Case Studies

A 27-year-old female attended physiotherapy following a referral from her dentist, presenting with jaw pain and clicking, primarily on the right-hand side. She reported that these symptoms had been occurring intermittently since her teenage years. Her dentist had ruled out any issues with her teeth and gums and suspected a possible temporomandibular joint (TMJ) disc dysfunction.

In addition to jaw symptoms, the client also experienced occasional ear discomfort and intermittent neck stiffness. She noted that the pain tended to worsen with prolonged chewing or talking and that she would sometimes apply pressure to the joint with her fingers in an attempt to relieve discomfort.

During assessment, her jaw was observed to deviate to the left during opening before clicking back into the midline. The clicking itself was not painful, but it indicated altered joint mechanics.

Treatment focused on reducing muscle tension and improving jaw function. Soft tissue massage and trigger point release techniques were applied to the muscles involved in jaw movement. Dry needling was also used to further reduce muscle tightness. The client was prescribed simple jaw tracking exercises to help restore normal movement patterns. In addition, manual therapy techniques were used to address stiffness in the cervical spine.

Over the course of three months, the client made a full recovery, with resolution of both pain and dysfunction.

A 38-year-old female attended physiotherapy seeking assessment and treatment for persistent tension headaches. She described a pattern of pain and tightness starting at the back of her head, often radiating to the top of the head and into the forehead above the eyes. She also reported intermittent neck stiffness.

The headaches were present most days, and she had been relying on regular pain relief for temporary management. However, by the time she booked her appointment, she felt that medication was no longer providing effective relief. Her lifestyle included caring for an 18-month-old child while working full-time in a predominantly desk-based role.

On assessment, there was notable stiffness and sensitivity in the upper cervical spine, just below the base of the skull. Gentle pressure applied to these areas during examination reproduced her familiar headache symptoms, indicating a strong link between neck dysfunction and her headaches.

Treatment focused on addressing these contributing factors. Gentle, targeted vertebral mobilisations were used to improve movement in the upper neck, alongside soft tissue massage to reduce muscle tension. Practical advice was provided on posture, both at work and when lifting and carrying her child. In addition, the client was given a simple exercise programme to support postural strength and alignment.

With treatment and self-management strategies in place, the client experienced a significant reduction in both the frequency and intensity of her headaches.

A 48-year-old male presented to the clinic with complaints of recurring episodes of knee buckling. Initially, these episodes occurred only once every few months, but they had progressively increased in frequency to almost daily occurrences, often happening at random. Although he had not experienced a fall, he was concerned that his knee might eventually give way completely.

The client had been attempting to strengthen the knee independently at the gym; however, he found that this appeared to aggravate the issue rather than improve it. He described a general feeling of tightness in the leg but reported minimal pain, aside from occasional aching after prolonged periods on his feet or following long walks. His medical history included a knee twist injury sustained during a rugby game at age 22, which he believed had fully healed.

On assessment, the client demonstrated a full range of motion in the knee, and clinical testing indicated that the joint itself was structurally sound. However, there was notable tenderness beneath the kneecap and along both the inner and outer aspects of the front of the knee. Signs of nerve tension were also identified in the front of the leg, likely linked to residual tightness from the previous injury.

Treatment focused on reducing muscle tension and improving neuromuscular control. Over the course of three sessions, dry needling was used to release tight musculature, alongside targeted soft tissue techniques applied to the quadriceps and front of the knee. The client was also provided with a simple home exercise programme aimed at relieving tension and strengthening the surrounding structures.

By the end of the treatment plan, the episodes of knee buckling had completely resolved.

A 42-year-old male presented to physiotherapy with acute lower back pain accompanied by significant muscle spasm. He reported waking one morning with sharp pain, despite going to bed the night before completely symptom-free. On reflection, he recalled experiencing a slight “twinge” during a gym session the previous day.

By the time of his first physiotherapy appointment—four days after the onset of symptoms—the pain had initially seemed to improve but had since worsened considerably. He was finding everyday activities difficult, particularly putting on socks and rising from a seated position.

During the initial assessment, his range of movement was extremely limited. He relied on pushing through his thighs to help straighten up when standing from a chair. Examination revealed pronounced muscle spasm in the lower back, a common protective response to injury, along with stiffness in several segments of the spine.

Treatment focused on reducing pain and restoring movement. This included vertebral mobilisations, soft tissue massage, and cupping therapy. Supportive rigid taping was applied to the lower back to improve comfort, and the client was prescribed gentle exercises aimed at calming the nervous system and improving mobility in the affected areas.

By the second session, the client reported approximately 60% improvement. While some stiffness remained when standing up, the sharp pain had resolved, and he was able to complete his exercises comfortably.

After four treatment sessions, the client returned to full function. He was provided with a short daily routine (approximately 10 minutes) to maintain his progress and was advised to complete a six-week Pilates programme to further strengthen and support the lower back.

A 35-year-old client attended the clinic with a complaint of progressive weakness in her right arm. Over time, this had worsened to the point where her ability to move the arm became restricted. She reported that symptoms were consistently aggravated by overhead movements, such as lifting plates from a cupboard or performing shoulder press exercises at the gym.

Interestingly, she noted that lifting heavy objects was often manageable, yet at certain angles—even lifting something as light as a cup—her arm would feel weak and unresponsive. She also described occasional pins and needles, along with a slight tingling sensation in her fingers. The client had no history of shoulder or arm injury, though she did mention intermittent neck stiffness.

During the assessment, the client was unable to fully lift her arm overhead or out to the side independently. However, with assistance from the physiotherapist, full range of motion was achieved, suggesting that the restriction was not due to joint damage. Further testing ruled out structural issues within the shoulder.

Attention then shifted to the neck, as nerve involvement was suspected. Gentle palpation of certain areas in the neck reproduced a mild tingling sensation in the shoulder and arm, indicating nerve irritation. Treatment was therefore focused on the neck and surrounding musculature.

Following the initial session, the client experienced an immediate improvement, with increased range of movement and reduced tension. It was determined that her previous episodes of neck stiffness had progressed to place pressure on a nerve as it exited the neck and travelled down the arm.

After two additional physiotherapy sessions, combined with targeted corrective exercises, the client’s symptoms fully resolved.