The Benefits of Integrative Manual Therapy on a Patient with Chronic Low Back Pain
Author: Denine Savage PT
Abstract: This case report illustrates the benefits of Integrative Manual Therapy (IMT) when used on a 32-year old woman who presented for evaluation and treatment focusing on complaints of low back pain and an inability to stand erect.
Key Words: Ulcerative Colitis, Gastrointestinal Tract, Chronic Pain, Low Back Pain, Degenerative Joint Disease
History
This case report illustrates the benefits of Integrative Manual Therapy (IMT) when used on a 32-year old woman who presented for evaluation and treatment focusing on complaints of low back pain and an inability to stand erect. Upon Evaluation, the patient reported that she had been shoveling in her garden six months prior with sudden onset of severe back pain, greatest in the area of the right lumbar spine. The patient complained of severe muscle spasm in the right lumbar area ever since, despite five months of traditional physical therapy. Previous traditional therapeutic modalities included: ultrasound, electric stimulation, massage, heat, ice, stretching and gentle exercises. The woman reported an increase in pain over the last several weeks. She had developed slight numbness and tingling in the right leg and foot. The patient also reported she was only able to be comfortable in bed and that for the past six months, standing, sitting and all out-of-bed activities were very painful and limited.
The patient’s previous medical history included a severe episode of ulcerative colitis four years prior resulting in removal of her colon and connection of the stomach to the anus via an internal pouch. She also suffered a miscarriage two months prior to her back injury and was very desirous of regaining a healthy back and trying to become pregnant again. The patient had an MRI report from two weeks after back injury concluding degenerative joint disease of lower lumbar spine discs with a moderate, central disc herniation at L4-L5. In addition, she was suffering discomfort from a polyanal cyst. She was taking antibiotics for the cyst and muscle relaxants for her back.
The patient had muted affect and complained of a depressed feeling over her miscarriage and the recent months of pain and disability.
Evaluation
The patient’s evaluation revealed total-body positive Myofascial Mapping on a transverse plane (). (Total body positive mapping indicates the body is in a state of crisis.) In static, standing posture, the patient could not stand up fully and was "stuck" in a posture of 20 degrees right lumbar sidebending, 15 degrees lumbar flexion and 10 degrees right rotation of lumbar spine. Severe protective muscle spasm was palpable over the right lumbar paraspinal musculature, respiratory diaphragm and stomach. A 5 Point Longitudinal Pressure Scan () indicated the stomach as the primary area of the body needing IMT from the prospective of a medical model.
Treatment
IMT treatment commenced with:
The 2nd hour of treatment (performed 4 days later) included:
The 3rd hour of treatment (performed 5 days after initial evaluation) included:
The 4th–6th hours of treatment over the next week, included:
At the 7th and final hour of treatment, 23 days following her first treatment:
Outcome
The patient reported a steady decrease in all symptoms over the course of her treatments. She reported she was able to discontinue muscle relaxants after her second treatment. The patient’s mood was elevated, without signs of or complaints of depression.
Static, standing posture was improved, and after completion of six hours of treatment, she could stand fully and comfortably erect without any deviation to the right. The patient had resumed full activities after 6 hours of treatment with no complaints of pain.
After the 7th hour of treatment, Myofascial Mapping (1) was repeated and found to be reduced to being positive in areas over the sacrum, abdomen, neck and cranium, with a few small areas on the extremities. Patient plans to return for more IMT in order to address her goals of becoming pregnant and clearing up the rectal cyst completely.
References
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Rehabilitation 1997
2. Weiselfish-Giammatteo, S 5-Point Longitudinal Pressure Scan. Integrative
Diagnostic Series Part III: Neurofascial Release. Dialogues in Contemporary Rehabilitation 1998
3. Giammatteo, T, Weiselfish-Giammatteo, S IMT for the Autonomic Nervous
System and Related Disorders. Berkeley: N. Atlantic Books, 1997
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11. Weiselfish-Giammatteo, S Type III Dysfunctions. Visceral Mobilization with Muscle Energy & Beyond Tech. The Gastrointestinal Tract. Dialogues in Contemporary Rehabilitation 1998