36 YO F presented to me with a chronically stiff neck and shoulders, and reports that she occasionally experiences “pins & needles” in both her hands as well as headaches. Dx - A) Cx spine = degen (mod) ; postural overload symptoms of Cx/Thx spine stabilizers (mod/chronic) B) Scapular/shoulder = postural overload symptoms of scapulohumeral stabilisers (mod/chronic) ; b/g of scapular instability (mod) ; ?MDI GH joint C) Neural = ?Exiting Cx spinal nerve root compression ; transient bilateral neuritis (mild) Tissue integrity - ?Hypermobile ; ?EDS Treatment over the next 3 weeks - A) Manual therapy through scapular/thx/cx - Deep tissue/joint mobilizations/dry needling/fire cupping B) Rehab focus - Scapular stability (shrugs/chest & face pulls/seated rows etc) Treatment helped address her stiffness & headaches. However, the pins and needles didn’t disappear. And are worst in the morning. Referred for Chiro ; regular weekly adjustments for a further 3 weeks ; nil change in symptoms a/a. She says the pins and needles happens most in the morning when she brushes her teeth. Where do you think I went from here? What other considerations to her current symptoms did I make that changed my diagnosis? SHOOT

Medial and lateral epidcondylitis are super common pathologies I see on a regular basis. As a thought experiment what are common things you look for and do for this condition and the why it can happen for very non-specific reasons biomechanically outside of golf and tennis. Comment below your insights or odd connections you have found in the past!

Welcome to the CASE STUDY CORNER—Are your clinical skills up to the challenge?! Each week, I’ll post a fresh case study for us to dissect and debate. Share your treatment strategies, challenge ideas, and sharpen your clinical decision-making. It’s the ultimate way to build confidence and expertise. Got an interesting case of your own? Drop it in the thread and we’ll break it down together. Make the most of this valuable discussion space. It is a powerful tool for your professional growth and mastery!

It’s the end of Monday. I’m fully booked. Not just fully booked, I’m running my wait list (3-4 weeks) & have premium emergency appointments on offer for over $400Aus for 60mins (and I booked 2x of them just today). I’m going to tell you the 5 things I do to make sure my diary is like this every week! Keep reading… I’m not saying this to boast, I’m saying this to make you read more, so you can do the same things I do to be fully booked ahead of the week and run premium appointments. After all, Rulan has made this page for us to help each other grow! Now firstly - I live in Dubai, so I understand the market is different - it’s impossible to justifiably charge $400 [or is it?]. But the premise is the same - emergency appointments for a premium of a sought after service. 1) Have limited spots available! Dictate to your client what appointments are available. Don’t let them say “I want Tuesday at 3.15pm” - especially if that leaves an awkward gap between patients when you can’t fit anyone in. Get specific with your appointment times so your diary is as efficient as possible. Tell them “you can have 2pm or 3pm, which works best for you?” 2) Value your time! Have strict start times and end times (easier if you’re working in a clinic). Don’t give out 8.30pm at night because you want to squeeze them in and do them a favour. That’s a “premium” or “emergency” spot. This appointment is only available for more $$$. 3) Follow up with last weeks appointments! How many appointments did you do last week? Does this week already look the same? If not - WHY NOT?! Write down Monday to Sunday and write their names. Go through the list; if they are booked in cross them off. If they aren’t - why? Follow up With them!! “Hey John just checking in, how’s your shoulder?” , “Hey Mary, I saw you at 5 on Wednesday last week. Currently it’s available but I’m filling up. Can I reserve it for you?” I guarantee if you do this for all of last week you’ll get some rebooking!! 4) Develop a rebooking strategy!

Hey Guys. I am a little stumped on this one. I just want to make sure that I am getting this right. I will hold off on my thoughts so not to scew anyone elses 46 YOA Truck driver with a history of Lx4-Lx5 Disc herniation. Fell off a step of the truck 2/52 ago. More of a missed step into a drain. Didnt go down. ​ Getting pain on the R side in the back of the glut and down the Leg down into the back of the ankle and for the first time to the top of the foot. ​ On noproxen, codeine and panadole. painkillers seem to be the only thing that helps. ​ took on this morning at 7am. ​ Progressively gotten worse over that time. Tried to do stretches and knees to chest which didnt help it. Findings. Hip Hip scour and quadrant test Positive B/L with the L side triggering the R. No pain in the lower back. All in the top of the R glut down to the base of the glut hip extensoin Lx driven B/L Trigger points high in glut med Lx Standing posture large lean off to the R Standing extensoin very limited Flexion less limited SB R feels it on the R, SB L okay Very positive SLR on the R. Can barely lift the leg at all. Rx Responded really well to progressive passive extension, soft tissue, needling and cupping to lx and gluts. Zero pain on the table. Got up and was severely aggravated. Worse than when he walked in. Tried to calm it back down with very little success. Earliest i could get him back in was the week after. Similar result. walked in. responded well untill he got up but it was not too bad. Then when moving the R leg severe aggravation that would not calm down. Thoughts? Am I missing something?