Est. since 2000
Case Studies
Note:
This case study highlights a portion of a 30-minute treatment session. While the patient presented with multiple underlying issues contributing to their discomfort and limited mobility, the focus here is on illustrating one aspect of the treatment process for clarity and ease of understanding. This example demonstrates how targeted assessment and precise treatment techniques can yield significant improvements, even within a short session.
#9 Chronic Hamstring Tightness: More Than Just a Muscle Problem?
Over the past few months, I’ve noticed a trend among my patients — many have come in with persistent hamstring tightness or discomfort. Interestingly, they all shared a common history: a minor to moderate hamstring strain that happened years ago.
But that wasn’t the whole story. Alongside their hamstring issues, these patients also reported stiffness or discomfort in other — some had tight upper backs, others experienced lower back soreness. Their medical history often included multiple past injuries, like a broken elbow from childhood, repeated ankle sprains, or even a hard fall onto their buttock.
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Why Does an Old Hamstring Injury Keep Causing Problems?
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During my assessments, I found that their back and neck movements were generally within normal limits, with only minor restrictions in the lower neck, mid-back, or both. Their hamstring flexibility, tested with a straight leg raise, ranged from 45 to 60 degrees — well within the average range for most people.
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Despite this, their hamstring tension remained stubborn. So, what was really going on?
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Finding the Root Cause: The Key Lesion Approach
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My treatment philosophy follows a simple yet effective principle:
1. Locate the restriction in the hamstring.
2. Identify the Key Lesion elsewhere in the body using Touch Inhibition.
3. Treat the Key Lesion and reassess.
4. Repeat the process until the hamstring tension is fully resolved.
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Through this approach, I discovered some common Key Lesions that were holding these patients back from full recovery.
1. The Knee Cap’s Periosteum (Bone Skin)
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Almost everyone has bumped their knee at some point in life. Over time, even minor impacts can create tension in the periosteum — the thin, sensitive layer covering the bones. This tension can trigger a protective spinal reflex, causing the hamstring to engage more than it should.
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As the tension builds up over the years, the hamstring becomes chronically tight, making it resistant to stretching — even with regular yoga or Pilates. In some cases, this accumulated tension can even lead to a sudden hamstring strain.
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2. The Thigh Bone (Femur) and Weight-Bearing Stress
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Our lower limbs bear all the weight and forces we place on them throughout daily activities. Over time, tiny amounts of inflammation develop around the periosteum of the femur due to constant load-bearing.
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These micro-inflammations may not cause pain at first, but they subtly increase muscle guarding as a protective mechanism. Eventually, the hamstring becomes so tight that it’s more prone to injuries like muscle pulls or persistent stiffness.
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3. The Gut’s Fascial Connection
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The body is designed to distribute mechanical forces efficiently. But sometimes, tension in the fascia around the gut disrupts this process.
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Why does this happen? Potential causes include:
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- Food intolerances or allergies
- Bacterial or viral infections
- Underlying inflammatory responses
I’ve treated several patients whose hamstring tightness was directly linked to abdominal fascial restrictions. Once the tension in the gut was released, their hamstrings relaxed significantly — something traditional stretching or strengthening never achieved.
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4. Unlikely Connections: The Elbow and the Collarbone
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One of my most surprising cases involved a patient whose hamstring stiffness stemmed from an old elbow fracture. Another had lingering hamstring tightness due to stiffness in the periosteum of the clavicle (collarbone).
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These cases reinforce a crucial point: the source of pain is often far from the actual site of discomfort.
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Why This Approach Works Better Than Traditional Methods?
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When I trained as a physiotherapist over 20 years ago, I was taught to use clinical reasoning to connect symptoms with their likely causes. But in my 25+ years of practice, I’ve realized that traditional assessment models often miss the full picture.
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By using Touch Inhibition and Fascial Counterstrain, I can now precisely locate the root cause of symptoms — even when they originate in seemingly unrelated areas. While it takes time to fully clear all restrictions, this approach achieves lasting relief, unlike conventional methods where symptoms often linger despite ongoing treatment.
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If you’ve been struggling with persistent hamstring tightness that just won’t go away, the problem might not be in your hamstring at all.
