal systems.

First Treatment
(4-9-14) Treatment consisted of strain counterstrain to the upper trapezius and sternocleidomastoid muscles bilaterally, cervical mobilizations, postural reinforcement, passive cervical range of motion and patient education on strain counterstrain, plan of care, and instructions post treatment including walking and drinking plenty of water following treatment. The patient demonstrated a positive response to strain counterstain techniques immediately following the first treatment session as shown by increased cervical rotation range of motion bilaterally. She was pleased with the relief she felt following the first session; however, the pain returned to 5/10 prior to the next session.

Subsequent Treatments
The patient was seen 2-3 times per week for 9 weeks then decreased to once per week for the rest of physical therapy. Remaining treatments included muscular and fascial strain counterstrain techniques to the extremities, spine, visceral, neural, dural, cranial, venous-lymphatic, arterial and musculoskeletal systems. Other treatment techniques included Kinesio taping to bilateral thoracic and lumbar paraspinals, cervical spinalis, upper trapezius and levator scapulae; Mobilizations to the cervical, thoracic and lumbar spine;  Upper Extremity Nerve Glides; Dry Needling Technique; Myofascial Release to the back, neck and shoulders; and  Home Exercise Instruction. The patient’s home exercise program consisted of postural retraining, upper extremity glides for the median and ulnar nerves, prone on elbows mobilization and sustained traction, Pilates exercises for core stability and overall mobility, and spinal self-mobilizations. With these treatments, the patient showed slow but continuous improvements in pain and function with significantly decreased headaches. On visit number 7, dry needling technique was performed at one point in the upper trapezius. Following this treatment, the patient reported that she no longer needed to take ibuprofen for pain and headaches. Therapists then continued treating with all techniques listed including dry needling technique to the back, neck and shoulders. With continued treatment using a combination of all of the above techniques, patient reported significant improvement in headaches, sleep, daily activities and mobility.

Discharge status
Upon discharge patient reported that she no longer experienced tension headaches. She occasionally experienced migraines, but they were no longer triggered by neck pain and tension. Her symptoms no longer affected her work, sleep, daily routine, recreational and social activities. She was able to perform all upper body activities and movements with minimal to no aggravation of symptoms. She was now able to pick up her 3 year old daughter and hold her for a prolonged period without aggravation of symptoms. She was also able to begin light weight lifting exercises without flare-ups. When her symptoms did come on, she was able to manage her symptoms independently with the positions and exercises given to her in physical therapy.

Patient Testimonial
At the time of discharge, the patient reported how her symptoms have changed since beginning physical therapy at Burkhardt Physical Therapy Center, LLC. Prior to therapy she stated, “I was dealing with pain of 6/10 on a daily basis before coming to Burkhardt PT including pain tightness, tension, horrible headaches and some mobility problems. These symptoms were drastically affecting my daily life at night while trying to sleep, throughout the day while working and also dramatically affecting being around my children. I was unable to pick my 3 year old daughter up without experiencing a substantial amount of pain.”

Upon discharge she said, “I have learned skills to control any flare-ups I may experience. The headaches have stopped and only come seldom now. My symptoms have improved on an enormous scale and I can finally sleep at night and not deal with pain and headaches on a daily basis. The strain counter strain technique, dry needling and other techniques that Burkhardt PT are known for that are not seen in mainstream PT have been that push I needed for my body to get better and heal.”

Implications and Conclusions
This case demonstrates the effectiveness of utilizing a combination of Jones Strain Counterstrain, Myofascial Release, Mobilizations, Exercise Instruction and Dry Needling Technique to relieve neck, back and shoulder muscle tension and headaches. The patient not only reported almost complete resolution of chronic symptoms and improved functional tolerance, she also gained independence in self-management of any occasional symptoms that arise. This patient responded very well to a team approach including two physical therapists, a physical therapist assistant and a physical therapist intern at Burkhardt Physical Therapy Center, LLC.

Diagnosis: Restless leg syndrome

Onset and History: Symptoms began when he was a young boy and worsened over the years. About 15-20 years ago, symptoms worsened to the point of being very frequent – every night. He rarely had a night that did not affect him.

