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- The client is an 82-year old woman complaining of a chronic ache in her right hip.
- She rates the ache as a level 3 out of 10 and indicates that she feels the most discomfort around the right sacroilliac (SI) joint.
- The client notes that she had a “bad left hip,” as well as weakness in her left leg, which she attributes to an episode of shingles that affected her left leg many years ago.
- She also tends to experience episodes of sudden pain that she describes as an intense cold sensation down the backs of both legs.
- When these episodes occur, she needs to immediately lay down.
- The client experiences discomfort on the left side of her neck and occasional midback discomfort, although these are secondary concerns to the hip pain.
- The client also expresses that she has trouble falling asleep and staying asleep at night.
- At Week 8 of treatment, the client indicates that she has developed some trouble with loose stools in the morning, which she believes is due to a new thyroid medication dosage she was given.
- The initial postural and range-of-motion assessment reveals the right hip is anteriorly rotated and the low back has an exaggerated lordodic curve, with anterior pelvis rotation.
- Adhesions are palpated along the connective tissue attachments at the illium, with tender spots and trigger points noted at the right SI joint.
- The external hip rotators are tight on both sides, although tighter on the right with less ROM noted in right hip joint.
- Left side gluteus maximus, minimus, and medius are all extremely tight, with trigger points palpated throughout.
- Tension pattern also noted in the left side erector spinae group predominately between T5 and L2.
- Adhesion noted in the left side middle scalenes near acupressure point LI18.
- The client began 60-minute treatment sessions two times per week for a course of four weeks, followed by one 60-minute treatment per week for the next six weeks.
- Four main goals were identified to work towards:
1) alleviating hip/back of leg pain
2) alleviating shoulder/neck pain
3) improving insomnia
4) improving loose stools – Week 8 onward
- Manual tissue therapies, to include Chinese medical massage rolling technique, compression, kneading, pressing and deep tissue stripping were applied to the neck, back, gluteal muscles, external hip rotators, and legs every session.
- Passive joint manipulation with pressing was performed around the greater trochanter on the right and left sides.
- Primary acupressure points targeted during session work include: BL26, BL23, BL40, anmian, and LI18 (left).
- Moxibustion was applied over SP6 and ST36 at sessions during Weeks 8-10 to help with loose stools.
- The client first reported lasting improvement (lasting more than 1-2 days) in her low back/right hip and neck pain following Session 2.
- Sleep quality also improved after two sessions. Sustained pain-relief (lasting more than 5 days) in the low back/hip area was achieved around Week 9 in the treatment.
- Loose stools improved after two moxibustion treatments were performed in Weeks 8 and 9 (one treatment per week) and remained stable with regular weekly moxibustion application thereafter.
- Client continued with maintenance sessions, spaced 2-3 weeks apart, and was able to maintain the ability to function with little to no pain and better quality sleep.