This week I will tell you about the rapid recovery of an ipsilateral shift. An ipsilateral shift was described by Robin McKenzie of the McKenzie Method®, and the treatment of this patient of the week follows Mechanical Diagnosis and Therapy® principles exactly as I was taught them. The patient presents with a lateral shift deformity of the trunk shifted away from the side of dominant pain.
Gerry, (not his real name), arrived with his wife to clinic after suffering 10/10 pain in his back, buttock, and thigh, and had a severe ipsilateral shift. This had been present for 2 weeks, and Gerry stated it had recently worsened after a massage session. Gerry could not recall any incident that caused injury or otherwise caused the onset of pain. He stated he had tried standard chiropractic treatment with no effect.
While I was taking Gerry’s history, his wife reported that he had to crawl to get around their home for the first hour after getting out of bed. Even at his best, he could barely make it down the hall to my office. He was completely unable to dress himself, drive or go to work.
The shift made the mechanical diagnosis easy. It was most likely a mechanical derangement. Any attempt Garry made to bend forward or backward resulted in severe pain, and nearly no range of motion. Trying to correct the shift himself, even when leaning against the wall for support, also resulted in severe pain and no gain in range of motion.
Therefore, manual forces had to be applied by the MDT therapist – in this case – me! (I have achieved certification in Mechanical Diagnosis and Therapy® by the McKenzie® Institute, designated by “Cert. MDT”).
Manual shift correction is described in various published works by Robin Anthony McKenzie, the originator of the McKenzie® Method of Mechanical Diagnosis and Therapy®. It involves full body pressure against the hips and opposite side of the trunk provided by the therapist. It can be painful to experience, however, only pain that centralizes is permitted, according to McKenzie®. As I learned in my McKenzie® training from expert therapist Colin Davies, the duration of force application can last a long time – up to 45 minutes. Gerry’s shift was challenging. I applied force for 45 minutes, but still there was only minimal correction of his shift!
By day two, Gerry could walk better, but was still shifted. This time, manual force corrected the shift in 15 minutes. The next day Gerry could correct his own shift and he was not taking any pain medication anymore!
Now, one week later, he is no longer shifted at all. He can dress himself, including his socks and shoes, drive, and go to work. Regarding walking, he only needed to swing his Right arm normally again – he had been supporting his back with it and lost normal gait in the interim. He reported pain levels of 1-2/10.
Treating Gerry was very satisfying. His mechanical diagnosis was clear, treatment was difficult, but not confusing. I credit the McKenzie® Method of Mechanical Diagnosis and Therapy® with giving me the expertise to be so successful in treating this, and other painful spine and joint conditions. Thank you for your interest in the clinical case study of the week!
Nick Rinard Physical Therapy is back from the long Memorial Day weekend– getting patients results.
If you are in pain- let us help you get rid of what ails you before the first days of summer!
“Bi-lateral flank pain. This issue does not appear to be structural, but Nick helped treat mid-to-upper back pain which was also present. I feel I have the tools and techniques to self-treat this and prevent future flare-ups. Thanks!”
A mistake that people often make is waiting too long to start physical therapy treatment for their aches and pains. This commonly occurs because you may be thinking, “this will go away on its own,” or, “it’s just normal for me to feel like this at my age.” I want to clear up some confusion on mechanical pain versus normal muscle soreness that does not require skilled therapy or treatment.
Muscular Pain:
Experienced after a sudden increase in activity or exercise.
Running 6 miles when you typically only run 2 miles
You increased the intensity or length of time to your typical workout
Will be experienced 1-2 days after the increased activity has been performed and will typically begin to dissipate or be gone in 3-5 days after onset.
Is typically vague pain or experienced in a general area. The pain will not be sharp or pin-point to a specific area.
If you’re educated on what muscles perform which actions, the sore muscles will correlate with what activity you were performing.
Does not have increased or decreased pain associated with positions.
Mechanical Pain:
May have a sudden onset without explanation of occurrence (you woke up with pain for no apparent reason).
Will typically have a loss in range of motion. For example: it may be difficult to stand up straight in the morning or after prolonged sitting or driving.
Will have positions that will increase or decrease symptoms. For example: pain increases with sitting, pain is better while lying down.
If you’re experiencing mechanical pain the sooner you seek physical therapy treatment, the better! A good Physical Therapist can determine which exercises will reduce your symptoms and get you back to doing the activities that you love!
Waiting to start PT after an accident can actually INCREASE your healing time
Some people are told to “rest” for 4-6 weeks before starting therapy after an accident. The problem with this? There are many things a person can do immediately after a car accident to facilitate healing and prevent dysfunction.
All too often, we see people 6 months or more after a car accident or motor vehicle accident (MVA).
Without exercises at home, the picture is this: limited, painful movement of the spine or joints, global weakness, and poor posture that becomes painful when corrected.
The same is true for other types of trauma as well! Prolonged rest causes stiffness, and can lead to increased pain.
Nick Rinard Physical Therapy has a very effective treatment protocol that helps patients avoid loss in range in motion, and decrease pain!
Vertigo is different than just feeling dizzy from time to time.
It is an episode that can come on quickly, resolve just as quickly or last for hours and even days.
Vertigo can be caused by no apparent reason, antibiotics, jumping, sneezing, allergies, sleeping, falling to name a few. It can have serious effects on your safety while walking and driving.
Nick Rinard Physical Therapy has had many patients call his/her MD only to be told vertigo will go away on its own or scheduled an appointment to receive a generic hand out-that is not patient individualized. We have found this one size approach does not fit all. These self-help hand-out are most beneficial with the guidance of a physical therapist.
Please do not spend days or even weeks trying to heal yourself or wait for your symptoms to go away.
In as few as 2 visits our tailored approach can get you back on solid ground. Safely walking and driving around without fear of falls or a sudden onset of dizziness while driving.
Thank you Troy for sharing your Nick Rinard Physical Therapy experience on google.
“As a competitive weightlifter, the pain in my back was seriously stalling my training.
Nick really listened and understood my goals and my issues and helped me get rid of the pain I’d been dealing with for over 6 months with only 2 visits and some assigned stretches.
I couldn’t believe it!
I’d seen doctors and other PTs and was about to get an MRI so I could get cortisone shots which was going to take months and only mask the pain if it solved it at all.
