Case Study: Patient with Back Pain, Scoliosis and External Foot and Hip Rotation Successfully Treated

Our Patient

Our patient was a 22 year-old male presenting with low back pain, scoliosis, and external hip and foot rotation.

The Challenge

The patient had previously sought orthopedic consultations and underwent MRI. The suspected diagnosis was ischio-femoral impingement, a condition associated with hamstring syndrome, to which his external hip and foot rotation were attributed. The rotations were corrected at the thoracic and upper lumbar level (L1-2), and the sacroiliac joint (SIJ) position was restored, but his treatment did not provide significant relief.

Exam and Diagnosis

In addition to a general clinical exam, we conducted a comprehensive assessment that involved a battery of physical tests and functional neuromuscular ultrasonography. The patient’s health history was carefully reviewed to better understand his overall health profile, as well as any previous treatment he had received.

We determined that the patient’s foot and hip external rotation were related to his spinal and pelvic posture.

Our Treatment Approach

We took a holistic and multimodal approach to target the underlying causes of the patient’s pain and dysfunction.


Our treatment protocol encompassed:

  • Ultrasound guided dry needling to target myofascial trigger points
  • TECAR therapy with INDIBA to facilitate manual release of multiple tight muscles
  • HEIT neuromodulation to decrease muscle hypertonicity, modulate pain and downregulate the sciatic nerve
  • Focused shockwave therapy to treat a thickened semimembranosus muscle that was narrowing the ischio-femoral space
  • Physical therapy to address rotational and postural issues and optimize mobility
  • Recommendation of appropriate footwear
  • Prescription of muscle-specific home exercises and physical activity

Final Results

As a result of our treatment protocol, the patient reported multiple positive outcomes:

  • Postural misalignment, scoliosis and spinal rotation were corrected
  • Pelvic alignment and SIJ movement were restored
  • Ischiofemoral space was increased from 12mm to 20 mm


Our patient’s complaints of back pain, scoliosis and external hip and foot rotation were resolved through a comprehensive assessment and a targeted multimodal treatment approach, resulting in significant improvements in the patient’s overall condition.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

Buy now 3D Gait
Payment Success
Request Telehealth Request Telehealth Request in office visit Book now