Clinical Case Study
Clinic: Movement Matters Remedial Massage, Lathlain WA
Practitioner: Leone Marchant
Client: Renae
Age: 48 y/o Female
Duration of Symptoms: 4-5 Years
Duration of Care: 6 Weeks
Frequency: Weekly 90-Minute Consultations
Presenting Complaint: Chronic Non-Specific Lower Back Pain (CNSLBP)
Case Overview
Renae presented to Movement Matters with a 4-5 year history of chronic lower back pain with no identifiable mechanism of injury. She described a constant low-grade ache across the lower lumbar region that progressively worsened throughout the day. Prolonged sitting was the most aggravating factor, with end-of-day pain frequently reaching 7-8/10.
Client reported increasing difficulty with sit-to-stand transfers and stated that she would often remain seated in her car after work for several minutes before attempting to stand, anticipating the pain associated with getting out of the vehicle.
Sleep was often disturbed and participation in exercise had progressively declined due to recurrent symptom flare ups.
Renae also reported that symptoms consistently worsened during colder weather, with increased pain, stiffness and reduced mobility. During winter, prolonged sitting and standing became significantly more difficult.
Previous management included physiotherapy, chiropractic care, exercise rehabilitation, sports massage and dry needling, all producing temporary relief lasting several days at best.
Initial Assessment
Findings
- Constant low-grade lumbar pain
- EOD pain 6/10
- Difficulty with sit-to-stand transfers
- Reduced sitting tolerance
- Sleep disturbance
- Protective movement guarding
- Slight R hip hike
- Increased lumbar lordosis
- Reduced T/S extension
- Reduced lumbopelvic dissociation
- Increased resting tone throughout lumbar ESG
- Hypertonicity throughout GMax, GMed, proximal HStrings, adductors and quads
- Significant tissue density throughout the TLF
- Markedly reduced superficial fascial glide throughout the lumbar region and entire SFBL
Presentation was consistent with chronic lower back pain with significant myofascial dysfunction, posterior chain overload and persistent superficial fascial restriction.
WEEK ONE
Treatment Performed
- DTM – Lumbar ESG, QL, GMax, GMed, Piriformis, HStrings, adductors and quads
- TrP – QL, Psoas, GMed, Piriformis, TFL, adductors and Rec Fem
- MFR – TFL, regional SFBL
- MET – Hip flexors, HStrings, adductors and quads
- Home Exercise Programme (HEP) – Mobility drills, posterior chain stretches and sitting modification strategies
Client Feedback
Renae reported feeling noticeably looser following treatment and throughout the evening. By the third day, stiffness and pain had returned to baseline.
Clinical Outcome
Temporary reduction in tissue tension
Nil meaningful reduction in pain
Nil change in sitting tolerance
Nikl change in functional capacity
WEEK TWO
Treatment Performed
- DTM – Lumbar ESG, TLF, GMax, GMed, HStrings, adductors, quads and TFL
- TrP – QL, Psoas, GMed, Piriformis, TFL and adductors
- DN – GMed, Piriformis, TFL and proximal HStrings
- PNF Stretching – HStrings, gluteals, hip flexors and adductors
- Movement Retraining – Pelvic tilting and lumbopelvic dissociation drills
Client Feedback
Renae reported less gluteal tightness for approximately two days and slight improvements in walking and general mobility. Lower back pain remained unchanged.
Clinical Outcome
Mild reduction in perceived tightness
Slight improvement in movement quality
Persistent daily pain
Persistent sitting intolerance
WEEK THREE
Treatment Performed
- MFR – TFL, lumbar fascial planes, posterior oblique sling
- DTM – Lumbar ESG, GMax, GMed, HStrings, adductors and quads
- TrP – QL, Psoas, GMed and Piriformis
- DN – GMed, Piriformis and TFL
- K Cupping TFL and L ESG, Lx ESG and Cx ESG
Client Feedback
Renae reported standing from sitting may have been marginally easier but continued experiencing daily pain and ongoing functional limitations.
