We put these before and after photos on our facebook page last week and it practically went viral. We thought you all may want to know more about this woman's journey so we thought we'd fill you in. We're going to call her Sally for the rest of this article - not her real name, of course.

Sally came for her first appointment earlier this year. She reported that she was in a car accident years ago that left her with neck pain. Shortly after she was treated by a physical therapist who alleviated the neck pain completely. When she was caring for her baby the year after, she started noticing the return of her neck pain as well as left arm pain, decreased range of motion, and decreased function of her arm. A little while later she tried physical therapy and did not notice any change in her symptoms or function.

At her first visit she had pain and burning between her left shoulder blade and spine, left sided neck pain, and her head felt heavy.

Here's what we noticed in her first session:

• Standing posture: flattened thoracic (upper back) and cervical (neck) spinal curvitures, right shoulder blade low and unstable, right shoulder low
• Muscle strength: right shoulder strength was 5/5 and pain free, her left shoulder was generally weaker at a 3/5 and unstable. The head of her arm bone could be heard clunking in the socket as we applied pressure.
• Alignment: left rotated cervical spine and malalignment of her left first rib
• PRI: Poor hip positioning and muscular control of the hip on both sides, approximately 6 inches from her toes when bending forward
• Range of motion: decreased active and passive shoulder range
  • active left abduction 90,  flexion 120 (both out of 180)
  • passive left abduction60, flexion 120, internal rotation 55, external rotation 90 (rotations are out of 90). She also had limited right flexion at 125

Her treatment consisted of a lot of education and only one exercise. This exercise put her on her back and facilitated her hamstrings, abs, and promoted diaphragmatic breathing and getting breath into her right upper chest. After this activity she had proper hip positioning on both sides, restored cervical and first rib alignment, full left shoulder internal rotation and improved flexion by 30 degrees (150 total)

In her second appointment (9 days later):

• She had not had any shoulder blade burning pain at all since the first session. She continued to have some left neck pain and pain into her left shoulder when she moved it, but the intensity was much better than before. She had not done her exercise in the previous 2 days.
• PRI: good hip positioning on both sides, poor muscular control of the hips on both sides, integrated strength 3/5 on the left and 1/5 on the right
• Alignment: unremarkable
• Range of motion:
  • active left shoulder flexion and abduction 160 (out of 180) with significantly less pain at the end of her range
  • passive shoulder internal rotation 90 on both sides, flexion 145 (out of 180) on both sides

Her treatment in this session was to progress her previous exercise into one in standing while supported by a wall. We also added a reaching component with her left arm and made her breathe into a balloon. This moved her into a much more integrated position as she now has to control all of the joints of her body while standing and performing an exercise. The right arm reach and addition of the balloon helped to strengthen her abdominals both concentrically and eccentrically, especially on the left side. This improved her shoulder flexion to 160 on the left, and 165 on the right (out of 180)

We also added a strengthening activity for her left inner thigh while lying on her right side. This improved her integrated strength score to a 2/5 on the left side.

In her third session (11 days later):

• She had no shoulder blade or neck pain at all. She felt that she had full left shoulder range of motion, but had a bit of tightness at the end of her range
• Muscle strength: left shoulder 5/5 and pain-free without any clunking of the head of her arm bone in socket
• Alignment: unremarkable
• PRI: proper hip position and good control of hip joint on both sides, limited hamstring motion, 5 inches from touching toes when bending forward, integrated strength 3/5 on both sides
• Range of motion:
  • active left shoulder flexion and abduction 180 (full range)
  • passive shoulder flexion 180, internal rotation 90, and external rotation 90 on both sides (full range)

In this session we added a hamstring stretch which allowed her to reach further toward the floor while bending over. We tookaway the support of the wall in her standing activity from the session before and made her reach with her left arm to strengthen the left abdominals in both positions of ribcage rotation. Lastly, we added a rotator cuff and scapular strengthening activity in sitting being careful to maintain a good ribcage position and breathing pattern throughout the exercise. This will help to stabilize her shoulder blade position and head of her arm bone in the socket. 

At this point, Sally was completely pain-free, hadfull left shoulder range of motion, and much improved postural alignment. We could discharge her at this point as her therapy goals had been met, but we have seen her a few more times to fully stabilize her posture and left shoulder/shoulder blade so that her symptoms do not return.

Interested in learning more? Want to maximize your results even if you've had unsuccessful physical therapy in the past? Call Integrate 360 at 314-733-5000 or email us at Lesley@integrate360pt.com or nancy@integrate360pt.com