Previous treatment
Medications (started 14 years ago), chiropractic adjustments ( mild relief of tightness)

Symptoms
Prior to coming to Burkhardt Physical Therapy Center, LLC the patient could not sit still due to restless leg symptoms. He had bilateral legpain and sometimes a queasy feeling like bugs crawling in the skin. Sometimes symptoms were in his arms as well.

Initial Function
Symptoms interfered and affected his sleep to a severe degree. His daily routine (walking, bending, lying down), recreational, and social activities were affected to a moderate degree. Sitting prolonged was painful and difficult to perform to a severe degree. He had great difficulty tolerating driving long distances. Standing was painful to his knee.

6-11-14- Initial Evaluation at Burkhardt Physical Therapy Center: (15-20 years after symptoms became frequent) He demonstrated with tightness and tenderness to a moderate degree throughout the muscles in the neck, shoulders, low back, hips, and legs. He demonstrated with hypo-mobility throughout his entire spine; and palpation demonstrated neuromuscular dysfunction present in the nervous, parasympathetic, visceral, dural, and venous-lymphatic fascial systems.

6-11-14 -First treatment: Fascial Strain Counterstrain was performed to the parasympathetic nervous system, right lower thoracic spine, bilateral lower legs, and hamstrings. Joint mobilizations were performed to the cervical, thoracic, and lumbar spine.
*After the first treatment the patient reported the restless leg attacks have been less severe and it has taken longer for symptoms to come on while driving and sitting watching TV.

Subsequent treatments
The next sessions focused on decreasing  remaining dysfunction through Strain Counterstrain(SCS) of the lower extremities, viscera, dura, nervous, and lymphatic systems; Myofascial Release Techniques to the neck, shoulders, back, abdomen and lower extremities; Joint Mobilizations to the cervical, thoracic and lumbar spine including gentle traction/decompression at L5-S1; Periosteal SCS techniques to the bilateral lower extremities; Kinesio taping to the bilateral heel cord; Therapeutic Exercise including  self spinal mobilization, inner core re-training, gentle stretching for spinal elongation, and Strain Counter Strain positioning for self-management of symptoms. After four treatments the patient reported that he went two days without symptoms, and was very pleased with that. After 6 treatments he went three days without symptoms and could tolerate going for a long walk. After 7 treatments he reported he is doing great and has not had one restless leg symptom episode in four days!! He was even able to go for a long drive and watch a movie without symptoms which would usually aggravate him. After 10 visits the patient reports feeling 50% better. Able to sit through an entire movie without aggravation of symptoms. Sleep has greatly improved as he is not tossing and turning due to restless leg symptoms.
7-7-14:  “I had a restless leg episode on 6-30-14, but since then I haven’t had any even during a long road trip to Pepin, WI and back. That is the longest I’ve gone without a restless leg syndrome episode in more than a year (and probably much longer)”. He went seven days without any symptoms!!

Conclusion
8-15-14: Patient is doing well. He continues to have restless leg symptoms but much less often and to a significantly lesser degree. He continues to tolerate riding in a vehicle for long periods ( up to five hours) and watching movies with little to no symptoms. His quality of life and function have improved! This case study shows that even if you have experienced pain for the last 20 years there may be help for you! Restless leg syndrome and many other syndromes such as headaches, back pain, neck pain, etc. can be helped using Strain Counterstrain and other techniques at  Burkhardt Physical Therapy Center. The combination of Fascial Strain Counterstrain, Therapeutic Exercise, Joint Mobilization, Myofascial Release, and Patient Education all played a role in helping this patient become well. This patient responded very well to a team approach including a physical therapist, a physical therapist assistant and a physical therapist intern at Burkhardt Physical Therapy Center, LLC. Call today if you are still suffering with pain and don’t know what to do! WE CAN HELP!

Diagnosis: Neck and Upper Back Pain

History: Date of Onset: 9/20/2013.She was in a Motor Vehicle Accident and was T- boned by a school bus.