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For more information about Fascial Counterstrain, visit www.counterstrain.com.​
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#8 Neck stiffness coming from dural tube and phrenic nerve
At our clinic, we recently worked with a patient who had been struggling with ongoing soreness in her left shoulder. The discomfort was centered in her upper trapezius and rhomboid muscles, creating a persistent ache that she couldn’t seem to relieve, no matter what she tried. Though massages provided brief relief, the soreness always returned. Her job as a phlebotomist for the past 10 years had involved repetitive motions, which seemed to aggravate the discomfort during work.
An X-ray was performed and showed mild, age-related changes at the C3/4 level of her cervical spine, but no significant injury. Her past medical history was mostly unremarkable, except for an old motorbike accident.
When evaluating her symptoms, we noticed that while she could bend her back fully, her flexibility reduced when she bent her neck forward simultaneously. This revealed a restriction in her spinal cord’s mobility. Further examination indicated that the source of this restriction was from the Falx Cerebri—a connective tissue structure within the skull. Additionally, we identified local stiffness at the C3/4 cervical level.
To address these restrictions, we began treatment at the cranium to release the Falx Cerebri. This allowed us to work down to her C3/4 level, where we discovered the phrenic nerve was contributing to the tightness in her neck. By focusing on releasing this nerve, she not only experienced relief in her shoulder but also felt a noticeable release of tension in her chest.
With this approach, her cervical restriction eased, and the muscle tension in her shoulder area began to dissipate. Her flexibility was fully restored, allowing her to bend forward comfortably again—an indication that her spinal cord’s mobility had improved.
#7 A Weekend Farm Trip Leads to Unexpected Foot pain
# 7 A Weekend Farm Trip Leads to Unexpected Foot Pain
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One weekend, a patient booked an urgent appointment due to a sudden onset of right foot pain. The discomfort had developed over two days, starting shortly after a long car ride. The patient explained that they had spent about an hour seated in the back of an old 4WD, en route to a farm. Though it wasn’t an off-road journey, the uncomfortable seating left a lasting impact.
The day after the trip, the patient noticed a sharp pain on the top of their right foot, right in the middle. As the day progressed, both the pain and swelling worsened, making it difficult to walk. By the third day, the patient was limping, struggling to bear weight on the affected foot. At this point, they decided to seek help at our clinic, desperate for relief.
Upon assessment, it was clear there was more at play than just foot pain. The patient's lumbar extension was limited, and a touch inhibition at the upper sacral region (S1) notably improved their range of motion. Observing their walking pattern, I noticed that the patient was favoring the foot, holding it rigidly and avoiding full use of the ankle. Another touch inhibition at the lower sacrum temporarily eased the pain in the foot.
To gain a clearer diagnosis, I performed a detailed palpation while the patient lay on the treatment table. Swelling was evident across the top of the midfoot, and the entire right foot was supinated. Ligament stress tests on the ankle and foot came back negative, ruling out any sprain, and the patient confirmed they had no history of gout or arthritis.
Further investigation into the spinal segments revealed key fulcrums at both S3 and L1. The findings pointed to fascial restrictions affecting several structures:
- At L1: the anterior longitudinal ligament, spinal vein, spinal artery, and white rami.
- At S3: sacral alignment, nerves, and arteries.
In addition to these spinal issues, there was a local problem in the foot, where venous return was compromised, contributing to the supination and swelling.
Using Fascial Counterstrain (FCS) techniques, I addressed these fascial restrictions, releasing the tension in both the lumbar spine and sacral regions, as well as in the foot.
Following treatment, the patient’s lumbar extension was fully restored. Even more impressively, the right foot pain that had caused them to limp was completely resolved after walking just 10 meters. The patient was thrilled to report that they could now fit comfortably into their shoes without any further discomfort.
#6 Rib cage pain influenced by kidney resolved in 1 treatment session
A patient came to the clinic with long-standing discomfort in the upper lumbar and lower thoracic spine. The pain would flare up after prolonged sitting or periods of inactivity, but movement provided noticeable relief. The patient had been living with this discomfort for quite some time, unsure of the underlying cause.
