In every issue of our journal, you will find the Case of the Month, which we select from among the submitted cases. Everyone who uses MEDICAL MASSAGE PROTOCOLS in their practice may submit their cases for review, and we will share the best one with our readers in every new issue.
We chose this contribution to our Journal’s Case of the Month section because its author was unfamiliar with the MEDICAL MASSAGE PROTOCOL to treat this particular abnormality. However, using SOMI’s training and resources, Stephen Ryason, LMT, CMMP, obtained quick and stable results while other conventional and alternative treatments failed. Please pay attention to how deeply he understands what happened to this patient and what needs to be done to help her. Stephen used a scientifically based approach to the treatment and wasn’t afraid to try it to help his client, who was in severe pain.
Dr. Ross Turchaninov, Editor in Chief
MEDICAL MASSAGE vs SEVERE FACIAL PAIN
The client is a 54-year-old female with severe left-sided facial pain and migraine.
Clinical History
The client is a lifelong migraine sufferer. She usually treats migraine symptoms with ice packs to the front and back of the head, bed rest, and several prescription medications. However, the client had never experienced intense facial pain before.
Initial complaints
The client arrived in severe discomfort from migraine symptoms with facial pain on the left side. She had been experiencing migraine symptoms of varying intensity for nearly two weeks. Her migraine symptoms started mildly and increased steadily after three days. She treated her symptoms with ice packs and bed rest, with minimal results.
After five days, she began having severe facial pain. Pain had an intermittent, shooting, burning characteristic, followed by intense itching sensations. The client was so uncomfortable that she went to see her neurologist. Her neurologist diagnosed Trigeminal Nerve Neuralgia (TNN) and prescribed a powerful anti-seizure medication. Medication was partially effective, but she stopped taking it because of very unpleasant side effects.
Clinical Symptoms
During the initial interview, I examined the client’s upper body using soft tissue evaluation techniques I learned during live seminars by the Science of Massage Institute (SOMI). Her upper shoulder and posterior cervical muscles were hypertonic and hypersensitive, especially in the suboccipital space. Applying moderate pressure to the posterior cervical and suboccipital muscles increased the intensity of her headache. The left side of her face was hypersensitive to touch, slightly warmer, and more swollen than the right. Her scalp, especially on the left, was tight, and the cranial aponeurosis had almost no mobility and was hypersensitive.
These symptoms indicated severe compression of the left greater occipital nerve by posterior cervical muscles in the suboccipital space. I suspected that chronic irritation of the greater occipital nerve triggered occipital-trigeminal convergence, and this reflex reaction gave her facial pain.
Before beginning treatment, I informed the client that there was an established MEDICAL MASSAGE PROTOCOL for treatment of TNN and that I would like to try it if she was willing. She stated she was willing to try anything that would help.
MEDICAL MASSAGE PROTOCOL (MMP)
I began with the client supine. I performed MMP in the inhibitory regime on the upper back, shoulders, and neck for 20 minutes. I also used trigger point (TP) therapy and Postisometric Muscular Relaxation (PIR) to the posterior cervical and suboccipital muscles. Muscle tension was reduced significantly. Next, I decompressed her cranial aponeurosis using lateral shift techniques on her scalp. Finally, I started the MEDICAL MASSAGE PROTOCOL for Trigeminal Nerve Neuralgia, published in the Medical Massage textbook by Dr. Ross Turchaninov. I had never used this protocol before, so I put my textbook on a stool next to the table and followed the procedure step by step. I finished with the recommended Lymph Drainage Massage LDM protocol. This took another 20 minutes.
With the client still supine, I worked on the Special Point to address the Vertebral Artery (VA) on both sides. Treatment consisted of moderate pressure held for one minute at a time, with slight vibration for the last 30 seconds. I applied this three times to each side. I left the client on the table for 10 minutes with a cold pack on her forehead to treat her migraine symptoms.
I helped the client sit up and asked how she felt. She looked different from when she arrived; she was more relaxed and alert. She stated her headache was gone. The sensations in her face were still present, but significantly reduced and bearable. We were both impressed that such simple procedures could yield such dramatic results on the first treatment.
She came back the following week for follow-up treatment. Her migraine symptoms were “barely noticeable,” and her TNN symptoms were still present but had remained reduced and bearable. I performed the same protocol, except for LDM, and achieved nearly identical results.
When she returned the following week, she had no migraine symptoms and only a slight tingling in her face. I began treatment with the client prone this time and performed 20 minutes of MM in the inhibitory regime on her back, shoulders, and neck. I then moved her to the supine position and performed TP and PIR on the posterior cervical and suboccipital muscles. I then performed the TNN protocol, again without LDM. At the end of treatment, the client was symptom-free.
The client has had no TNN symptoms since this last treatment (over one year). Periodically, she still experiences migraine episodes, but they are much lower in their intensity. As soon as she feels the first signs of migraine coming, she comes to the clinic, and I perform MMP on her back, shoulders, neck, and head. I then concentrate on the VA points. She always reports that migraine symptoms ceased.
By decompressing the suboccipital space, I was able to free the greater occipital nerve from direct compression. It eliminated trigeminal nerve irritation formed by reflex occipital-trigeminal convergence. Additionally, the work of vertebral arteries decreased their reflex vasconstriction and restored proper blood supply to the brain.
MM therapy gave my client her life back and eliminated the necessity of taking several medications to control her migraines. SOMI’s training is a fascinating professional gift for all therapists and patients.
Message from SOMI: We are looking for clinically oriented therapists who would like to make real changes in the lives of clients/patients with proper training in theory, soft tissue evaluation, and clinical application of Medical Massage protocols. Give your ten magic fingers a chance to practice massage based on clinical science.. Here is a list of SOMI’s Training in Medical Massage: https://www.scienceofmassage.com/seminars/
ABOUT THE AUTHOR
Stephen Ryason was born in Seattle, WA, and currently resides and works in Scottsdale, AZ. He has been a full-time Massage Therapist since 1996 and practices medical massage in his clinic in Scottsdale. Aside from his passion for more knowledge related to his career, his hobbies include golf, backcountry fly-fishing, and aviation. He is a licensed helicopter pilot. Stephen may be contacted through this website.
Category: Case Studies