MEDICAL MASSAGE vs MEDICAL MYSTERY (a.k.a. Essential Dyskinesia)
I would like to share with our readers a unique case that was recently treated in our clinic. For this patient, the medical massage effectively treated the medical condition, which had been labeled a medical mystery by several physicians. It was effective when all other medical modalities had failed. This case is for educational purposes only, and it doesn’t participate in our yearly contest for the ‘Best Case of the Month’.
Clinical History
The patient is 17 years old, completely healthy, an A-grade student, active in school and after-school programs (he is the leader of a rock band). In December of 2009, he had a severe flu infection. Two weeks after what seemed like complete recovery without any other clinical triggers, he developed a very unusual medical condition. The patient began to experience uncontrollable, bilateral muscle contractions in the upper shoulder and neck muscles, resembling shrug-type movements. Muscle contractions were very intense, and both shoulders simultaneously and constantly jumped up. These contractions were uncontrollable, and they continued even at night after the patient fell asleep from complete exhaustion. Sleep pattern is greatly affected.
The patient was seen by a family physician, an internal medicine physician, and two neurologists. For almost a month and a half, he was examined with all possible tests, from a brain MRI to various blood tests. All tests confirmed that he was completely healthy, but the involuntary contortions did not stop even for a second.
The case became a complete medical mystery, and the best diagnosis proposed was ‘Essential Dyskinesia’, a movement disorder of unknown origin. The only way the involuntary contractions were controlled was by a cocktail of high doses of Benadryl and strong sedative medications. The medications helped to reduce the intensity of the involuntary contractions, but they made the patient heavily sedated, and he wasn’t able to attend school.
Neurologists told his parents that the nature of these contractions is unknown, and they may disappear with time or they may stay with the patient for the rest of his life. He was sent home.
Clinical Symptoms
At this point, the desperate parents brought the patient to our clinic for initial evaluation. Despite that, we had a phone conversation with the parents before the appointment, no one in our office expected to see how violent these contractions were. Both shoulders were constantly jumping, and the patient didn’t have any control over contractions. It was difficult to believe, but both shoulders constantly jumped up to the height of almost 3 inches, 24 hours per day, even during exhausted sleep!
The range of neck and shoulder movement was completely normal, but involuntary contractions continued even while the patient executed each movement separately. The palpation of the cervical and shoulder muscles showed complete chaos of their contractile function to the degree that myofibrils in one part of the muscle contracted in the opposite direction compared to the myofibrils in other parts of the same muscle. This was a bizarre clinical picture.
As I mentioned above, the brain and spinal cord MRI didn’t find any abnormalities. Consider that we assumed that something happened in the lower motor centers in the spinal cord and that they lost control over the activity of proprioceptors, first of all, muscle spindle receptors.
Treatment
Session 1
We required the patient to stop any medications 24 hours before the first session. We considered several treatment options, but there is no medical literature on the disorder, and no one had any idea of its origin. We decided to experiment with medical massage tools and techniques.
First, we applied continuous electric vibration in a fixed regime to the motor points, i.e., the areas where the nerves that innervate each affected muscle enter it. We hoped that electric vibration, as a significant inhibitor of the peripheral receptors, would suppress the activity of muscle spindle receptors and help the motor centers regain control over involuntary muscle contractions. Unfortunately, it didn’t work. To our surprise, it increased the amplitude of the contractions.
Light, repetitive effleurage strokes and gentle kneading in the inhibitory regime, aimed at relaxing the affected muscles and decreasing the excitability of peripheral receptors, were also ineffective. Repetitive compressions on the tendinous parts of the affected muscles to engage H-relex didn’t do anything as well. At this point, it seemed that this particular patient would not benefit from medical massage.
Many years of clinical application of medical massage and manual therapy have taught us to be patient and never give up, even when only a single tool remains, and to think outside the box. Sometimes textbooks are wrong. So, we decided to try a stimulating kneading regime in a highly intense mode. We apply kneading with a fast pace using constantly changing techniques, including transverse leading, stretching leading, scrolling kneading, and digital kneading, among others. It didn’t make any sense because the affected muscles were already overstimulated.
To our complete surprise, the intensity of the involuntary contractions on the side we worked on visually decreased. We have now added very intense, strong effleurage strokes to drain interstitial fluid, and also increased speed and intensity of the stimulating kneading techniques to their maximum. With every second, we felt a lesser degree of involuntary contractions in the cervical and upper shoulder muscles. We continued to push the intensity until we were out of breath and our stamina. After almost 15 minutes of this marathon, we stopped, and to everyone’s shock, including the patient’s parents, he was lying on the table with very light involuntary contractions. Now we had a basic idea that it could be controlled without medication through medical massage.
