Case Studies

Patient Profile

65-year-old female, retired. Underwent left total knee replacement for degenerative joint disease. Referred for rehabilitation 4 weeks post-surgery.

Chief Complaints

Limited left knee mobility with flexion only to 70 degrees; required walker for ambulation; difficulty with stairs; nighttime pain affecting sleep.

Initial Assessment

• Pain score: 6/10 (with activity)
• Knee flexion: 70 degrees
• Quadriceps strength: 3/5
• Independent standing: Difficult

Treatment Plan

Weeks 1-2: Range of motion exercises, soft tissue mobilization, quadriceps activation
Weeks 3-4: Progressive strengthening, balance training, gait training
Weeks 5-6: Functional training, stair training, home exercise instruction

Home Recommendations

• Daily quadriceps isometric exercises
• Knee flexion/extension exercises, 15-20 reps each
• Short indoor walks, gradually increasing distance

Patient Profile

42-year-old male, IT professional. Prolonged desk work with 10+ hours of daily computer use. Recurring neck discomfort for 3 years, worsening in past month with right hand numbness.

Chief Complaints

Neck stiffness and pain, limited rotation; right scapular area soreness; numbness in right middle and ring fingers; sleep disturbance.

Initial Assessment

• Pain score: 7/10
• Cervical ROM: 40% rotation limitation
• Forward head posture evident
• Trapezius and levator scapulae tension

Treatment Plan

Physical Therapy: Cervical traction, soft tissue release, joint mobilization
Acupuncture: Cervical and upper extremity points, twice weekly
Postural Training: Workstation ergonomics, chin tuck exercises

Home Recommendations

• Take breaks every hour, stand and move for 5 minutes
• Adjust monitor height and sitting posture
• Neck stretching exercises, 2-3 times daily

Patient Profile

48-year-old female, homemaker. Developed low back pain after lifting heavy objects, progressing to left leg radiating pain. MRI showed L4-5 disc herniation. Under conservative treatment.

Chief Complaints

Persistent low back pain; radiating pain from left buttock to posterior lower leg; worsened by prolonged sitting/standing; increased pain with coughing; limited walking distance.

Initial Assessment

• Pain score: 8/10
• Straight leg raise test: Positive
• Lumbar flexion: Significantly limited
• Decreased sensation on left dorsum of foot

Treatment Plan

Weeks 1-2: Traction decompression, heat therapy, gentle manual therapy, acupuncture for nerve root symptoms
Weeks 3-4: Core stabilization training, McKenzie extension exercises
Weeks 5-8: Functional training, daily activity guidance

Home Recommendations

• Avoid bending to lift heavy objects, use proper technique
• Daily core muscle exercises
• Use lumbar support to maintain spinal curve

Patient Profile

55-year-old female, homemaker. Right shoulder pain and stiffness for 6 months, gradually worsening. No specific injury history. Severe limitations in daily activities like dressing and combing hair.

Chief Complaints

Persistent right shoulder pain, worse at night; severely limited shoulder motion; unable to raise arm overhead; unable to reach behind back.

Initial Assessment

• Pain score: 7/10
• Shoulder abduction: 60 degrees (normal 180)
• External rotation: 15 degrees (normal 90)
• In "frozen phase"

Treatment Plan

Physical Therapy: Joint mobilization, soft tissue release, heat therapy
Acupuncture: Shoulder and surrounding points with moxibustion
Therapeutic Exercise: Pendulum exercises, wall walks, shoulder stretches

Home Recommendations

• Daily shoulder stretching exercises
• Apply heat before exercises
• Avoid maintaining same position for extended periods

Patient Profile

68-year-old male, retired. Left-sided hemiplegia following cerebral infarction 3 months prior. Condition stabilized after acute treatment. Referred for rehabilitation to improve function.

Chief Complaints

Left upper and lower extremity weakness; requires assistance for ambulation; difficulty with left hand grasping; poor balance, fear of falling.

Initial Assessment

• Left upper extremity Brunnstrom stage: III
• Left lower extremity Brunnstrom stage: IV
• Berg Balance Scale: 28
• Requires assistive device for walking

Treatment Plan

Physical Therapy: Neurofacilitation techniques, functional training
Gait Training: Weight shifting, stepping practice, assistive device use
Acupuncture: Scalp and body acupuncture to promote neural recovery
Upper Extremity: Hand function training, ADL training

Home Recommendations

• Family-assisted daily exercises
• Home modifications to reduce fall risk
• Encourage affected side participation in daily activities

Patient Profile

38-year-old male, recreational runner. Runs 3-4 times weekly. Developed right heel pain 2 months ago, most noticeable with first steps in the morning.

Chief Complaints

Right heel medial pain; worst with first steps out of bed; painful when standing after prolonged sitting; worsens after running.

Initial Assessment

• Pain score: 6/10 (morning)
• Plantar fascia tenderness evident
• Calf muscle tightness
• Limited ankle dorsiflexion

Treatment Plan

Physical Therapy: Soft tissue mobilization, ultrasound therapy, shockwave therapy
Acupuncture: Foot and posterior lower leg points
Stretching: Calf muscle stretching, plantar fascia stretching
Advice: Orthotic insoles, running volume adjustment

Home Recommendations

• Daily calf and plantar stretching
• Use arch support insoles
• Gradually return to training volume

Patient Profile

75-year-old female. Unsteady gait over the past year, with 2 falls (fortunately no fractures). Family concerned about future falls, seeking rehabilitation.

Chief Complaints

Unsteady feeling when walking; dizziness when turning; fear of going out; feeling of leg weakness.

Initial Assessment

• Berg Balance Scale: 36 (high fall risk)
• Timed Up and Go: 18 seconds
• Lower extremity weakness
• Decreased proprioception

Treatment Plan

Balance Training: Static balance, dynamic balance, weight shift exercises
Strength Training: Lower extremity strengthening, hip stabilization
Gait Training: Proper gait pattern, turning techniques
Home Guidance: Environmental safety recommendations

Home Recommendations

• Daily standing balance exercises
• Install grab bars and non-slip mats
• Wear non-slip shoes, avoid slippers

Patient Profile

45-year-old female, corporate executive. High work stress, chronic insomnia for over 2 years. Difficulty falling asleep, frequent waking, poor sleep quality, daytime fatigue.

Chief Complaints

Takes 1-2 hours to fall asleep; wakes 2-3 times per night; total sleep about 4-5 hours; daytime fatigue and poor concentration; accompanied by anxiety.

Initial Assessment

• Pittsburgh Sleep Quality Index: 14 (poor)
• Self-rating Anxiety Scale: Moderate anxiety
• Tongue: Pale red with thin white coating
• Pulse: Wiry and thin

Treatment Plan

Acupuncture: Points including Baihui, Shenmen, Neiguan, Sanyinjiao, twice weekly
Ear acupressure: Heart, Kidney, Shenmen, Subcortex
Lifestyle guidance: Sleep hygiene education, relaxation techniques

Home Recommendations

• Maintain consistent sleep/wake schedule, avoid staying up late
• Avoid electronic devices 1 hour before bed
• Practice deep breathing relaxation before sleep