Previous Treatment included chiropractic treatment,  trigger point injections, massage therapy, medications, and  PT (outside of Burkhardt Physical Therapy Center) for 3 months including exercise instruction and strengthening with no relief of symptoms.

Initial Evaluation at Burkhardt Physical Therapy Center : 3/6/2014 ( 6 months after injury)

Initial Symptoms: This 17 year old female complains of pain in the right upper trapezius muscle and neck starting at the occiput to shoulder blade area.  Pain Scale: Worst in the last week=7/10. Symptoms aggravated with sitting prolonged, looking down, lying flat and trying to sleep.

Initial Function: Her symptoms interfered and affected her work, sleep, daily routine, recreational activities, social activities, sitting, outdoor work, vacuuming,  housework, bending her neck to look down, lying down, reaching, lifting, carrying, overhead activities, dressing, and driving.

Initial Findings. She demonstrated with hypo mobility in the cervical and thoracic spine, FRS (flexion, rotation, and side bent) mechanical dysfunction per muscle energy technique of the cervical and thoracic spine, and palpation demonstrated dysfunction present in the visceral, venous-lymphatic, arterial, neural, dural, cranial, and musculoskeletal fascial systems.

First treatment: Fascial Counterstrain was performed to the right lymphatic system and Kinesio taping was applied to the bilateral neck and upper shoulders. She experienced decreased pain and slept better following the first treatment.

Subsequent treatments: (approximately 1 time per week for 11 weeks and then decreased to 1 time per month for two months.)The next treatment sessions focused on relieving the remaining pain and dysfunction in her body through Strain Counterstrain of the nervous system, lymphatic system, and spine; Craniosacral techniques to the head and spine; Deep Myofascial Release to the neck and shoulders; Kinesio taping to the neck and shoulders;  Therapeutic Exercise to improve core stability, thoracic and cervical mobility, and  posture; Joint Mobilizations to the cervical, thoracic, lumbar spine, and sacrum; Dry Needling  Technique to the bilateral neck and shoulders; and Patient Education on home Kinesio taping, rest, proper progression of therapeutic exercise and stretching.

Patient testimonial

On 3-27-14 the patient reported that prior to beginning physical therapy at Burkhardt Physical Therapy Center, “I had a lot of upper trap and neck pain varying from a 5/10 to 8/10 every day. It also was very hard to sleep. I had headaches almost every day. I tried every kind of other treatment possible and nothing ever changed for longer than a day pain-wise.” The patient went on to say that now (after 6 visits), “I have lowered my pain to a 2/10 at its highest and I only have pain in my neck, on the right side, if there is any. I do not have pain everyday like I did prior to coming to Burkhardt Physical Therapy Center. I get a headache occasionally but it is not as bad. Also, I can sleep a lot better. I get complete relief of pain up to 4-4 1/2 days, and it keeps progressing to longer periods of time with more treatment.”

By the 7th visit on 3/31/14 the patient reported feeling 90% better since beginning physical therapy (not even one month prior) here at Burkhardt Physical Therapy Center! For the next 4 weeks the patient continued to come in for treatment 1 time per week. She continued to be 90% better throughout with only occasional pain. By 4/28/14 the patient was seen as needed 1 time per month until 6/18/14 for follow up care. She continued to have additional progress with each visit and is now able to control symptoms independently. If she does experience pain she takes care of it right away so that is does not interfere with her daily life.  Currently, she is an active 17 year old again with excitement and big plans for the future.

This case study emphasizes the importance of getting treatment as early as possible. The earlier you get treatment the more effective it is. It also emphasizes the profound effect of Fascial  Strain Counterstrain. The patient had significantly decreased pain after the first visit and was 90% better in less than one month of treatment despite the chronic nature and failed prior medical interventions. The combination of Fascial Strain Counterstrain, Dry Needling Technique, Therapeutic Exercise, Soft Tissue Mobilization, Kinesio taping, Myofascial Release, and Patient Education all played a role in helping Alyssa become well.