During the assessment, bending the lumbar spine to the left moderately increased the pain. Further investigation using touch inhibition revealed that the 11th and 12th ribs on the left side were tightly anchored to the spine. On closer palpation, it became evident that the fascia was restricting the movement of the corresponding renal artery, contributing to the patient's symptoms. (Renal arteries are paired arteries that supply the kidneys with blood)
Utilizing the fascial Counterstrain technique, I targeted these fascial restrictions. By releasing the tension, mobility was instantly restored during the session, and the patient felt an immediate improvement.
At a follow-up visit, the patient reported that the back pain had completely disappeared and had not returned, providing long-awaited relief after just one session.
#5 Unexpected Relief: How Treating a Calf Lead to Freedom of the Mid-Back
When the patient first came to see me, his primary concern was tightness in his calves, a common issue for an elite long-distance runner like himself. Little did we know that this journey would not only address his calf pain but also resolve a mid-back stiffness that had plagued him for over twenty years.
During the initial assessment, the patient mentioned occasional sciatic pain on his right side, which sometimes caused his leg to give way. Upon examination, I found a tender spot in his right piriformis and noted restrictions at T8 in the thoracic spine—an area that became our first focus for treatment. Using touch inhibition, I determined that T8 was the Area of Greatest Restriction (AGR), and the treatment began by targeting the spinal venous and arterial systems at that level. I also addressed the fascial systems around the pleura and liver, and worked on the parasympathetic nervous system in the sacral region and the collateral ganglia in the pelvic area. By the end of the first session, the mobility of T8 had improved, and the tenderness in the right piriformis had significantly diminished.
By the second session, the patient reported that the sciatic pain had disappeared, but he still felt tightness in his right upper lateral calf. Through palpation and touch inhibition, I discovered that the paraspinal muscles in the left lower back were connected to this calf tightness. The AGR was now at L4, which also showed restrictions when the patient bent forward. A cranial scan indicated that treatment should focus on the mesenteric system, spinal ligaments, venous systems, and the preganglionic nervous system, along with the arterial system in the right calf. Following treatment, the patient's lumbar flexion and calf tightness were significantly improved.
In the third session, the patient mentioned that his calf tightness had returned after running. Further assessment revealed paraspinal muscle tension at T7/8, linked to his right calf tension. Additionally, T7/8 was connected to the left 7th and 8th ribs. Guided by a cranial scan, I focused first on the myofascial chains along the right lower limb, followed by work on the spinal venous system, ligaments, fascial systems of organs, and the sympathetic nervous system. After this session, the T7/8 segment's mobility was restored, and the calf tension was relieved.
By the fourth session, the patient reported difficulty with heel raises on his right leg, needing considerable effort to complete even three repetitions. A closer examination revealed that an old stress fracture in the same tibia was inhibiting his calf strength. I focused the session on releasing the tension around the old fracture site, and afterward, the patient could perform heel raises without any issue.
When the patient returned for his fifth session, he mentioned some lower back pain but, more importantly, shared an incredible revelation: the mid-back stiffness that had been bothering him for over two decades was completely gone. He now had a newfound freedom of movement in his back that he hadn’t experienced in years.
#4 Restoring Shoulder Function: A non-specific pathology
A patient came to the clinic with a troubling issue — non-specific right shoulder pain that had been bothering them whenever they tried to raise their arm. The pain would spike whenever they attempted to flex their right shoulder to 90 degrees, making even simple movements uncomfortable.
During the initial assessment, I noted that their cervical spine had full range of motion, which suggested that the issue was likely more localized to the shoulder or surrounding areas. However, all the impingement tests to the shoulder were negative. These all led me to identify the Area of Greatest Restriction (AGR) at the T2 vertebra.
To confirm the involvement of T2, I performed Touch Inhibition (TI) at this level, and the results were telling. With the inhibition of T2, the range of motion in the patient’s right shoulder increased dramatically, almost returning to full range. To further investigate, I conducted a palpation and another TI while the patient was lying in a supine position. It became clear that the issue wasn't isolated to T2—T1 was also inhibiting T2.
With this understanding, I tailored a treatment plan focused on addressing the restrictions at T1 and T2. The treatment included targeted interventions such as anterior and posterior intercostal vein release, spinal venous system at T1 and T2, and work on the epidural vein and preganglionic nerve at these two segments. Additionally, I addressed the grey rami communicantes and Sibon’s fascia, as well as the cervical thoracic fascia and the posterior intercostal nerve at T1 and T2.
