Improving Spinal Range of Motion Using Integrative Manual Therapy^SM

Author: Helen Quirk MSPT

Abstract: This article is a case report on a 59 year old woman with complaints of chronic multiple joint pain and decreased ease of movement. The patient reported difficulty in activities of daily living, including driving. The woman was evaluated and treated with Integrative Manual Therapy (IMT) for a total of three and a half hours. Upon evaluation, patient presented with decreased spinal motion on all planes and pain during motion. The patient was treated with IMT that focused on biomechanics. After treatment was completed, the patient presented with full spinal flexion and an elimination of pain during spinal movement. The patient also had an improvement of static and dynamic posture.

Key Words: Spine, Joints, low back pain

 

Introduction

The patient (pt) is an active 59 year old female with complaints of long standing multiple joint pain which has been progressively getting worse. She complained about loss of agility and ease in doing her gardening, truck driving and lawn mowing.

Examination

History: Hysterectomy several years ago, bilateral carpal tunnel surgery, aching of joints especially her right knee, hips and low back.

Medications: Thyroid medication

Static Posture: Forward head, rounded shoulders

Spinal Range of Motion (ROM) Limitations: Moderately limited in all planes for spinal ROM. Pt was unable to touch the floor with her hands and the movement was painful (see figure 2).

Walking: Reduced arm swing, short stride.

Treatment

The principles of Integrative Manual Therapy^SM (IMT), as stated in Weiselfish’s book Manual Therapy with Muscle Energy Technique for the Pelvis, Sacrum, Cervical, Thoracic & Lumbar Spine (11), were used for diagnostics and treatment. All treatment techniques used, were learned from course work offered by Dialogues in Contemporary Rehabilitation (DCR) and are referenced.

The patient was treated over a 3.5 hour period. The treatment sequence and plan were decided from the pt's Myofascial Map of the transverse plane (12) (figure 1).

Muscle Energy (7, 10, 11): Bilateral Flexed Sacrum, Ascended Right Sacrum, Right on Left (ROL) Sacral Torsion, Left Upslip, Bilateral Extended Sacrum, Left on Left (LOL) Sacral Rotation, Lumbar vertebrae 5 (L5) Flexed Sidebend Rotated right FRSR, L5 Extended Sidebend Rotated right (ERSR), L3 FRSR (11), Accessory Sacroiliac Joints Mobilization (10), Type III MET at the cranial base (7), ankle subtalar joint mobilization (11).

Bone Bruise Technique (7): Right Posterior Inferior Iliac Spine (PSIS) and Left PSIS

Advanced Strain and Counterstrain (9): All Diaphragms, Iliac Artery, Femoral Artery

Disruption of Membrane Technique (8): Right Iliac Artery, Right Cecum, Small Intestine, Subclavian Artery

Myofascial Release (12): Thoracic Inlet Diaphragm, Respiratory Abdominal Diaphragm

Compression Syndromes (8): Great Vein of Galen Decompression

Outcome

After treatment, the patient presented with full spinal flexion with no pain. She was able to touch the floor without posterior translation of her buttocks (see figure 3). The patient’s stride increased and she had a more upright standing posture.

Discussion

Integrative Manual Therapy^SM is indicated for all persons with joint range of motion limitations. Traditionally, spine flexibility is used to evaluate individuals with back pain (2). Flexibility measures have been and are used as a screening tool for physical examinations and employment screening in the effort to identify back health (1). People with low back pain usually present with limited ROM, and move extremely slow and controlled (5). Often physical therapy intervention involves regular stretching to help with ROM limitations (6). This intervention as the main practice needs to be reevaluated. Often, it appears the patients limit their movement and activities in order to protect and guard against increased stress on the spine (5). The reason a person could have decreased ROM could be from several factors. A person with a systemic disorder, muscular disease, neurologic problem, joint dysfunctions, surgical intervention could all contribute to loss of ROM (3). If the therapist is using stretching as their only tool for increasing ROM, they could be stressing another system. If the joint, does not have the ROM required to accommodate the stretch, it can be hypothesized that more compensation occurs leading to a break down at the joint and/or other body parts. This study shows that if biomechanics and soft tissue dysfunctions are addressed a more normal and full ROM can be restored.

Summary

Background and Purpose: The purpose of this case report was to present the examination and treatment of a woman with spinal range of motion limitation. It showed how lumbar flexion can be changed after treatment and how increased range of motion can change walking posture as well as static posture.

Case Description: The patient, a 59 year old female, had multiple joint complaints and spinal range of motion loss.

Outcomes: The patient was seen for 3.5 hours using Integrative Manual Therapy^SM. She started with limited forward flexion and had full forward flexion of her lumbar spine after the treatment. Her stride length increased and her speed of walking improved. Her forward head posture was reduced and thoracic kyphosis was not as prominent.

Discussion: Recognition that limited joint range of motion is a common cause of dysfunction, pain and disability in our population using Integrative Manual Therapy^SM is a way to help our population prevent and overcome disability.

Conclusion: This case report describes a patient with limited spinal range of motion before treatment and full spinal flexion after treatment. This case reviewed the intervention that helped obtain these results. The case was presented in order to help other therapists see how effective and efficient Integrative Manual Therapy^SM can be in treating a person with limited spinal range of motion. This intervention can benefit multiple disorders and can greatly affect the millions of Americans and people in our world who suffer from pain and disability.

References

1. Advanced Clinical Biomechanics of Sacrum. Course text. 1998.
2. Battie C. Bigos J., Sheehy ,Wortley MD. Spinal flexibility and Individual Factors that Influence it. Physical Therapy. 1987:67,#5:653-658.
3. Frymoyer JW, Cats-Baril W. Predictors of Low Back Pain Disability. Clinical Orthopaedics and Related Research. 1987; 221:89-98.
4. Kisner C, Colby Lynn A. Therapeutic Exercise Foundations and Techniques. United States: Davis Co., 1990.
5. Klein AM, Snyder-Mackler L, Roy SH, Deluca CJ. "Comparison of Spinal Mobility and Isometric Trunk Extensor Forces with Electromyographic Spectral Analysis in Identifying Low Back Pain." Physical Therapy. 1991; 71,#6:445-454.
6. Marras WS, Wongsam PE, "Flexibility and Velocity of the Normal and Impaired Lumbar Spine." Archives of Physical Medicine Rehabilitation. 1986: 67:213-217.
7. O’Sullivan SB, Schmitz TJ. Physical Rehabilitation: Assessment and Treatment. Philadelphia: F.A. Davis Co. 1994.
8. Weiselfish-Giammatteo S. Assessment, Diagnostics and Treatment of Type III Dysfunction with Muscle Energy Techniques and Beyond MET 4. Course text. 1997.
9. Weiselfish-Giammatteo S. Diaphragm Compression Syndromes. Course text.1998.
10. Weiselfish-Giammatteo S, Giammatteo T. Integrative Manual Therapy for the Autonomic Nervous System and Related Disorders. North Atlantic Books, Berkeley California. 1997.
11. Weiselfish-Giammatteo S. Integrative Manual Therapy for the Low Back and Spine – Weiselfish S. Manual Therapy with Muscle Energy Technique for the Pelvis, Sacrum, Cervical, Thoracic and Lumbar Spine.
12. Weiselfish-Giammatteo S. Myofascial release – An Approach to Soft Tissue Mobilization with Fascial Fulcrum Techniques for the Orthopedic and the Neurologic Patient. Course text. 2000.

 

Appendix

 

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Figure 1. Patient’s Myofascial Map of the Transverse Plane Before Treatment