File - Aziz. Ahmad, SMT

Medico legal Report
Prepared by
Aziz Ahmad, RMT
786 young St, Toronto Ontario, M3r 4t7
[email protected]
State Farm Insurance
678 Cabbage St. Toronto, Ontario, M7d 3e6
(Tel) 416-792-4575 (fax) 416-656-5645
[email protected]
October, 30th, 2012
I am a qualified massaged therapist who has 10+ years of rehabilitative clinic experience. I will take my
expertise to treat Mr. Tom Drake for his piriformis syndrome (gluteal pain). The client has been referred
by his physician for massage therapy treatment. Massage therapy can be helpful and effective to treat
and reduce the nerve impingement of the sciatic nerve and the possible trigger points on the piriformis
muscle X-rays were not provided
Patient: Tom Drake
Chief Complaint: piriformis syndrome
Type of treatment: Rehabilitation
Date: October, 10th, 2012
Short term treatment Plan: 2x 45min tx/wk. for 2 wks. = 4 treatments
Second Plan: 1x 1hr tx/wk. for 4wks= 4 treatments
Consent obtained: Yes
Impairment levels
 Suspected left sciatic nerve compression by the piriformis muscle causing pain and altered
sensations down R gluteal and post lower leg into foot
 Point tenderness in gluteals and TP’s in piriformis, hypertonicity in iliopsoas, quads and QL
 Decreased lumbar AROM 75% in flexion, Pain when returning from flexion, decreased internal
 Decreased hip AROM internal rotation, PROM, decreased internal rotation, decreased flexion
(right hamstrings) mild pain in flexion(no hamstrings involvement), RROM, pain and weakness
internal rotation
 Postural malalignment- external rotation of foot , excessive L-spine lordosis, forward head
 Ataxic gat, Restricted right SI joint
Outcomes of Care
 Decrease TP’s in piriformis muscle
 Decrease hypertonicity in iliopsoas, quads, and QL’s
 Decrease tenderness in gluteals
Medico legal Report
Prepared by
Aziz Ahmad, RMT
786 young St, Toronto Ontario, M3r 4t7
[email protected]
 Mobilize restricted Left SI joint
 Improve gait
 Increase restricted ROM in in Left side
 Restore muscle balance to improve postural malalignment
Notes: postural malalignment will be addressed throughout the treatment plan. If after the short term
reassessment the pain pattern has not changed, a referral to a physician or osteopath will be made.
Long term Treatment Plan: 8 treatments over 6wks. (4treatmetns over 2wks, reassess, then 4tx over
**Reassess after short term treatment plan, refer client or continue with care**
Functional Limitations
 Cannot drive more than 20 mins without experiencing sharp pain in the lower back and right leg
Outcomes of Care
 To enable Mr. Drake to drive for 1hr without pain
 To provide remedial exercises that can alleviate pain felt in certain positions
 To educate client on posture and ergonomics, to decrease aggravating factors
NOTES: reassess after 8 weeks, discharge or change and continue with treatment plan if necessary
Techniques to be used
 Thermaphore to gluteal region
 Effleurage, specific compression, broad contact compression, stripping, passive stretching,
gentle PNF, fascial spreading, petrissage and joint mobilizations
 AROM and strengthening exercises for hip and piriformis
 Passive stretching and resistance exercises
Intended effect
 Decreased hypertonicity, decreased muscles, pliability in gluteal region
 Decreased TP’s, restore normal muscle resting tension, decreased sciatic nerve compression
 Restore normal ROM, strengthening exercises to improve piriformis function and core strength
to support L-spine and pelvis
 Normalize agonist/antagonist relationship to improve muscle endurance and structural support
NOTES: Contraindication: no deep vigorous work due to blood thinning and anticoagulant medications.
No resistance exercises before full ROM has returned. Cautions: passive stretch to be done very slowly
to decrease chances of tissue damage. Guarding may be stabilizing the area; release of piriformis may
cause the area to loose support.
Remex: hydrotherapy to gluteal region and passive stretch of piriformis, PROM for lumbar area to
increase ROM and muscle length. Stability ball exercises to increase core strength and decrease lordotic
curvature, quad and iliopsoas stretches. Strengthening exercises for piriformis
Medico legal Report
Prepared by
Aziz Ahmad, RMT
786 young St, Toronto Ontario, M3r 4t7
[email protected]
**Upon research massage therapy is well documented in successfully treating piriformis syndrome
(human anatomy. P. 83) it involves using massage techniques and modalities which enable to take
compression off the sciatic nerve by treating TP’s and hypertonic tissue in the surrounding area.
Furthermore, peer review journals have stated massage therapy is the best suited to treating piriformis
syndrome. It allows the therapist to emulate various techniques such as: muscle stripping, stretching
techniques, specific compression and hydrotherapy modalities to treat piriformis syndrome (Peer review
journal: Relieving sciatic nerve pain, John P. 4) **
Conclusions and Recommendations
In conclusion, I strongly believe massage therapy will be the best candidate for treating piriformis
syndrome. It involves soft tissue manipulation, treating TP’s, decreasing hypertonic tissue and alleviating
pain from muscle and nerve compression and much more all in which are the expertise of a massage
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