The Benefits of Integrative Manual Therapy on Chronic Pain
Author: Martha Moran, MT
Abstract: This case study focuses on a 31-year-old man with chronic pain. Upon intake, the man complained of headaches, low back pain, and left knee pain. He was treated with Integrative Manual Therapy focusing on Cranial Therapy and biomechanics using Muscle Energy and ‘Beyond’ Technique. The patient experienced a total relief of symptoms after therapy was completed.
Key Words: Headache, Low Back Pain, Chronic Pain, Gastrointestinal Problems, Cranial Therapy
History
The patient was a 31 year-old male; height 6 feet; weight 175 lbs. Chief complaints included chronic low back pain, left knee pain, headaches, and chronic gastrointestinal problems. Symptoms started about 5-6 years ago after a car accident. He received physical therapy, chiropractic and Craniosacral work to treat effects sustained in the accident, i.e., whiplash, sore back and neck and knee hitting dash. Currently, symptoms present 1-2 times per week. Hot or cold weather do not seem to have an effect on the symptoms. Pain is not noticed unless sitting or standing still for long periods of time. Lying down or movement does not reproduce symptoms. Medications are limited to taking Excedrin on rare occasions to control pain along with daily use of multivitamins. The patient is in good general health.
Past medical history includes chickenpox in 1978, appendicitis and appendectomy in 1994. Past history of trauma includes the following accidents: Hyperextended lumbar spine while jumping on trampoline in 1983; MVA where car hit telephone pole at 35-40 mph-- patient was in back seat with no seat belt and flew forward and hit right shoulder with no apparent injury in 1984 or 1985 (15 years of age); patient had a headache that lasted 16 hours after bungee jumping in 1992; the patient was in another MVA where he was rear-ended at about 10 mph in 1994. The patient had x-rays in 1994 after a car accident for lumbar/thoracic/cervical regions. Findings showed a loss of lordosis in the cervical spine. Family history includes lung cancer and throat cancer. Personal and social history includes being married for 4 years. The patient works as a chiropractor in a stable office environment with a partner he has known since he was a teenager. He works 5 days a week from 7:30 AM to 7:00 PM and serves as a board member with the state chiropractic association. His job does contain a lot of mental and physical stresses (x-ray chemicals and postural strain). He has many friends and family in the area and reports feeling well supported.
Subjective
Patient complains of a dull ache in low back area that is centrally located bilaterally around spine – specific to L5-S1 region. Pain does not radiate. Chiropractic adjustments, exercise and movement decrease pain. Inactivity and sitting increase pain. Patient complains of hot, aching, swelling feeling in the anterior knee. Throbbing pain is experienced only when swollen. Ice and elevating decrease left knee symptoms. Patient reports that he gets headaches 1-2 times per week but does not correlate them to the low back pain or knee pain. Headaches begin in occipital region with a dull ache and then move temporal and frontal with increasing intensity. He has noticed that headaches seem to be present especially after sleeping more than 8-9 hours. The patient reports taking 2 Excedrin to relieve pain.
Current health status
The patient reports not using tobacco products and states that he drinks alcohol 1 time per month. He reports no regular exercise program, no restricted diet, drinks two 20 oz. caffeinated tea/coffee beverages a day, craves dairy foods and foods that are heavy (eats Mexican or Italian food at least 1 time per day), and rarely drinks water. The patient has not had any vaccinations since childhood.
Evaluation
Observation and palpation of the client presented the following:
Myofascial Mapping presented as total body still space (IDS, W. Giammatteo PhD, PT). The 5 Point Longitudinal Pressure Scan (IDS, W. Giammatteo, PhD, PT) located several areas with most predominant areas at the left leg, hip, and knee. Local Listening and General Listening located several areas with the primary area at the left leg, hip, and knee (Jean-Pierre Barral, DO).
Limitations in range of motion testing presented as follows:
The above tests helped to determine the cause of the dysfunction.
Treatment
Scanning tests such as Myofascial Mapping (W. Giammatteo PhD, PT), and General and Local Listening (Jean-Pierre Barral, DO) helped to locate the cause of the dysfunction. Based on the results of the scanning tests, a course of treatment was chosen using the Integrative Systems Approach. The following are Integrative Manual Therapy techniques:
Outcome and Discussion
Low back pain, headaches, and intestinal stress were the client’s main complaints. The client was seen three times for a total of seven hours in a one month period. Scan tests confirmed that the pelvis and sacral areas were rigid and low back paraspinals were in protective muscle spasm. In checking biomechanics of the pelvis, I found that both pelvis and sacrum were inferior (descended), thereby, putting extra tension on the dura and spinal cord, a compression to the lower sacral plexus nerve roots, and in the proximal end of the cord, a foramen magnum compression. Examination of the cervical spine and cranial base also showed a compression of the upper cervicals with an anterior shear of C1. Muscle Energy and ‘Beyond’ Technique, Cranial Therapy, and Neural Tissue Tension Techniques were very helpful in bringing the body into better alignment. After two sessions, the client reported feeling better – he had no low back pain. Overall, he was experiencing a better sense of self although not feeling like himself yet. He had one headache and had been biting the inside of his right cheek. On the last session, most of the work was based on Cranial Therapy and Biologic Analog techniques which included balancing mobilities and motilities of brain structures plus using the Disruption of Membrane technique (W. Giammatteo PhD, PT) on vasculature to restore integrity of cerebral vascular tissues. After the last session, the client reported feeling more balanced and relaxed. The plan for the next session was to follow-up on his progress regarding the headaches and investigate further his chronic intestinal stress.