Chronic Low Back Pain Case Study

Low Back Pain Moncton

An active lady in her 30’s came to the clinic complaining of low back pain that has been persisting despite seeing many manual therapists (chiro,physio,osteopath,massage therapists).

She was desperate for answers as nothing seemed to effectively decrease the low back pain for more than 24hrs at a time. Enough was enough, she said. She wanted lasting relief and to be able to go the the gym without pain.


During her first visit, I evaluated basic everyday movements such as bending forward and walking. Forward bending, is what brought on the symptoms at about 8/10 intensity directly in the middle of her low back pain. Sitting and lying down also brought on the symptoms as well.

Upon assessing her with P-DTR, I found her Transversus Abdominus (TVA), Glutes, Psoas, and Piriformis muscles on both sides of her body to be VERY weak, and her internal abdominal oblique muscles to be hypertonic (Strong, but unable to normally inhibit).

In other words, she lacked the majority of the vital stabilizing musclulature in her lower back and her body compensated with the obliques, which were holding on for dear life at this point.

In my experience, when there is weaknesses of the same muscle on both sides of the body, I often find the root cause of this is fixation(s) of the spine.

More on the TVA (fun facts)

The TVA, a deep core muscle, plays a crucial role in creating proper intra-abdominal pressure and maintaining normal posture. It is the deepest among the abdominal muscles, and it in normal function it automatically contracts a few milliseconds BEFORE the larger, more superficial muscles contract to produce movement. Think of the TVA as a stable foundation to generate force from. If it doesn’t function, the brain will choose another way to achieve stability.

Clinical Outcome

I saw her a total of 3 visits. For the first 2 sessions, I found some restrictions and treated them accordingly, but none lead to any real difference in the back pain. It was during the 3rd session when I found the areas that flipped the ‘ON’ switch for her low back muscles.

Ultimately, what resolved her pain was a P-DTR correction to dysfunctional Stretch Receptors (Golgis) at the base of her skull and at the last segment of her spine. This “pattern” of restriction, if you will, is called a ‘Lovett Reactor’. This was the only correction that offered relief from the symptoms she had.

Knowing now that dysfunctional stretch receptors was generating the symptoms, it made a lot sense why bending forward, sitting, and lying down all made her symptoms worse – those positions were all STRETCHING a dysfunctional stretch receptor in ligaments of her low back.

We had a one week follow-up later, and still no pain. This is the longest the pain has been gone for since she had first had the issue about 1 year ago.

Lovett Brother Explanation

Used clinically for decades by many body workers, and is a common finding for those who are using neuro-muscular therapy techniques such as NKT® and P-DTR®.

In the most simplest of explanations when there is a rotation in L5 there will always be a rotation in C1, its ‘Lovett Partner’, even in the absence of symptoms of pain or lack of function at C1. With all the listings they can work both ways. For example, a  dysfunction at L5 can cause a C1 dysfunction and a C1 dysfunction can cause an L5 dysfunction.

When one is out of neutral so will its “partner” or “pair”. Often it is necessary to address the Lovett Partner as well to get a lasting or even successful correction. Remembering that the joint above and below at the dysfuction is also likely to be affected you can see the cascade of musculoskeletal problems that can arise. This is why treating TMJ(jaw) and sacrum/coccyx (pelvis/tailbone) together in some people is so important.

If you or someone you know is suffering from low back pain without getting desirable results, you should begin considering that the root cause has not yet been addressed. To schedule an appointment in our office, please click HERE.

Patellofemoral Syndrome

Patellofemoral Syndrome & Our Approach



What Is It, and How Does It Happen?

Patellofemoral syndrome is a patella (knee cap) tracking problem. It if often refers to as “runner’s knee”. The lateral quadriceps muscle, Vastus Lateralis (and often the ITBand) becomes very tight and over powers the medial quadriceps muscle, Vastus Medialis. Ideally the patella should slide up and down in the patellar groove as the quadriceps contract. When the lateral side is too tight the patella is pulled to the lateral side. This causes a tracking problem for the patella and therefore rubbing and inflammation under the patella. The pain underneath and around the patella is the symptom but the areas that need to be corrected are the lateral quadriceps and ITband. At this point we need to examine further and try to determine why the lateral quad is tight. It may not always be a quadriceps problem! 

“Other areas including the hip and the foot also are of concern in this condition.”

This injury is seen in people with poor mechanics of the foot. A person that over pronates with their ankle/foot will put extra strain on these structures. This may be corrected with something as simple as a change of shoes. If the shoe still does not give enough support to control the over pronation, often a custom orthotic will help.

“This syndrome is more common in women due to our wider hips causing a more extreme angle down to the knee (the Q-angle). The increased angle automatically puts more tension on the lateral side of the leg. We cannot change the boney structure of the hips but we can address the muscles in the area and make our clients aware of the importance of stretching.”

