fdm-textbook_section4.pdf

S ECTION F OUR

C ASE H ISTORIES

222

Neck Pain in a 27 Year Old Woman

Ms. M. presented to the office on March 22, 2002 with a complaint of neck tightness and

pain for the past six months. There was no known injury. Prior diagnostic work-up

included an x-ray, and previous treatments consisted of OMT (osteopathic manipulation)

and physical therapy. In addition, she had faithfully performed the exercises as instructed

by her therapist and had taken the various medications prescribed by her physician.

However, there was no reduction in her discomfort.

On physical exam, neck rotation to the right was 80° and half speed with stepping noted.

Rotation to the left was likewise slow with stepping, but went to a full 90°. Cervical

extension and flexion were both 50% speed with stepping present. The thoracic fascia

was palpated as tight (particularly along the posterior rim of the supraclavicular fossa).

Abduction and external rotation of the shoulders were normal. Internal rotation was also

normal (bilaterally equal with a total height of 15 inches, and no subtle pathological signs

of stepping, flaring, hesitation, or loss of speed were appreciated).

FDM Impression: Neck strain secondary to the SCHTP

Ms. M. was treated with herniated triggerpoint therapy of the SCHTP (which was abutted

bilaterally against C 7 and T 1 ). This improved cervical motion so that immediately there

was normal flexion, extension, and rotation (i.e., there was normal speed, no stepping, and

she was able to rotate past 90° bilaterally).

Discussion: Anatomical Location of SCHTP – Clinically, the findings of altered neck

motion (particularly cervical rotation and subtle signs of stepping and loss of speed) but

normal shoulder abduction and internal rotation, are indicative of a medial location of the

SCHTP within the supraclavicular fossa. Conversely, loss of shoulder abduction or

internal rotation with normal neck motion is suggestive of a lateral location of the SCHTP.

223

Low Back Pain in a 37 Year Old Man

For the past 12 years Mr. K. has complained of an ache deep in his lumbar spine. It started

suddenly but there was no known injury. Over the years he has seen a number of

physicians, etc. which included six chiropractors, two neurologists, a neurosurgeon, a

couple of rheumatologists and several other specialists he can’t recall. Diagnostic workup

consisted of x-rays, MRI’s, and a bone scan. For treatments he received attempted

manipulation (“no one can crack my back . . . I’m too big”), medications, injections,

physical therapy (four different treatment centers), and pain clinic protocols twice.

Despite the efforts of his doctors and therapists, there was no reduction in his discomfort.

Mr. K. was first orthopathically evaluated on 1/29/02 and found to be 6’2" and 350lbs.

His lumbar range of motion was normal. There was no point tenderness, kidney punch

was negative, and patellar reflexes were normal. He showed a body language of first

placing his right fist on his low back followed by placing the dorsum of his left hand over

the low back.

FDM Impression: Long-standing low back pain secondary to folding distortions

Discussion: The mechanism of injury is not known, but the verbal complaint of aching

deep in the spine and the body language of fist or back of hand placed on low back are

clinically indicative of lumbar folding distortions. Mr. K. was treated with unfolding chair

technique as well as wall technique and hallelujah maneuver. 1 After the fourth treatment

he noted that his back was “substantially better” and after the sixth treatment (3/19/02) he

stated that “this is the best I’ve felt in 12 years.” At office visit on 3/29/02, he said he was

feeling “great” and expressed that he was pain free.

Prior attempts at manipulation by his chiropractors were unsuccessful not because of his

huge size (which was a factor) but because the direction of thrust employed with lumbar

roll was lateral and therefore did not engage the folding tissue of his lumbar spine.

Likewise, since none of his other treatments were directed at resolving his anatomical

injury, his symptoms remained unchanged.

1 Note that inversion therapy is an adjunct treatment reserved for those patients with stubborn folding back injuries that

fail to make subjective or objective progress on two consecutive office visits in which folding/thrusting manipulation is

employed.

224

Sacroiliac Pain in a 68 Year Old Man

Mr. R. was seen in the office on March 19, 2002 with a five day history of right “low back

pain.” He denies any injury and says he woke up one morning with pain and it has been

getting worse ever since. In particular, his discomfort is aggravated by bending forward

and raising from a supine position to standing.

Past Medical History: Positive for Marie-Charcot-Tooth Muscular Dystrophy for forty

five years

Body Language: Points with one finger to right sacroiliac joint

Physical Exam: Normal rotation, extension, and side bending of lumbar spine

Lumbar flexion is 50% speed, painful and to 60°

Mild point tenderness over right SI joint

No lumbar spasm

Negative straight leg raising test

Patellar reflexes are 0/4

FDM Impression: Continuum sacroiliac strain

Discussion: Although the patient complaint was of low back pain , pointing with one

finger to the spot of pain on the sacroiliac joint is the quintessential sign of continuum

sacroiliac strain. He was therefore treated with continuum technique — in this case, in

the standing position, leaning forward with his hands resting on the counter. The thumb

palpated the distortion and force was held until the transition zone shifted. (Mr. R. easily

appreciated this as a melting sensation as his pain dissipated and then ceased.)

After continuum technique, the right SI joint was manipulated with scissors technique. At

time of discharge Mr. R. had normal motion and no pain.

225

Plik z chomika:

Inne pliki z tego folderu:

Inne foldery tego chomika: