Mr. T, a 31 year old sales manager presented with a 6 month history of R leg pain, focussed around the mid hamstring area. There had been no specific injury, but Mr T reported that he did a lot of driving and sitting for work. He also reported some soreness in his R shoulder after playing squash.
He had regular massage for these areas which gave him temporary relief, but the problem was not going away.
Mr T’s main goals:
- To be able to stretch pain-free after prolonged sitting(self rated 7/10 where 10 is normal painfree function).
- To be able to sit for 2 hrs without leg pain(4/10).
- To have no shoulder pain after squash(8/10).
We performed a systematic assessment of Mr T’s musculoskeletal system and found the following imbalances:
- Muscle guarding around both shoulders, R>L.
- Poor sitting posture and weak shoulder stabilisers, R shoulder blade poorly positioned.
- Restricted R shoulder rotation.
- Restricted R hip flexion and lumbar flexion(bending forward).
- Restricted hamstring flexibility R>L.
- Stiff lower thoracic and lumbar segments L2-4.
Through a clinical reasoning approach, we worked out together that Mr T’s R hamstring flexibility was a good test to measure changes in his condition. Through a process of treatment directed testing, we found the biggest and quickest change in this test occurred with a R subscapularis release, which improved Mr T’s hip and shoulder movement concurrently.
Through further work on the shoulders particularly the subscapularis muscle, postural correction and motor control strategies, we were able to achieve all of Mr T’s goals and resolve his hamstring pain within a few sessions.
This case demonstrates how upper body posture can influence symptoms in the lower body, and how a systematic whole body approach is required to solve these type of problems. In Mr T’s case, he spent long hours sitting for work and also driving, and his poor sitting posture was having a detrimental effect on his musculoskeletal system.
If you would like to learn more about the neuroscience behind the approach we used with Mr T, please click here.