All medical arts provide treatments based on research evidence that supports the
best treatments for most patients. Those last three words, “for most patients,”
are critical in understanding these case studies. Most patients do not seek the
services of the physical therapists at the Pain Management Program because traditional
evidenced-based strategies have worked well for them. However, there are individuals
for whom traditional evidenced-based strategies have not worked and repeating those
strategies will not improve the outcome. This is where the Pain Management Program
may be able to help. Our goal is to provide help to individuals who do not respond
as anticipated to acute care, traditional or other interventions.
We have provided a number of case studies covering various types of pain to demonstrate
how the Pain Management Program’s physical therapy services, which uses a
form of therapy called
multi-dimensional manual physical therapy (MMPT), has helped others and
may be able to help you.
Migraine
A woman was seen one year after a motor vehicle accident. She had also been hospitalized
for a swallowing difficulty and was diagnosed with cephalgic herpes zoster (shingles
in the head). She had been having daily headaches with spike headaches after the
hospitalization. She had been treated with spinal manipulation, traditional physical
therapy that included exercise, muscular and postural strategies as well as medication
management with limited success. Daily headaches were rated as ‘5’ out
of a possible ‘10’ for pain severity. The spike headaches occurred daily
and were rated up to 9 out of a possible ‘10’ for pain severity.
Multi-dimensional manual physical therapy findings:
Connective tissue mechanical restrictions in the lower
thorax adversely influenced the spine up to the neck and head. Mechanical restrictions
of the brain stem and cranial meninges were also identified.
Treatment
After normalization of the chest and brain stem restrictions, the spike headaches
virtually ceased. The patient no longer needed to take pain medications at this
time. After normalization of the cranial meningeal motion, the daily headaches began
to decline to ‘2’ out of a possible ‘10’ for pain severity.
After starting exercises designed to normalize nerve mobility, the headaches disappeared.
Groin and leg pain after childbirth
A woman reported experiencing pain in the left groin and inside of the left thigh
after child birth. She also noted that the left leg did not have the stamina or
strength it once did.
MMPT findings
There was nerve tightness from the lumbar and sacral spines into the thigh because
of fascial tightness between the structures of the pelvis.
Treatment
After normalization of the pelvic structural mechanics and connective tissue mobility,
the pain in the groin and inside of the left thigh had almost completely disappeared.
After normalization of the lumbar and sacral nerve mobility, both the strength and
stamina of the left leg had improved. She was then able to participate in strengthening
and endurance exercises without difficulty and without pain.
Neck and arm pain
A woman was experiencing persistent headaches, neck and right arm pain after a motor
vehicle accident. She had been treated with trigger point injections, cervical epidural
injections, medications and spinal manipulations. Previous traditional physical
therapy included ultrasound, hot-packs, exercises, myofascial release and massage.
She has been through several changes in her medication regime by her attending physician.
Regardless of these interventions, her pain persisted.
MMPT findings
A mechanical restriction of the right lower thorax was pulling on the connective
tissues through the posterior abdominal fascia into the spine and mechanical nervous
system. This finding was responsible for the mechanical tightness and pain in the
right brachial plexus (the nerves that go into the right arm).
Treatment
Correction of this restriction normalized the neural dynamics (the ability of the
nerve to move) of the right arm immediately. There was a marked reduction in arm
pain, neck pain and headaches. She was then able to gradually resume range of motion
and endurance exercises. She was able to tolerate traveling in the car for long
distances now and was able to return to work full time without pain.
Low back and leg pain
A woman who worked as a meat wrapper slipped and fell while carrying 50 pounds of
meat, injuring her lower back. The injury resulted in a lumbar disc rupture requiring
a surgical discectomy and lumbar fusion. Despite the benefit from the surgery this
woman continued to have persistent lower back and leg pain. She had been treated
with spinal manipulation, traditional physical therapy that included exercise, muscular
and postural strategies as well as medication management with limited success.
MMPT findings
A mechanical restriction of the left upper rib and the pleura (inside lining) of
the chest was not allowing normal thoracic or spinal mobility resulting in mechanical
influences all the way down to the sacrum. Having had pain for a sufficient amount
of time, irritability through the peripheral and central nervous system needed to
be addressed.
Treatment
Normalization of the pleural mobility and rib cage mobility markedly improved the
symptoms in short order. As she was recovering, a flare up of pain resulted due
to familial stresses, necessitating treatment strategies that reduced the nervous
system irritability. The MMPT approach was able to help identify and differentiate
the mechanical, neural and stress components to the pain. Neural treatment strategies
were included and only a couple of review sessions with her counselor were needed
to assist the pain management. After each of the mechanical, neural and stress components
of the situation were addressed appropriately, the lower back and leg symptoms have
been minimal and intermittent.