Clinical Outcome
- Mild reduction in perceived lumbar tightness
- Minimal improvement in sit-to-stand transfers
- Persistent daily pain
- Minimal carryover between treatments
Clinical Reassessment
Following three consecutive weekly Treatments, multiple modalities and techniques we would routinely perform for clients presenting with chronic lower back pain and none of these had given Renae positive results for longer than a few days if that.
We asked Renae to see her gp for a CT referral of the Lumbar region to rule out legions or internal scarring or any other possible conditions which may have been out of our scope of practise to treat. Ct was clear on all accounts.
One finding remained consistent first three Treatments, significant superficial fascial restriction throughout the lumbar region of the SFBL with markedly reduced fascial glide overlying the bilateral lumbar ESG and Hamstrings.
As a process of clinical elimination, treatment focus shifted away from muscular dysfunction and towards persistent superficial fascial restriction and sensitisation.
A superficial fascial dry needling approach directed specifically at the lumbar ESG was trialled.
WEEK FOUR
Treatment Performed
- KC – Bilateral ESG, ITB and HStrings
- Superficial Lumbar ESG DN – 3 needles vertically placed either side of L lumbar ESG approximately 5 mm into the superficial fascia ONLY and left in sitte for 15-20 mins. We left the needles in for 15 to 20 mins until Cl/ CO burning stinging around entry point. This is not normal practise and client consent was gained again during Rx before proceeding.
Client Feedback
Renae returned reporting substantial changes throughout the week. She described the first night still stinging at entry points. Then getting out of bed more easily the next morning, standing from her chair with significantly less pain and experiencing noticeably less discomfort at work. Despite colder weather during the week, symptoms remained considerably improved. Client continued with heat packs to the lumbar spine.
Clinical Outcome
- Approx. 40 to 60% reduction in symptoms
- Significant improvement in sitting tolerance
- Improved sit-to-stand transfers
- Reduced EOD pain
- Improved sleep quality
WEEK FIVE
Treatment Performed
- KC – Bilateral ESG, ITB and HStrings
- DN – Superficial Fasia L ESG
- Wk 4 protocol repeated with additional DTM & MFR Tx & Cx
Client Feedback
Renae reported continued improvement with almost nil symptom regression. She returned to Pilates
Clinical Outcome
- Approx. 60 to 70% reduction in symptoms
- Minimal discomfort during prolonged sitting
- Return to Pilates
- Increased confidence with movement
- Nil post-work pain escalation
WEEK SIX
Treatment Performed
- KC – Bilateral ESG, ITB and HStrings
- DN – Superficial Fasia L ESG
- Week Four protocol repeated
Client Feedback
Renae reported feeling almost symptom free and has resumed normal activities, We couldn’t have hoped for a better result.
Clinical Outcome
- Near complete resolution of daily symptoms
- Full participation in Pilates and ADLs
- Nil sleep disturbance secondary to lumbar pain
- Significant improvement in overall quality of life
Long-Term Outcome
At the time of writing this, Renae maintains these improvements and now attends Movement Matters for maintenance treatment approximately every one to two months. She has resumed normal daily activities, participates in exercise without apprehension and no longer plans her life around chronic lower back pain. Occasional increases in pain and subjective stiffness may still occur during colder weather however, symptoms no longer return to their previous chronic intensity and remain highly manageable.
Clinical Success Summary
This case study highlights an important principle of practice at Movement Matters and that is that appropriate treatment does not always equal effective treatment. We need to sometimes expand our normal
Three weeks of evidence-informed interventions produced minimal change. Significant and sustained improvement occurred only after treatment focus shifted towards the superficial lumbar fascia in the Superficial Back Line.
Through ongoing reassessment, clinical reasoning and a process-of-elimination approach, an effective treatment strategy was identified for this individual client. The combination of kinetic cupping and superficial fascial dry needling produced substantial symptom resolution and long-term functional improvement following more than four years of persistent lower back pain.
