Integrative Manual Therapy to the Shoulder Girdle Complex

Author: John Alegi, PT, IMPC

Abstract: In this case study, a 39-year-old man was treated with Integrative Manual Therapy for complaints of chronic neck and back pain. The patient had an interesting past medical history including two concussions and several respiratory infections. The patient received treatment focusing on the vascular system. After therapy was completed, the patient reported feeling taller and more mobile. The patient presented with significant improvements in posture and spinal ranges of motion.

Key Words: Chronic Pain, Neck, Spine, Low Back

History

Subjective: A 39 year-old male was evaluated for complaints of chronic, right neck, mid-spine, and left low back pain related to weight lifting about 12 years ago. Other complaints included moderate stiffness, mild decrease in concentration/attention, mild short-term memory loss, mild allergies, mild sinus problems, mild bowel problems, and mild snoring. Functionally, he reported that standing, walking, driving, working, too much activity, bending, reaching, lifting, kneeling, and too little activity made his symptoms worse. He reported that lying down and sitting alleviated his symptoms. The patient also reported that driving, sitting in a car, walking, and running were difficult. His sport and leisure activities were compromised, and he stated that his low back "goes out" when he ski’s.

Past Medical History: His medical history includes epiglotitis 3 years ago, two concussions, and a severe strep infection and pneumonia that required hospitalization. Traumas include several neck injuries and a rollerblading injury to his left knee. Currently, he is not taking medication, and during the past five years he has taken antibiotics.

Evaluation

Objective findings were as follows:

• Positive Myofascial Mapping(¹⁾ on a transverse plane of the arterial kinetic chain⁽²⁾
• limited lumbar range of motion-- lumbar flexion and extension limited by 80%
• Disruption of Membrane(²⁾ of the left brachiocephalic vein and sublcavian artery
• Osseous Compression Syndrome⁽³⁾ of the left clavicle
• Hypertrophy motility⁽⁴⁾ of the left clavicle
• Bone Bruise⁽⁵⁾ of the left clavicle
• Left shoulder protraction, increased thoracic kyphosis, and moderate forward head and neck posture
• Positive Myofascial Mapping on a transverse plane of the bilateral sacroiliac joints, the left S2 nerve root, and portions of the bilateral sciatic nerves

Treatment

The patient was treated with Integrative Manual Therapy, including the following techniques:

• Disruption of Membrane technique of the left brachiocephalic vein and left proximal subclavian artery
• Resistance Therapy⁽²⁾ to the Hypertrophy motility in the left clavicle
• Osseous Compression Syndrome technique for the left clavicle
• Bone Bruise technique to the left clavicle

Outcome

After therapy was completed, the patient presented with the following post-treatment results: Decreased left shoulder protraction, kyphosis, and forward head and neck posture; full lumbar flexion. Subjectively, the client reported feeling more mobile, taller, and noticed improved spinal posture. The patient presented with decreased positive Myofascial Mapping on a transverse plane of the arterial kinetic chain. There was also an elimination of positive Myofascial Mapping on a transverse plane of the bilateral sacroiliac joints and of the neural tissue of the buttock and posterior thighs.

References

1. Weiselfish-Giammatteo, Sharon, Ph.D., P.T., DCR Course: Integrative Diagnostic Series Level 1.

2. Weiselfish-Giammatteo, Sharon, Ph.D., P.T., DCR Course: Diaphragm Compression Syndromes.

3. Weiselfish-Giammatteo, Sharon, Ph.D., P.T., DCR Course: Upper Extremity Compression Syndromes.

4. Desert Light Health Associates Intensive Program, Bloomfield, CT, 2000.

5. Weiselfish-Giammatteo, Sharon, Ph.D., P.T., DCR Course: Cranial Therapy Series Level 3.