Functional Gains Using Integrative Manual Therapy with a Patient Experiencing Multiple Sequelae and Pain from Separate Trauma to the Sacrum and Cranium

Author: Scooter LeBleu PT

Abstract: This case study illustrates the functional gains that can be attained with the use of Integrative Manual Therapy in a patient who suffers from pain secondary to trauma to the head and sacral regions.

Key Words: Irritable Bowel Syndrome, Nystagmus, Digestion, Headache, TMJ

History: An Eighteen year old female experienced a fall on her sacrum/coccyx in 1990. She was diagnosed with irritable bowel syndrome in 1991. Results of an upper gastrointestinal (GI) test were negative. In May of 1997, the patient fell and struck the left side of her head sustaining a concussion and losing consciousness for five to ten minutes. Two CAT scans were negative. Since that injury she has experienced migraines, low back pain, nystagmus, weak right lower extremity, vertigo, tinnitus, trouble sleeping, blurred vision, memory loss, poor concentration, moodiness, temporo-mandibular dysfunction, poor balance, tactile defensiveness, reflux, digestive problems, and fatigue.
From September of 1991, through December of 1999, the patient received physical therapy twice weekly consisting of crawl patterning, deep pressure massage, and sensory integration with no change or improvement. In October of 1999, she began to wear an intra-oral splint for nocturnal bruxism.

Evaluation: In June of 2000, the patient was brought by her mother for evaluation and assessment. Patient goals included elimination of pain, increased energy, and improved memory. The patient was treated for three hours that day and ten days later, she received another two hour treatment session.
Integrative Manual Therapy assessment techniques included 5 Point Longitudinal Pressure Scan (5XLPS), Segmental Longitudinal Pressure Scan, Myofascial Mapping, and range of motion. Range of motion was tested with and without the intra-oral splint. All range of motion that was tested with the intra-oral splint was decreased when compared with range of motion tested without the intra-oral splint. This included coronal, sagittal, and transverse planes at the spine, shoulders, hips, knees, and ankles. However, all range of motion tested without the intra-oral splint was greatly diminished as well.

Treatment: A number of Integrative Manual Therapy techniques were utilized during the treatment sessions, including the following: Bone Bruise Technique, Resistance Therapy to Immune Deficiency Motility, and Disruption of Membrane technique at sacrum, coccyx, sternum, sphenoid, occiput, and temporo-mandibular joint; Muscle Energy and ‘Beyond’ Technique for a descended sacrum; Articular Fascial Release at L5/S1; Advanced Muscle Energy and ‘Beyond’ Technique for a tethered spinal cord; thoracic inlet Diaphragm Compression Syndrome for the carotid sheath; Cardiac-Lymph Functional Output (Lymph Bypass Technique); motility/mobility relationship between ethmoid-vomer-maxilla and thalamus-insula-tentorium (BANRA - Neuro-Reflexogenic Autonomic Associations); Advanced Strain and Counterstrain for the diaphragms, basilar arteries, circle of Willis; Type III shears at sphenoid, temporo-mandibular joint, and diaphragms. Treatment also included a home program of Neurofascial Process focusing on elimination and detoxification.

Outcome: After the two treatment sessions (five hours total assessment and treatment time) were finished, the following changes were noted: spinal kinetic chain flexion increase by 50%; spinal kinetic chain extension increase by 30%; cervical rotation bilateral increase by 10-15 degrees; cervical side bend bilateral increase by 5 degrees; shoulder extension bilateral increase by 15 degrees; shoulder flexion bilateral increase by 15 degrees; shoulder horizontal abduction bilateral increase by 15 degrees; shoulder internal rotation bilateral increase by 10 degrees; shoulder external rotation bilateral increase by 10 degrees; trunk side bend bilateral increase by 20%; hip internal rotation bilateral increase by 5 degrees; hip external rotation bilateral increase by 20 degrees; hamstring bilateral increase by 40 degrees; ankle dorsiflexion bilateral increase by 10 degrees.
The patient reported no headaches in the two weeks since beginning treatment and a decrease in pain by 50% at the temporo-mandibular joint. She reports feeling hungry again. The patient previously reported that her jaw would be “locked” upon awakening in the morning whenever she used her temporo-mandibular splint. The patient has slept several nights without the splint and reports that she has not experienced the feeling that her jaw is “locking” up.

Discussion: As noted above, this patient has demonstrated observable objective physical changes and, also, reported subjective changes indicating positive improvement in regard to function and pain. These changes have been recognized since implementation of Integrative Manual Therapy in her treatment protocol. Previous therapeutic interventions have resulted in either no improvement or exacerbation of pain and symptoms. Dysfunctions of multiple physiological, structural systems are able to be addressed and accessed through Integrative Manual Therapy.
This particular patient sill requires treatment to reach all of her goals. Her multi-factorial clinical presentation should provide further treatment, study, and documentation.