Nutrition Case Reflection Template

Name Dimitrios Anthopoulos: 12054582 

/student
number
Patient/ Age / Sex 21yr/old Male
subject  
information
   
  Presentation  The patient presented with a two-week onset of
  Lower back pain, fatigue and cramps (during/post
exercise). He is a semi-professional football player
who is training 3-4 days a week. He works as a sales
assistant at target (3 shifts a week) and is at Tafe
studying personal training.

   
  Investigations/approaches  The patient presented with lower back pain with a
  VAS of 6/10. He presented a dull ache predominantly
right sided. The pain was not constant and increased
after training sessions for football. Heat was a
relieving factor as well as rest, with physical activity
the major aggravating factor.

Physical exam – On physical exam there was no

neurological or visceral signs. Passive testing was pain
free but showed significant decreased range of
motion on all lumbar and hip ranges of motion. Active
and resisted testing reproducing the painful
symptomatology. On palpation there was tenderness
and hypertonicity through the erector spinal muscle,
QL, Glutes. Orthopaedic exam: Negative for
neurological inclusion via disc/nerve, Facet joint
involvement. Positive indication from prone active hip
extension, Trendelenburg (overactive hamstrings and
lumbar Muscles with inhibited Glutes).

X-Ray – presented with AP and lateral lumbar imaging

+ report from GP. There was no significant findings
present on the Images.

Nutrition – Has used food diaries in the past month

and allowed the clinic to add copies of these to his
files. They showed a high intake of meat protein and
carbohydrates but also showed deficits in his fibre,
 calcium, magnesium intake. The patient had been
taking multiple supplements such as whey protein
and a series of multivitamins.

 
 
Biometrics    weight BP …………. ……… ……… ……….
… … .

pre 71KG   119/79        

  post 70KG  116/76         

Relevant Medication Dosage Before Dosage After

  Intervention Intervention

NIL Medications NIL NIL

   
  Diagnoses  
   The patients was diagnosed with a
postural/biomechanical disfunction. Lower cross
syndrome with inhibition of the gluts, over activation
of the Hamstring and lumber extensors causing
myofascial mediated pain of the lumbar spine.

treatment/ Nutrition  
intervention The patient was educated and pushed to research
  the subject of nutritional balance in diet as he is
  studying personal training it would be of benefit to his
future profession. The major change proposed
nutritionally was to change from multiple
multivitamins to a single powder form to provide the
same results. The clinic sold the patient a Fibroplex
Plus Magnesium powder by Metagenics, which is
relevant for this case as it has both magnesium and
calcium included in the ingredient profile. The patient
was educated to try and increase his fibre intake
naturally through raw foods.

Physical activity/rehabilitation  
 A rehabilitation plan was put in place to coincide with
the patients current football training regime. This
Included:
- Stretches Gluts, Hamstrings, quads, hip
flexors, calfs
- Functional strength/proprioceptive
progressions for Posterior chain, glut
 activation, lower limb kinematic chain.

Chiropractic Management  
 The chiropractic management for this patient
included soft tissue work mixed with adjustments to
restore function back to restricted joints in the lumbar
spin, hips and pelvis. The soft tissue work included
manual massage to hypertonic muscles and Active
release myofascial release work. The adjustment were
all manual diversified adjustments with some drop
piece and blocking to the pelvis. Treatments began
twice a week for the first 2 weeks then once a week
for 4 then fortnightly for 8.

Co-management/interdisciplinary  
management  Therewas no co management or referral for this
patient once in care.

Clinical Process /  
summary management /
review  The patient progressed through treatment as expected and was
extremely compliant. He was diligent and interested in learning more
through his own research. The management plan was followed with 2
treatments a week in the first 2 weeks and with once a week for the
next 4 then fortnightly for the next 8. The Fibre intake was successfully
increased through raw foods and calcium and magnesium through the
fibroplex plus supplement.

Outcomes /  
results
 The patient outcome from treatment was good. The patient felt
stronger and mostly pain free after the initial 2 week period and was
totally pain free after 4 week of treatment and rehab. Retesting on
functional testing has shown improvement along with postural
improvement. He feels his sleep has improved and puts this down to the
fibroplex plus increasing his magnesium and calcium levels. The patient
also feel to have learnt from this clinical experience and can take what
he has learnt into his new profession as a personal trainer.

 
 
Reflections/  
Notes Reflecting on this case I feel the successful result can’t be dismissed. The timeframes
(500-750 words
as a guide)
originally set were adhered to and followed with great success. The physical treatment
(use a separate and rehab for this case I feel has been successful and for this individual case need no
sheet if desired) improvement or changes.

With the nutrition side of the treatment/advice I feel some changes and investigations
could have been done/utilized better.
I feel that testing could have been done to test the levels of Vitamins and minerals
rather than relying on a food diary although a proper food diary is nothing to be ignored.
A referral to a GP for blood work is a simple improvement. Along with the food
diary we will be able to get a more thorough picture of the patient intake and
how the patient body is controlling the levels of vitamins and minerals.
Magnesium deficiency is not commonly seen in healthy adults as its excretion is
controlled by the kidneys which help to limit excessive loss ("Office of Dietary
Supplements - Magnesium", 2021). In this case I would have liked to have seen
more investigation into the patient’s food diary and what makes it up as we see
the lack of vitamins and minerals in processed foods (DiNicolantonio et al., 2018).

The recommendation of raw food intake to increase the patients fibre I feel could
have been mirrored with an increase in magnesium and calcium rich foods. We
find calcium easily in food like Yoghurt, cheese, leafy vegetable and nuts
("Calcium", 2021). With magnesium we can find it again in leafy greens
vegetables, spinach, nuts and seeds ("Magnesium", 2021). I would have liked to
see this positive raw food approach as a first port of call as the patient is
extremely compliant and aware of his body and health. Protein intake was not
looked into thoroughly. The consumption of protein above the RDI has been
shown in the long term to have negative health effects (Delimaris, 2013). For this
reason, the same raw food approach would be ideal to investigate for this
patient.

I feel this case was a successful with physical and nutritional advise but some
adjustments still could have been made to better educate, investigate and be
positive with the nutritional choices.
References
Calcium. (2021). Retrieved 27 January 2021, from
https://www.nrv.gov.au/nutrients/calcium.
Delimaris, I. (2013). Adverse Effects Associated with Protein Intake above the
Recommended Dietary Allowance for Adults. ISRN Nutrition, 2013, 1-6.
https://doi.org/10.5402/2013/126929
DiNicolantonio, J., O’Keefe, J., & Wilson, W. (2018). Subclinical magnesium
deficiency: a principal driver of cardiovascular disease and a public health
crisis. Open Heart, 5(1), e000668. https://doi.org/10.1136/openhrt-2017-000668
Magnesium. (2021). Retrieved 27 January 2021, from
https://www.nrv.gov.au/nutrients/magnesium.
Office of Dietary Supplements - Magnesium. Ods.od.nih.gov. (2021). Retrieved 27
January 2021, from https://ods.od.nih.gov/factsheets/Magnesium-
HealthProfessional/#en3.