Abstract: The client was a 31 year old male who was in a motor vehicle accident (MVA) and experienced whiplash in October of 2000. After the accident, the client complained of Chronic Fatigue Syndrome, anxiety, and pain during activities of daily living. He was a musician by trade. The man started treatment with Integrative Manual Therapy (IMT) two months status/post the MVA. The IMT treatment focused on the client’s nervous system, vascular system, and musculoskeletal system. His initial pain complaints ranged 8-9 out of 10 on a visual rating scale. At discharge, the client reported all pain diminished to 0 out of 10.
Written by, Ann Bernard, OT(C), RCST
Diagnosis:
Motor Vehicle Accident with Whiplash and Seat Belt Injury
Mechanism of Injury:
MM, age 31, was involved in a Motor Vehicle Accident on October 31, 2000.
He was the front seat passenger when the car he was riding in hit the car
in front. The accident occurred on a city street at low speed.
Occupational and Social History:
MM is a musician of multiple instruments and a composer of New Age and mood
music.
Previous History:
MM experienced physical abuse as a child. As an adolescent, he had Mononucleosis
and later, Chronic Fatigue Syndrome. In recent years, he has been in better
health. His current list of symptoms included many that were unrelated to
his accident.
Signs and Symptoms
MM had restricted range of motion in the neck and low back and had a forward
head posture. Symptoms included pain in bilateral knees, low neck, low back,
sacrum, right leg, right arm, hand and shoulder. He was not sleeping normally.
He said that he was awake too much, woke too easily, was feeling frazzled
and was super-sensitive to events around him. He was concurrently experiencing
a lot of stress in his personal life.
Assessment
Myofascial Mapping on a Transverse Plane was positive at the following sites:
T7-L5, Sacrum, Thoracic Outlet, base of the neck, and Hyoid. Sacrum and Ilia
were downslipped on the left with a left anterior rotation. Diaphragms were
sheared. Forearms, hands, brachial plexus, lower legs, feet, and eyes including
the Zygomas were Still Space.
Client Goals of Treatment
1) To play all his musical instruments without pain (pain visual rating scale:
9/10).
2) Writing and typing without pain in his arms (pain visual rating scale:
9/10).
3) To be able to walk and ride his bicycle without pain in his knees (pain
visual rating scale: 8/10).
4) To be able to sleep normally (difficulty visual rating scale: 8/10).
5) To be free of pain in his body (pain visual rating scale: 8/10).
Treatment
MM received 15 hours of treatment between November 10, 2000 and February 26,
2001. He was treated with Integrative Manual Therapy (IMT). Techniques used
included Muscle Energy and ‘Beyond’ Techniques, Strain and Counterstrain,
Advanced Strain and Counterstrain, Neural Tissue Tension Techniques, Myofascial
Release, Type III’s, and IDAP (Integrative Diagnostics for Applied Psychosynthesis).
Areas that were focused on with IMT included: the brachial plexus, upper extremity
nerves and arteries. He responded well to the above listed techniques. His
low back, sacrum and knees responded very quickly. The base of his neck, brachial
plexus and arms needed more intensive intervention.
Because of the problems in his personal life, he was often distracted and
produced large areas of Still Space. These areas were aged and addressed appropriately.
Currently, many of these problems have been resolved in some way and his life
at the moment has some new opportunities. He currently complains of anxiety
and panic when he rides in a car as a passenger.
Discharge Status
All goals were achieved with pain visual rating scales at 0 out of 10, except
the following: MM continued to have difficulty with writing, stating that
it caused him pain in the back of his forearms, his upper arms and elbows.
He rated this pain as a 2 out of 10.
The client’s feelings of anxiety and panic while riding in a car initially
decreased (IDAP) but then increased as he became more socially active and
rode in more cars. His general health and mood were noticeably improved.
It would have been beneficial to address the client’s Chronic Fatigue
Syndrome with IMT but with the resolution of the symptoms directly related
to the MVA within the treatment plan as agreed to with the insurance company,
the client was discharged.