Groin pain in a male
A gentleman slipped on ice while trying to get into his truck. He caught himself
from falling, but the effort to break the fall created significant pain and soreness
in the right groin and thigh regions.
MMPT findings
A mechanical irritation of the right ilioinguinal and femoral nerves was identified.
Localized muscle soreness of the proximal thigh muscles was also present.
Treatment
A combination of lymphatic circulation treatment in the right groin region with
neural strategies reduced the pain markedly. The pain reduction was such that that
the morning after treatment this gentleman forgot to take his pain medications and
was able to get out of bed and walk around before noting that he did not have the
stiffness and pain typical in previous mornings.
Herniated cervical spine intervertebral disk with arm pain
A dental physician was referred to the physical therapist with a diagnosed C 5,
6 herniated disc confirmed by an MRI. The doctor was experiencing neck pain and radicular
pain into the right arm. The dentist could not identify a particular incident that
caused the pain. He ‘just woke up with it.’ The doctor had not been
treated by any other physical therapists or physicians who did spinal manipulation.
The Nebraska Medical Center Pain Clinic physician referred the doctor directly to
the Pain Management Program physical therapist.
MMPT findings
A mild scoliotic rotational tendency was located in the thoracolumbar spine related
to neuromuscular and neurovascular restrictions in this region. There were additional
mechanical restrictions limiting normal diaphragm movement during respiration. When
informed of the MMPT findings, the doctor recalled that he had fallen off of the
roof of a garage as a child while playing. He specifically recalled having landed
on his back, on a wooden board across his middle back.
Treatment
The mechanical stress on the muscles of the spine and arteries in that region of
the spine was reduced in combination with normalizing diaphragm movements. There
was an immediate improvement in reported inhalation excursion (he could take a deeper
and easier breath).
The next week the dentist reported that his pain had reduced 90 percent. He was
able to identify specific activities and postures that irritated his pain. Re-examination
revealed that both the neurovascular stress and the scoliotic rotation in the spine
had disappeared. Only two more treatment sessions were needed to eliminate the pain.
Acute torticollis
A construction worker had slipped on a muddy surface while at work. He broke his
fall by grabbing onto a railing nearby. Within a few days he developed neck pain
and could not hold his head upright. There was a marked head tilt to the right.
His physicians had ruled out any specific muscular injury. All surgical spinal problems
had been ruled out as well as the possibility of a brachial plexus injury. Traditional
physical therapy that included myofascial release and cervical spine mechanical
traction only made the pain and head tilt worse.
MMPT findings
Examination of this gentleman revealed a mechanical strain to the muscles in the
large arteries of the upper chest and arm.
Treatment
Treatment to address the muscle spasm of the smooth muscles of the blood vessels
and the neurovascular protective reflexes reduced the pain within 24 hours of the
first physical therapy session. The head posturing had improved 50 percent immediately.
Two more treatment sessions corrected the head posturing and virtually eliminated
the pain.
Two weeks later this gentleman had been asked to assist a family member with car
trouble on the interstate. He jerked a stuck lug nut with the right arm causing
a modest re-injury to the vasculature of the upper chest and arm. After having reinjured
himself he admonished himself, but explained that he felt so good he didn’t
think it would be a problem.
Two more treatments returned him to being pain free and reestablished his ability
to hold his head upright in a normal manner.
Temporomadibular dysfunction
A young woman fell down her stairs at home a week before she started to have problems
with her jaw. She had a history of back pain after a work injury but had recovered
well from that. Her main complaint was that of grinding of the teeth at night as
well as pain and muscle tension in the left side of the jaw.
MMPT findings
A mechanical restriction of the connective tissues in the pelvis was not permitting
normal movement of the pelvic joints which influenced the spine upwards. The spine
acted as a lever mechanically influencing the cranium (head posture) and ultimately
the jaw.
Treatment
Normalization of the pelvic connective tissue mechanics and pelvic joint mechanics
reduced the grinding and tension immediately. Two more treatments resulted in elimination
of the pain. A couple of months later this lady requested more treatment because
the pain and tension in the jaw had returned. A re-examination revealed that all
mechanics of the pelvic connective tissues, spine, cranium and jaw were normal.
However, an abnormality in the nervous system was present. A discussion with this
lady regarding possible stressors revealed that she had a significant life change
that was stressing her. No mechanical treatment was necessary, but she was referred
to a counselor for stress management strategy review. These strategies corrected
the symptoms.
