Single Case Study: A Combined Approach to Improve Segmental Spinal Mobility with Integrative Manual Therapy SM
Author: Jan Alt, PT
Abstract: This single case study is to demonstrate improvement of a patient’s segmental spinal mobility by applying the combined approach of Integrative Manual Therapy SM.
Key Words: Chronic Pain, Low Back Pain, Spinal Motion
Examination
History: This patient (pt) is a 53-year-old male who was injured in an ultralite airplane accident in which he sustained a wedge fracture at L3. He has had chronic low back pain with intermittent radiating left (L) LE (lower extremity) pain.
Static Posture: This pt’s posture is fair with externally rotated R LE (right lower extremity), slight anteriorly tilted pelvis, right pelvic obliquity, slight hyperextended thorax, and moderate forward head. He is also noted to have a lateral shift of his pelvis to the right (R) and his thorax to the left (L), with a functionally short L LE (left lower extremity).
Spinal Range of Motion: This pt’s spinal range of motion (ROM) was full in forward bending (i.e., flexion) but with poor segmental mobility. His bilateral (B) side bending and backward bending (i.e., extension) was severely limited. All motions were painful.
Diagnostics: The treatment was based on the pt’s ROM limitations, posture and Myofascial Map of the transverse plane (5) (figure 1).
Treatment
The pt was treated over a two-hour period using treatment techniques, which were learned in Dialogues in Contemporary Rehabilitation (DCR) courses and are referenced below.
Muscle Energy and ‘Beyond’ Technique (3,4): Bilateral accessory sacroiliac joints (4), Osseous Compression Syndrome L2, Type III shear at T12 (4), Left (L) descended sacrum, Right posterior vertical rotation, T12 to L5 Right Rotated Left Side bent (3), L3 Flex Rotated Side bent right (FRSr), Right on Right (ROR) sacral rotation, Left anterior vertical rotation, and L1 Extended Rotated Side bent right (ERSr).
Bone Bruises (5): Bilateral posterior superior iliac spines.
Compression Syndromes (2): Left lateral distal surface of lung from left lateral superior surface of diaphragm release, Right lateral distal surface of lung from right lateral superior surface of diaphragm release, Liver from diaphragm release, and Stomach from diaphragm release.
Advanced Strain and Counterstrain (1): Liver, stomach, and pial arterial plexus from T12 through L5.
Neurofascial Release (6,7): Neurofascial release on a transverse and coronal planes.
Outcomes
At the end of the two hours of treatment, this pt had improved static posture with no lateral thoracic or pelvic shift, no anterior tilt to his pelvis, no hyperextension of his thorax, and decreased forward head. He was also noted to have equal leg lengths with no pelvic obliquity. His spinal ROM had significantly improved to full flexion with fair segmental mobility in his thoracic and lumbar regions, and a 50% increase in bilateral side bending and extension. His ROM was also pain free.
References