This injury is often seen in beginner runners, runners that ramp up their mileage too quickly and runners that are over training. It is important to see a sports specialist when you are having pain or discomfort (even better, see a sports specialist that is also an athlete). We tend to see the same injuries over and over and will therefore have a better understanding of what you can and can’t train through.

How We Approach This

Deep massage therapy is successful in treating patella-femoral syndrome, but I use NeuroKinetic Therapy or NKT to test and never guess what is really happening. This ensures that I can identify the proper structures that are neurologically involved with the biomechanical issue happening at the knee, treat the cause of it, and to assign the correct exercises to keep it away. With NKT the results are seen FAST and I can often get the client back out to regular activity after only a couple visits. For cases that do not immediately respond or that are chronic in nature, I resort to Shockwave Therapy as the tissues need to be stimulated to heal again in order to regain full function. A similar goal is achieved with Graston Technique as well.


Shockwave Therapy Moncton

Shockwave Therapy – The Better Alternative

R3 Integrative Health in Moncton specializes in Shockwave Therapy

Everyone with soft tissue injuries can benefit from Shockwave Therapy. Some common examples include hip/groin pain, rotator cuff tendonopathy, tennis and golfer’s elbow, patellar and Achilles tendonopathies and plantar fasciitis. Your body can heal most of these conditions with time but having some Shockwave Therapy treatment will accelerate the healing and get you back to your normal activity faster. In certain chronic conditions like calcification tendinitis, it has been proven to be just as effective as surgery!


Very simply, Shockwave sends sound waves into the tissue causing a bit of micro-trauma which initiates the inflammatory or healing response. Often with a chronic injury the brain begins to accept the state of the tendon as the new normal state. This micro-trauma to the area will remind the brain it needs to continue healing in that area. The biggest effect Shockwave has been seen to have is actual regeneration of tissue including blood vessels in the affected area. The shockwave treatment continues to work even up to three months after the sessions are completed.

“Extracorporeal Shockwave Therapy has been around for many years. Shockwaves and their effects were accidentally discovered many years ago off a South Pacific beach.”

Years later, shockwaves were developed to treat kidney stones and eventually a German doctor showed the benefits of shockwaves on healing tendonopathies. Shockwave machines were brought into Canada in the mid 1980′s. These machines were very expensive for a clinic to purchase so the cost of treatment was extremely high. Thankfully, the machines have been made smaller, more compact and more affordable for clinics to purchase and use, in turn bringing the cost of treatment down to a reasonable price.


No. Ultrasound does use sound waves but the big difference between Ultrasound and Shockwave Therapy is the intensity and power of the sound waves. When you have ultrasound applied you rarely feel anything during the application. With Shockwave you will feel the treatment. It is quite uncomfortable in spots. Those are the injured areas that need attention.

The patient will actually guide the therapista bit during treatment by the discomfort which assures the exact area of concern is being treated. Does it hurt? For some, yes. The Therapist will work within your tolerance and thankfully the actual shockwave application only takes about five minutes. As the affected area is treated, the patient usually will feel the pain diminish. Most shockwave sessions are an application of 2000 sound waves.

At R3 Integrative Health we will always treat the causative factors or structures first with NKT and manual work such as active release, and then apply Shockwave to the symptom site. By using this approach to treat the structures, tension is reduced into the symptom site making the Shockwave even more effective.

We are proud to offer the highest standard of massage therapy in the Greater Moncton Area. If you have any questions about Shockwave or our success with Shockwave please feel free to contact me directly.


The Nerve Problem You Didn’t Know You Had

Chronic pain can have several sources, one of these being nerve pain that can range from simply annoying to debilitating and excruciating.

Posterior view of the brachial plexus

And, unfortunately, determining the exact cause and finding relief from nerve pain can often be elusive.

 One of the most common causes of nerve pain is a can often as “nerve entrapment”. This is sometimes a temporary condition resulting from undue pressure on a nerve, often in an arm or leg. However, chronic nerve pain from entrapment is a condition that can usually be treated with conservative care. 

In our office, this is known as nerve compression syndrome, compression neuropathy, or as entrapment neuropathy. It is as a “medical condition caused by direct pressure on a nerve.” More commonly, it is referred to as a trapped nerve. Although it might actually be an instance of nerve root compression, which can be caused by a herniated disc, for example. Occasionally, someone can suffer nerve injury by a single instance of physical trauma. While this can certainly result in nerve pain, and is in one sense a compression neuropathy, it’s not typically a case of nerve entrapment.

Nerve Entrapment Signs and Symptoms

Typically, an individual will experience some level of pain, tingling, numbness or a burning sensation, and even muscle weakness. The tingling and numbness are limited to the area of the body affected by the corresponding nerve that is impacted.

