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Manual medicine
Published in Harald Breivik, William I Campbell, Michael K Nicholas, Clinical Pain Management, 2008
This leap forward in getting better pain control enabled future treatment to be much more focused on improving his physical impairments. Larger amplitude joint mobilization techniques were progressed from side-lying to prone positions and further into range. The progress with pain relief was paralleled with graded increases in repetitions, range, and speed/confidence of spinal exercises, as well as walking and sitting-based activities. Manual therapy techniques, called sustained natural apophyseal glides (SNAG), were found to be helpful in facilitating further increases in painless lumbar spine flexion and extension.26 Limitation of left leg movement/sciatic nerve sensitivity were addressed using neural mobilizations,18,19 these were performed as passive rhythmical mobilizations by the therapist in positions of SLR, as well as the base slump test. An active variation of the slump technique, whereby he performed smooth oscillatory repetitions of left knee flexion and extension was also included in his home exercise program because it helped to produce improvements in his pain-free flexion range (Figure 20.2). The specific program given for this exercise was carefully graded for the first few sessions to help prevent any flare up in nerve reactivity.
Treatment of thoracic spine pain and pseudovisceral symptoms with dry needling and manual therapy in a 78-year-old female: A case report
Published in Physiotherapy Theory and Practice, 2022
Results of the physical examination indicated that the patient had a high level of irritability, with impairments in thoracic joint mobility, strength, and motor control. It was hypothesized the patient also had active trigger points that were contributing to her thoracic pain and pain referred anteriorly to her chest. A myofascial trigger point in the thoracic multifidi can create a deep aching cramp as a referred pain sensation. Symptoms can also refer to the chest, along a rib, or downward and outward several thoracic segments (Fernandez-de-Las-Penas, Layton, and Dommerholt, 2015). Due to the patient’s tenderness and reactivity to palpation of the thoracic paraspinal levels T5, T6, and T7, dry needling was determined to be a better treatment option than manual massage or pressure techniques. Dry needling is quick, often minimally painful, and allows the therapist to treat deep musculature. Since the patient did not tolerate prone PA pressure to her thoracic spine, a different position and technique would need to be utilized to address her thoracic joint mobility impairments. Thoracic sustained natural apophyseal glides (SNAGs) were chosen because they are weight bearing and should be painless if appropriate for the patient and performed properly (Mulligan, 2010). It was postulated that the patient’s limited thoracic extension was creating pain when she was positioned in supine for sleep as well as interfering with her breathing. As the patient’s pain levels improved, exercises to improve thoracic extension were added to address these deficits.