Following the treatment, the patient experienced a significant improvement. Their right shoulder flexion was fully restored, and they reported feeling much better and freer in their movements. This case highlights the importance of a thorough assessment and a tailored approach to treatment, resulting in a positive outcome for the patient.
#3 Left Sacroiliac Joint (SIJ) Pain from bike riding
Ms XYZ came to my clinic with a troubling case of left sacroiliac joint (SIJ) pain. The discomfort had flared up following a bike ride the previous week, leaving her with significant pain when bending forward or getting up from a seated position. Although the initial muscle spasm in her lower back was beginning to ease, the pain persisted, making daily activities increasingly difficult.
During her assessment, I noted that her lumbar spine flexion was limited to just a third of the normal range, with any attempt at movement sharply increasing her pain. A pelvic compression test (touch inhibition) provided some relief, temporarily improving her lumbar flexion. However, a deeper look at her SIJ revealed a backward sacral torsion, superior sacral shear, and a noticeable deviation of the coccyx to the right.
To address these issues, I initiated treatment focused on Sacral Spinal Venous system and Spinal Arterial system as guided by cranial scan. Extra techniques on realigning the sacrum were carefully applied to correct the sacral and coccyx positioning and restore proper alignment to her SIJ.
The results were immediate and promising. After the treatment, she experienced pain-free movement when getting up from sitting, and her lumbar spine flexion improved by 50%. This significant progress marked a critical turning point in her recovery, allowing her to resume her daily activities with much less discomfort.
#2 Restoring Lumbar Flexion by treating Thoracic Spine
**Patient Background:**
A patient presented with limited lumbar flexion, experiencing significant discomfort and mobility restrictions.
**Assessment & Treatment:**
Upon examination, the Area of Greatest Restriction (AGR) was identified at L5, where the lumbar segment was notably immobile. Further assessment revealed tightness in the right lumbar paraspinal muscles from L1 to L3, which was contributing to the restriction at L5. By applying Touch Inhibition (TI) to the right lumbar region, L5 mobility improved.
Tracing the source of restriction upwards, the anchor or fulcrum of tension was found around the T8 vertebra. Applying TI at the T8 segment led to a significant increase in lumbar flexion.
To address the root cause, the patient was positioned supine, and a thorough cranial scan was done. It revealed the following system at T8 region was involved — visceral, mesenteric, and lymphatic systems, as well as spinal veins. Treatment focused on releasing these restrictions in this particular 30 minutes session.
**Outcome:**
Post-treatment, lumbar flexion was fully restored, and the tension in the right L1-3 paraspinal muscles was significantly reduced. Home exercise and ergonomic advice were given to maintain the gain and as a preventive measure as well.
#1 Shoulder and neck pain from skull
**Patient Background:**
A patient presented with right-sided shoulder and neck pain, likely due to extended computer use.
**Assessment & Treatment:**
During a 30-minute follow-up session, a detailed neurodynamic test revealed restrictions at the right 2nd rib. By palpating and testing for mobility, it was clear that the spring test indicated decreased mobility at the right 2nd rib. Notably, the tension in the left levator scapulae was not related to this rib.
To address this, the patient was positioned supine. Through palpation of the left levator scapulae and surrounding fascial tissues, I identified that tension in the left 8th rib contributed to the levator scapulae tightness. Upon further palpation, it was necessary to determine if the tension was local or distal. Given the patient's history of jaw surgery, I explored the connection between the head, jaw, and rib tension. Ultimately, targeting the jaw released the tension in the left 8th rib, significantly reducing the levator scapulae strain.
Meanwhile, the following were also done to address the issue:
- Right cervical anterior longitudinal ligament
- Left thyroid lymphatic and venous system
- maxillary artery
- Fascial nerve
- cervical spine artery
- Right jaw periosteum with scar tissue
- Left Mediastinum
**Outcome:**
Following treatment, the neurodynamic was restored, and the tension in the levator scapulae was significantly reduced. Neck pain was reduced with only residual ache. With some gentle stretching exercise to maintain the gain from treatment, the pain eventually went away.