The Benefits of Integrative Manual Therapy in a Client with Headaches and Low Back Pain

Authors: Susan Morrison DC and Adrienne Kramer PT

Abstract: In this case study, a 35 year old man with complaints of headaches and low back pain as well as transient pain in his joints, especially his knees, receives treatment with Integrative Manual Therapy. The man has a history of trauma that includes a motorcycle accident and surgery to his right ear. Upon evaluation, the patient presented with limitations of motion in his spine and postural deviations total body. After therapy was completed, the patient presented with significant increases in range of motion and improvements in posture. The man was able to return to his activities of daily living.

Key Words: Headache, Low Back Pain, Motorcycle Accident, Ear, Bone Bruise

History: In this case study, the patient, Gene D., is a 35 year old man with complaints of headaches, pressure in his head, low back pain, and transient pain in the joints, especially his knees. Past Medical History included a motorcycle accident with loss of consciousness in 1985 and right ear surgery in 1995.

Evaluation:

Posture: Moderate forward head and neck; Decrease in thoracic kyphosis between T2 - T7; Bilateral shoulder protraction; Loss of lumbar lordosis; Shift of the cervical spine to the right.

Joint Mobility of Spine: Hypomobility of right and left pelvic joints, lumbar spine levels l-4, thoracic spine T2 - T8, and cervical spine C5 - C7.

Spinal ROM: Lumbar spine limitations-- 80% flexion, 70% extension, 80% right sidebending, 70% left sidebending; Thoracic spine limitations-- 70% flexion, 60% extension, 50% right sidebending, 45% left sidebending, 80% left and right rotation; Cervical spine limitations-- 80% flexion, 70% extension, 60% right sidebending, 65% left sidebending, 90% right and left rotation.

Muscle Tone and Fascial Dysfunction: Protective muscle spasm was found throughout the spine and pelvic muscles.

Function: All movement are painful and difficult.

Myofascial Mapping: Patient presents with Mapping total body positive on a transverse plane.

5 Point Longitudinal Pressure Scan: Right vertebral artery

Treatment: Treatment consisted of the following Integrative Manual Therapy Techniques: Cranial Therapy Level Three Compression syndromes for the Vertebral arteries; Disruption of Membrane Technique (DOM); Resistance Therapy to Immune Deficiency Motility (IDM); Bone Bruise Technique (BB) to the cervical spine; Advanced Strain and Counterstrain for the diaphragms, aorta, superior and inferior vena cava, iliac arteries, proximal femoral arteries, subclavius, subclavian arteries, carotids, basilar arteries, Circle of Willis, and artery to hypothalamus; DOM , IDM and BB to all above areas; Muscle Energy and ‘Beyond’ Technique for the pelvis, sacrum, L5-S1, O/A joint, L1-4 Type I and II, T 2-8 Type I, C6 Type II; Myofascial Release Spinal Protocol. Further treatment was based on a new 5 Point Longitudinal Pressure Scan which located the right ear: Cranial Therapy Level Two-- Cranial Diaphragm Releases; Cranial Therapy Level One through Level four focusing on the temporal area and hearing; DOM, IDM, and BB to above areas; Cranial Therapy Level Three for the dura, arachnoid and pia mater; Neurofascial release on a sagittal, transverse, frontal and coronal plane; Advanced Neural Tissue Tension Techniques for the Cranial nerves; Intermittent emotional work using Integrative diagnostics for Applied Psychosynthesis (IDAP) and Neurofascial Process homework.

Outcome: Following treatment, the patient presented with the following improvements:

Posture: Improved lumbar lordosis, decreased forward head, symmetrical cervical spine posture.

Joint Mobility of the Spine: Normalized mobility of pelvic joints, moderate hypomobility of lumbar spine, moderate hypomobility of thoracic and cervical spine.

Spine ROM: Lumbar spine limitations-- 50% flexion, 50% extension, 70% right sidebending, 40% left sidebending; Thoracic spine limitations-- 50% flexion, 70% extension, 40% right sidebending, 40% left sidebending, 50 % right and left rotation; Cervical spine limitations-- 50% flexion, 40% extension, 70% right sidebending, 30% left sidebending, 40% right rotation, 50% left rotation.

Muscle Tone and Fascial Dysfunction: Decreased muscle spasm in spine and pelvis with significant decrease in fascial dysfunction throughout cranium.

Function: Patient is able to complete activities of daily living without significant pain.

Symptoms: Patient reports decreased pressure in head , decreased frequency and severity of headaches, and decreased back and neck pain. Patient continues to receive treatment to address the remaining restrictions and symptomotolgy.

Conclusion: Patient’s cervical spine motion increased as a result of treatment with Integrative Manual Therapy to the vertebral arteries and Bone Bruise Technique to the cervical spine. The patient’s trunk range of motion increased as a result of treatment to the vascular chain which increased effectiveness of Muscle Energy and ‘Beyond’ Technique and Myofascial Release to improve the patient’s biomechanics and decrease fascial Dysfunction. Cranial pressure decreased with treatment of the dura, arachnoid and pia mater along with the Neurofascial Releases that were performed. Scarring that was present in the cranium due to the ear surgery, IDM from a pierced ear and trauma to the body from work as a carpenter may be contributing to continued symptoms.