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G F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 75 Ida Rolf once said, "Where you think the pain is, the problem is not." This holds true in the worlds of osteopathy, physical therapy, massage, and bodywork. The following case study, taken from my own physical therapy clinic at the University of Oxford, illustrates Rolf's statement well. The patient presented with pain in her left shoulder, but after careful examination, evaluation, and detective work, it was determined that the cause of the problem originated in an area one might not have originally considered. CASE STUDY The patient in question was a 34-year-old female physical trainer for the Royal Air Force. She presented to the clinic with pain near the superior aspect of her left scapula (Image 1). The pain would present at the 4-mile mark of a run, forcing her to stop because it was so intense. The discomfort would then subside, but quickly return if she attempted to start running again. Running was the only activity that caused the pain. Her complaint had been ongoing for eight months, had worsened over the past three, and was starting to affect her work. There was no previous history or related trauma to trigger the complaint. After seeing different practitioners, who all focused their treatment on the upper trapezius, she visited an osteopath who treated her cervical spine and rib area. The treatments she received included the application of soft- tissue techniques to the affected area—namely the trapezius, levator scapulae, sternocleidomastoid (SCM), scalenes, etc. The osteopath also used manipulative techniques on the facet joints of her cervical spine: C4–5 and C5–6. Muscle energy techniques and trigger-point releases were used in a localized area, which offered relief at the time, but made no difference when she attempted to run more than 4 miles. She had not undergone any scans (e.g., MRI or X-ray). Glutes and the Muscle Energy Techniques to Address Them By John Gibbons Diagram of case study patient's painful area—left superior scapula. 1