Depending on the root cause of the entrapment, these symptoms may start immediately after a trigger, or as much as several hours or days later. In many instances, never pain is less common than tingling or numbness as a symptom of nerve entrapment. Although an uncomfortable burning sensation, can often occur as well.

Because these symptoms affect one part of the body, depending on which nerve is compressed, nerve conduction studies can be used to help confirm an accurate diagnosis. While surgery may help to relieve the pressure on the nerve, in some cases, it does not always bring relief from all the symptoms.

What Causes a Trapped Nerve?

Most people have experienced the odd and annoying sensation of having their arm “fall asleep.” While not usually painful, people usually describe it as a feeling of pins and needles, crawling skin, or numbness. In severe cases, a limb can be completely numb and temporarily immobile. What they are experiencing is known as positional paresthesia – a “burning or prickling sensation” that usually occurs in the limbs, hands, and feet. 

Anterior (front) view of the median nerve

Most commonly, the cause of parasthesia is simply a person’s position at a given time. For example, an arm can fall asleep because a person is lying in a position that is putting pressure on a nerve in the limb. Typically, positional paresthesia is harmless and only occurs when a nerve is under sustained pressure. The sensation usually goes away after a person changes position.

Another common, but temporary, cause is a nerve being compressed by a prolonged or repeated external force. This can be something as simple as someone having their arm resting over the back of a chair and unwittingly compressing the radial nerve or resting their elbows on a table for an extended period of time, which can press on the ulnar nerve. These are examples of temporary and usually harmless conditions that are similar to chronic nerve entrapment.

Tingling or Numbness

When the pain, tingling or numbness is chronic, the cause is usually due to an issue in the body causing the compression and is termed entrapment neuropathy.  The physical structure causing the pressure can sometimes be a lesion such as a tumor, ganglion cyst or a hematoma. However a more common cause is an expansion of the tissues around a nerve in a space without enough room for this to occur.

This is what happens in the case in carpal tunnel syndrome, for example. Sometimes deep scar tissue and adhesions from old traumas or overuse can form and entrap a nerve. The result can be chronic and even debilitating pain along with tingling, numbness and muscle weakness.

Finding Relief From Nerve Pain

Internal tissue scarring, or adhesions, can from injuries associated with repetitive strain, or acute athletic injuries. And, unfortunately, these adhesions may develop along the path where a nerve travels.

Posterior (back) view of the sciatic nerve

These adhesions can prevent normal and smooth movement of the tissues with their surrounding structures. Causing problems such as chronic pain, joint stress and nerve entrapment. They can also cause friction or improper interaction with nearby structures resulting in inflammation. Over time, inflammation will build leading to pain, fluid accumulation and restricted motion and flexibility. And, in many instances, nerves can become enveloped in the tissue and compressed

Healthy and unobstructed muscles glide smoothly and cleanly across other muscles, tendons, ligaments, lymphatic channels and nerves. However, if there are adhesions are present, the result is often friction and restriction of normal movement. In addition, nerves can become entrapped in the tissues affected.

Specific techniques which are used in our office can be used to release scar tissue, or adhesions, in the muscles and fascia. Which is the smooth connective tissue covering of muscles. Soft tissue injuries created by scar tissue can’t be detected by machines or orthopedic tests. As a result, we can use our hands or Graston Instruments to determine where the adhesions are and how severe the soft tissue injury is, simply by touch.

This approach is generally performed with a direct contact from us to the patient’s skin. We find the area to be worked on and either have you actively move a body part or passively move the body part. Our contact coupled with your movements is what allows the adhesions to separate.


You Can Get Relief – Let Us Help

At R3 Integrative Health, we can effectively treat nerve entrapment and, with time and patience on your part, bring relief from pain. Our overall goal is to identify why and how your nerve is compressed and then correct it with as little pain as possible, so you can return to life without fear of it returning.

Please, contact us now to ask any questions you may have or to set up an appointment. There’s no reason to continue living with pain when there is a way to treat it.


Why NKT®? (NeuroKinetic Therapy)

NeuroKinetic Therapy

NKT® (NeuroKinetic Therapy) is an innovative method of manual therapy which utilizes manual muscle testing to assess and correct dysfunctions of the coordination system of the brain. These dysfunctions commonly result from traumatic injury, over-use, under-use, repetitive stress, postural stress, etc and they ultimately get in the way of proper movement. They are eliminated resulting in immediate correction of imbalances and compensation patterns.

NKT® works with the body’s organizational intelligence, addressing pain at its source: the motor control center of the brain. Practitioners can quickly and accurately correct the dysfunctional postural and movement patterns that are the source of most mystifying chronic pain and degeneration.