Case study: 32 year old female

Diagnosis: recurrent neck pain; occipital Neuralgia

History: Date of onset: September 2012. This 32 year old active female was injured while participating in an athletic competition. While climbing a 10 foot wall she lost her grip and fell backward onto her head and back. She had signs of a concussion and went to the ER. She was instructed to take time off from work, but was unable. Previous treatment included physical therapy (outside of Burkhardt Physical Therapy Center, LLC) for 4 months. She did get better, but symptoms never resolved. She also had physical therapy for BPPV (inner ear vertigo). She was restricted from activity until April 2013. When she started doing more activity her symptoms worsened. She was unable to manage aggravation and worsening of symptoms independently, until a friend referred her to Burkhardt Physical Therapy Center for Strain Counterstrain and Craniosacral Therapy.

Symptoms: The patient’s symptoms included daily headaches; lower back pain; jaw tightness, clicking, and snapping. She also had right shoulder, shoulder blade , mid back tightness and pain that traveled up to her right occiput, forehead and eye. Other symptoms included exhaustion, poor memory, and poor balance.

Function:  She had ear and jaw pain with opening mouth and eating. She was unable to open her mouth to a normal range. She also had poor balance and increased overall symptoms when arising from a bent over position like picking something up from the floor.  She was unable to tolerate exercise or running. She was very exhausted from her normal routine and work activities. Prior to her injury she was very active without restrictions- running, etc. Occupation: teacher

Evaluation: 11/8/2013 (14 months after her injury) She demonstrated with forward head on neck posture and excessive lordosis. Her cervical ROM was significantly limited. Palpation demonstrated dysfunction present in the left anterior/posterior visceral, left upper posterior arterial, and left venous lymphatic, dural, and cranial fascial systems

First treatment: Fascial Counterstrain of the dural system including dural tube release, intraoral massage with instruction to do at home, and Trigger Point Dry Needling Technique to the bilateral masseters. She experienced overall decreased tension and complete relief of her jaw tightening or locking up for one complete week. One week later the tightness began to return but it was not nearly as bad as it was at the initial evaluation. Her ear pain and clicking were completely resolved following the first treatment.

Subsequent treatments: Focused on relieving the remaining dysfunction through Jones Strain Counterstrain of the dural system, venous/lymphatics system, and visceral system; Trigger Point Dry Needling Technique to the neck and jaw muscles; scapular stabilization, inner and outer core stabilization, and thoracic mobility exercises; Myofascial Release Techniques to the neck, shoulders, back, posterior pelvis, anterior chest wall and rib intercostals; Kinesio taping to the neck and upper shoulders; Patient education/ instruction to proper opening of mouth to avoid protraction of jaw,  proper training for return to running, engaging core control with functional activities, balancing work and functional activities, listening to her body, and proper rest for muscle and total body recovery. Therapist also educated patient regarding parasympathetic and sympathetic nervous system and foods and activities that affect the nervous system and pain.

Patient testimonial:

After 6 visits the patient reported, “Headaches gone. Exhaustion diminishing, range of motion in neck increasing, body aches going away”.

After 12 visits the patient reported that she is doing well and is able to be active again with running consistently and using her abdominal muscles engaged with running. She is pleased with her results in physical therapy and feels ready for discharge.

Satisfaction survey- patient comments-
This patient was very pleased with her care and reported excellent healthcare. When we asked her what else we could do to better serve her she stated, “Nothing. Excellent healthcare. Thank you”. We asked her what we are doing well and she stated, “Warm, Safe, Friendly, Honest, Caring environment that puts their patients healing first”.

This case study emphasizes that fascial Jones Strain Counterstrain is very beneficial in relieving both musculoskeletal and non-musculoskeletal pain syndromes. The patient not only benefited from decreased pain but also reported less exhaustion after 6 visits. The combination of fascial strain counterstrain, dry needling, therapeutic exercise, soft tissue mobilization, Kinesio taping, myofascial release, and patient education all played a role in helping the patient become well.  Patient responded best to the team approach at Burkhardt Physical Therapy Center, LLC being seen by the physical therapist for evaluation, Trigger Point Dry Needling, and re-evaluation. All other treatment to include Jones Strain Counterstrain, exercise instruction, myofascial release, and education was performed by the physical therapist assistant.