Four Case Histories
Case History #1
Diane, a 62-year-old retired female attorney, was involved in a motor vehicle accident in March 1997. She was wearing a shoulder and lap seatbelt. She was moving very slowly through an intersection with her body rotated to the left when she was rear-ended. After one month of physical therapy, her doctor decided to include Myofascial Trigger Point Therapy in her overall treatment plan.
Diane presented with diffuse low back pain which was worse at the left SI joint and a considerable amount of neck pain, worse on the left at the angle of the neck. Myofascial Trigger Point Therapy and soft tissue mobilization to inactivate trigger points in the SCM, scaleni, trapezius, latissimus dorsi, and paraspinals provided a modest decrease of her pain.
During intake, on her fifth treatment, Diane reported that the “butterfly stretch” for the adductors was very tight and restricted with pain in the medial thighs. She stated that her low back pain was becoming more specific at the SI joints, left worse than right. She had been experiencing vaginal pain with intercourse during the past 10 years. This pain had increased along with her back pain. Diane wondered if there might be a connection.
Palpation of taught bands of muscles in the lower rectus abdominis referred pain to the vaginal area as well as her low back and recreated the pain of dysmenerea. I treated the lower abdominal muscles including the pyramidalis and released trigger points in the adductors, bilaterally. I then used a muscle energy technique to mobilize the pubic symphysis and a loud ”pop” was heard followed by a nearly complete release of her pelvic pain.
Despite the dramatic release of the pubic symphysis, abduction of the thighs was still considerably restricted, right greater than left. There was, however, an improvement of approximately of 20% in abduction, bilaterally. Pain at the SI joints was decreased to a 1–2/10.
During the sixth treatment, Diane stated that her vaginal pain had decreased from as much as an 8 or 9/10 to a 1 or 2/10. Her low back pain at the SI joints had decreased considerably and was only slightly felt on the right. After a very thorough treatment of the adductor muscles, bilaterally, using ischemic compression and soft tissue mobilization, I used a muscle energy technique to mobilize the right hip joint. A loud cascade of 2 or 3 “pops” came from the right hip joint and the pelvic region. ROM in external rotation increased to almost 90°.
Although I saw Diane for three more treatments, most of the pain she had suffered since the car accident was gone. On her ninth and final treatment, Diane was both very happy and very angry. She was in tears as she recounted the pain she suffered over the course of 10 years while trying to have normal relations with her husband. She was angry that after thousands of dollars on ineffective treatments and tremendous emotional suffering, it took only three treatments to rid her the pain that almost destroyed her marriage. Needless to say, Diane was greatly relieved that this pain was gone.