Most musculoskeletal pain is caused by imbalances of neurologic origin. some muscles are over-stimulated, others under-stimulated. With specific testing, practitioners are able to detect and correct these patterns. This process allows NKT® to yield faster and longer-lasting results than many other techniques.

Some of the benefits of NKT® include:

  • Uses muscle testing to locate the source of the problem
  • Achieves faster, longer-lasting results than many methods
  • Eliminates enduring patterns of dysfunction from old injuries
  • Reduce the effects of repetitive stress injuries
  • Enhances athletic performance
  • Quickly improves muscle coordination
  • Increases range of motion, energy, strength and stamina throughout the body
  • Work is done with clothes on for maximum comfort
  • Coupled with corrective exercises for maximum benefit

NKT® uses strategy, not force to achieve results. It can provide solutions for conditions that have not responded to previous treatments. This advanced therapy blends well with and is the perfect adjunct to other treatments such as chiropractic, physical therapy and acupuncture.


Most Therapists make THIS mistake

Why is assessment so important?

Whether you go see a Chiropractor, Physiotherapist, Massage Therapist, Athletic Trainer, Osteopath, or other.. they all share a common goal with each patient – getting them better.

The typical problem, in my opinion, is that there is usually very little time spent in each session for assessment and re-assessment. Instead, they simply listen to your complaints, and go right into treatment. This is comparable to purchasing stocks of a company without doing any prior research about the company you’re investing in! Moral of the story: TEST, DON’T GUESS!

Gathering the RIGHT information

Gathering information through tests really should be the foundation of all you do in practice and should be what allows you to make proper treatment recommendations and provide accurate and effective therapy. To explain my stance, I’ll compare assessment/treatment with a road trip:

So first of all, to know where you have to go, you must first know where you are to begin with (what is your current range of motion/tissue health?).

Next, you need to figure out which direction you need to take in order to get to the destination and in a timely fashion (what areas to treat and why).

Lastly, and arguably the most obvious, is making sure you have made it there or not (re-test/re-measure after treatment). If one or more of these steps have been missed. It could be why you are still in pain and not getting better. Keep in mind, once again, that this is simply my view on the matter. It is simply the way I prefer to operate in practice, and it is what produces the best results.

Assessment and Measuring

At R3 Integrative Health, your first visit is largely assessment-based due to the fact that we are interested in figuring out your pain from its source and not only managing your symptoms you’re coming in with. Those symptoms will vanish if the main issue it addressed properly. The human body is complicated, and everyone’s body differs from the next. This means that your body requires very specific intervention and needs attention to detail. After the initial visit, your follow-up sessions also begin and end with assessment. Measuring your range of motion, not just guess but to KNOW how much better or not you actually are with the current treatment. By measuring, you can tell just how effective or not the treatment was.


This is NOT Graston Technique Therapy

“Oh, Graston® is going to hurt a LOT.” “My friend had Graston done, she looked bruised like she had been hit by a truck.” “My buddy just uses a spoon or mortal rod, it’s the same thing right?” If I had a dime for every time someone said something like those…

Graston Technique Therapy is 6 specifically designed stainless steel instruments that are used to detect and assist in the treatment of soft tissue dysfunction. A Certified Graston Technique Provider will know 14 different strokes and no less than 8 ways to make treatments more conservative or aggressive.

To clarify, It’s not about bruising a patient. For example, If a patient is treated and bruised on Monday, on Thursday we aren’t just treating the original complaint. We are treating the original complaint and bruised up, sore tissue.

What is it about then?

  • The stimulation of fibroblast. Graston Technique has been shown to increase fibroblast and these little cells can differentiate (change) into what your body needs (muscle, tendon, a communicating type cell).
  • Cellular reorganization. I have seen both stained slides and electron microscopy pictures of ligaments at 4 weeks out from time of injury both with and without Graston Technique. The difference is remarkable, see for yourself below!
  • The stimulation of resident mesenchymal stem cells. These cells are key for vascular repair, tissue healing and regeneration.
  • Change in elastic modulus. It’s about making tendons able to recover from loads without lasting deformation. Graston Technique has many case studies and case series showing positive changes in tendinopathies.
  • Changing range of motion. Scour the research and you’ll find numerous clinical trails where people have an increase range of motion in the shoulder or hip post Graston Technique Therapy.
  • Reducing pain. By increasing the activity in local mechanoreceptors (movement receptors), the brain will reflexively decrease the activity in local nociceptors (pain receptors).

Ricki Porter, RMT, owner and founder of R3 Integrative Health is a Certified Graston Technique Provider, and uses this method on a daily basis.

Do you think you have a condition that Graston Technique could help? Call us today ask, you wouldn’t want to miss an opportunity to fix a nagging problem. 506-863-8844

Click here for Graston Technique research resources.