Treatment of Limited Spinal Flexion: A Case Report on Effectiveness of Integrative Manual Therapy Techniques

Author: Carmen Smith P.T.

Abstract: This case report is to demonstrate the effectiveness and efficiency of a treatment session utilizing Integrative Manual Therapy techniques. The treatment consisted of 3 one hour sessions. Pre and post treatment pictures were taken to view functional outcome results. Prior to treatment, the patient presented with significant limitations in spinal motion. The subject of this study was a 6 year old female with no reports of pain or observable health issues. Parental concerns expressed at this time were changes in walking patterns. After treatment was completed, the patient presented with increased lumbosacral flexion.

Key Words: Pediatric, Spinal Motion, Bone Bruise

This case report is to demonstrate the effectiveness and efficiency of a treatment session utilizing Integrative Manual Therapy techniques. The treatment consisted of 3 one hour sessions. Pre and post treatment pictures were taken to view functional outcome results. The subject of this study was a 6 year old female with no reports of pain or observable health issues. Parental concerns expressed at this time were changes in walking patterns.

Medical History: Chickenpox.

Medications/vaccinations: Usual childhood vaccinations up to the age of 5, including Hepatitis B.

Evaluation findings: Picture A shows the patients mobility in spinal flexion. The patient was unable to flex beyond the mid-thoracic level without movement compensations.

Treatment: The patient was treated with the following techniques:

Specific manual therapy techniques for the C7/T1 area included:

1. Osseous Compression Syndromes of the vertebral segments of C7 / T1.(1)
• Disc Compression Syndromes for the above segments.(2)
• Advanced Strain and Counterstrain for the disc and vasculature component of the spine. (3)
• Neural Tissue Tension Techniques for nerve root restrictions at the C7 / T1.(4)
• Bone Bruise Technique for the vertebral segments of C7 / T1.(5)
• Muscle Energy and 'Beyond' Techniques were used to treat pelvic and sacral dysfunctions. The dysfunctions were a right ilial upslip with a right ischial downslip and a mild left ilial upslip with a left ischial downslip. In the sacrum, the dysfunctions were a bilateral flexed sacrum, right anterior vertical rotation, and bilateral posterior vertical rotations.(6)
  
2. Bone Bruise Technique to the ilium and the ischium. (7)
3. Type III Shear Technique to the interface of the ilium and ischium.(8)
4. Sacral coccygeal joint and filum terminale techniques.(9)
5. Myofascial Release at the sagittal sinus in the cranium. (10)
6. Disruption of Membrane Technique at the sagittal sinus. (11)
7. Bone Bruise Technique at the sagittal sinus. (12)

Outcome: Picture B shows post testing results of spinal flexion mobility. The patient was able to flex to the lumbosacral junction without compensatory movement.

References

1. Weiselfish-Giammatteo, Sharon Ph.D., P.T. Osseous compression syndromes of the vertebrae. Integrative Manual Therapy for the Low Back and Spine,Advanced Clinical Biomechanics of Sacrum. Tutorial with Sharon Weiselfish-Giammatteo,Ph.D.,P.T. 1999.
2. Weiselfish-Giammatteo, Sharon Ph.D., P.T. Disc compression syndromes. Integrative Manual Therapy for the Low Back and Spine, Advanced Clinical Biomechanics of Sacrum. Tutorial with Sharon Weiselfish-Giammatteo, Ph.D.,P.T. 1999.
3. Giammatteo T., Weiselfish-Giammatteo S: Integrative Manual Therapy for the Autonomic Nervous System and Related Disorders, North Atlantic Books, 1997.
4. Weiselfish-Giammatteo , Sharon Ph.D., P.T. Advanced Neural tissue tension techniques. Neural Tissue Tension. November 1999. Boulder,Colorado
5. Weiselfish-Giammateo , Sharon Ph.D., P.T. Bone bruise technique. Cranial Therapy Series Three. May 2000. Boulder, Colorado
6. Weiselfish S: Manual Therapy with Muscle Energy Technique for the Pelvis, Sacrum, Cervical, Thoracic, and Lumbar Spine, ANA Publishing, 1994.
7. Weiselfish-Giammatteo, Sharon Ph.D., P.T. Bone bruise technique. Cranial Therapy Series Three. May 2000. Boulder, Colorado.
8. Weiselfish-Giammatteo, Sharon Ph.D., P.T. Type III technique. Type III Dysfunction of the Spine and Extremity Joints with Muscle Energy and 'Beyond' Technique. May 1998. Boulder,Colorado.
9. Weiselfish-Giammatteo, Sharon Ph.D., P.T. Sacral coccygeal filum technique. Integrative Manual Therapy for the Low Back and Spine; Advanced Clinical Biomechanics of Sacrum. Tutorial with Sharon Weiselfish-Giammatteo, Ph.D.,P.T. 1999.
10. Weiselfish-Giammatteo, Sharon Ph.D., P.T. Sagittal sinus release technique. Myofascial Release for the Orthopedic, Neurologic, Pediatric, and Geriatric Patient: The 3-Planar Fascial Fulcrum Approach. August 1991. Colorado Springs, Colorado.
11. Weiselfish-Giammatteo, Sharon Ph.D., P.T. Disruption of Membrane Technique. Visceral Mobilization with Muscle Energy and 'Beyond' Technique: Focus on the Gastrointestinal Tract. March 1998. Eagle, Colorado.
12. Weiselfish-Giammatteo , Sharon Ph.D., P.T. Bone bruise technique. Cranial Therapy Series Three. May 2000. Boulder, Colorado.