The Casebook of Andrew Wilson-Smith ND, DO
Registered Osteopath and Naturopath, and our Orthotics specialist, Andrew Wilson Smith, shares some of his case studies.
Case Study 1 – Heel Pain & Orthotics
Patient presented with heel pain.
Pain had gradually come on with no specific cause as they could remember. Pain was located located on the bottom centre of the heel. The pain was characterised by being worse in the morning and then gradually getting better after 20 minutes or so. Then later in the day around 4-5pm getting worse again the more he was on his feet.
On examination I found the patient had pronounced dropped arches in their feet and the tenderness was located to be on the insertion of the plantar fascia. This condition is sometimes called policeman heel or plantar fasciitis. The plantar fascia is one of the structures that hold up the arch of the feet and when the arches drop the strain eventually turns to pain.
I explained that the fascia would only be able to heal if the mechanical stress could be alleviated. This was achieved by measuring and prescribing orthotics which support the arch and allow the tissue to heel and also prevent a recurrence. Alongside this advice I also recommended stretches for the calf muscles and rest from any unnecessary exercise for 3 weeks. I also saw the patients for 4 sessions of treatment which included ultrasound therapy hands on massage of the facia and laser impulse too.
After 3 weeks of this regime the patients was 60% improved and by 8 weeks all the symptoms had resolved. Long term the patient was made aware to keep using orthotics as a preventative.
Case Study 2 – Neck Pain & Osteopathy
Acute neck pain
Patient woke up with a ‘crick in her neck’ she came to the clinic and was in acute pain in the left side of her neck with pain radiating into her shoulder and upper arm.
She had had previous attacks like this before but the attacks had become more frequent in last 18 months since she had started a full-time job in London.
Listening to her history it became clear that since she had stopped going to the gym regularly and been commuting to London and doing a more static desk job she was experiencing feeling of neck stiffness regularly.
I examined her neck and she was unable to turn to the left without considerable pain. I checked her reflexes and also felt her neck muscles and all her neck vertebrae individually to see what could be causing all the pain. After a thorough examination I concluded that her neck muscles were in spasm on the left side of her neck and that two of her vertebrae’s movement were acutely restricted. The combination of these two problems was also giving her nerve irritation as a result.
I explained to her help I would release the spasm using combination of deep tissue muscle techniques and I would release the joint restriction by specifically manipulating the joints to open them up and freeing the restricted movements.
After performing both of these techniques she was able to be able to turn her neck almost fully again to the left and the pain in her arm had subsided. I explained that the neck would still be somewhat sore as result of the spasm and swelling caused by the joint restriction but that she should use a warm pack that afternoon and use nurofen to help as well. I recommended I see her again two days later to continue the treatment and I also gave her gentle stretching exercises to do to limit the amount of tension in her neck.
I also told her that I felt very strongly that long term she should definitely find some exercise to-do regularly to mitigate the effects of her sedentary job to employ and to do more stretches which I would instruct her on once she was fully better.
By the second appointment she was significantly better and I gave her some more stretches to do and also examined the rest of her spine which I found restrictions and tension in too. I treated her whole spine on this visit as the health of the whole spine would also help the neck resolve more quickly. I also went on to give her postural advice about sitting better at work place.
By the third appointment she was 90 % better, I treated the whole spine and the neck and told her that I could discharged her as she was so much better. Before she left I spent time checking the exercises I had given her were being performed correctly as she would be using these going ahead. She also told me she had taken my advice and was going to begin a yoga class once a week. I also recommended that she see a masseuse once every 6 weeks or so just to keep her neck and shoulder muscle looser as even with all she was proposing to-do I felt her job would still cause significant level of tension and massage would be most useful.