Considering the patient’s astonishingly good response to the stimulating massage techniques, we decided to add Postisometric Muscle Relaxation. We asked the patient to sit quickly and immediately drop his head as soon as he sat up. We used PIR for each group of cervical and upper shoulder muscles. After the end of the therapy, he didn’t experience any involuntary contractions or muscle twitching under the skin. It was a heart-wrenching moment for the entire family. No one could believe that a massage could do something like that.
We said to the patient and his parents that the involuntary contractions were more likely to come back, and they needed to pay attention to how long the treatment would work. We discussed other modalities such as hot showers, swimming in the pool, etc.
Session 2
The patient came back very encouraged. The involuntary contractions came back in approximately 45 minutes after the end of the first treatment, but they came back as half as strong as they were before the first session. Now we were certain that we had found the solution, and we followed the same protocol that we had developed during the first session. It started to work immediately. Even the first 10 minutes of treatment eliminated the involuntary contractions.
Hot showers helped the patient, but light, repetitive exercises and even gentle swimming had no effect, and in his opinion, they even slightly increased the amplitude. We stopped further experiments there and decided to use a combination of medical massage techniques daily, with self-stretching at home.
Before the start of the second session, we recorded the patient’s involuntary contractions and documented the results of the session (see video below). The first part of the video shows the patient before the beginning of the second session. What you will see in the video is 50% of the original amplitude of the involuntary contractions the patient had before the first session.
Unfortunately, we didn’t have a camera in the office to record the original clinical picture and everyone was stunned by the intensity of involuntary contractions. Now, imagine for a second that the patient had these unstoppable contractions 24 hours a day for more than a month without any hope of getting rid of them.
Sessions 3-6
Each session followed the same protocol. From day to day, the intensity of the clinical symptoms subsided, and before the 6th session, the patient was able to completely control the involuntary contractions, which had a minimal amplitude. As soon as he felt even the slightest muscle twitching, he started to stretch the vulnerable muscle, and his parents immediately began applying the massage strokes they had been taught in the clinic. After the 6th session, we gave the patient a one-week break to estimate the stability of the clinical results.
Session 7
The same protocol was performed. During the week off, the patient experienced only two instances of slight muscle twitches, which he was able to control easily. At this point, we agreed that he should return to school and gave him a two-week break.
Session 8
The final session was more than a month ago. Parents informed us that there were no clinical symptoms of involuntary contractions, and the patient had recovered entirely, returning to his usual physical and school activities.
Recently, his parents had called and informed us that they had visited the Clinic of Movement Disorders at the Barrow Neurological Institute, which is one of the leading authorities in modern neurology. The physicians in the clinic confirmed the very unusual nature of this abnormality, but the patient did not exhibit any symptoms at the time of the visit. The neurologists asked parents to send the video you just saw. We sent it, and the biggest surprise for the neurologists was the fact that massage therapy was able to cure such an abnormality without any medication.
WHY?
There is a reasonable question about what may cause this condition in the first place. We developed the following theory. As a result of severe viral infection (high temperature, intoxication with viral load and metabolites, etc), the muscle spindle receptors developed the severe condition of hyperirritability. In such cases, they started to react to any, even minimal stimuli, and their excessive stimulation produced an overwhelming flow of sensory information to the lower motor centers in the spinal cord. Their overstimulation led to a condition in which the lower motor centers lost control over the activity of the proprioceptors. All of that happened without engagement of the patient’s motor cortex, and as a result, the patient additionally lost conscious motor control.
As soon as MEDICAL MASSAGE PROTOCOL eliminated the condition of hyperirritability of muscle spindle receptors, the clinical symptoms subsided, and the lower motor centers were able to regain their normal control over the proprioceptors.
In a simple analogy, imagine the virus that infects the extensive computer network, and each computer (i.e., muscle spindle receptors) starts to generate a massive amount of useless information and sends it to the mainframe computer (i.e., motor centers in the spinal cord). In such a case, the mainframe computer sooner or later will be overwhelmed and will finally crash. To recover the entire network, the normal work of individual computers must be restored first. Only after that will the main computer regain the ability to process information. This is how medical massage solved the medical mystery.
We decided to share with our readers the case of ‘Medical Massage vs Medical Mystery’ for several reasons:
1. To show the clinical potential of Medical Massage therapy and how it can change the patient’s life in cases when all other modalities have failed, and the therapist is appropriately trained in Medical Massage application
2. To illustrate that Medical Massage is a concept rather than a fixed method, which is mistakenly presented by many educational sources on medical massage. Scientifically based Medical Massage includes various methods, techniques, and approaches. These ‘tools’ should be combined to find their most efficient clinical combination. In all challenging cases, such a combination is unique for each client.
3. To prove that the practitioner doesn’t need to be afraid to try any possible scientifically based methods and techniques and freely combine them for their clients’ health benefits. In the worst-case scenario, your treatment won’t work, but in many instances, the experiments with different medical massage techniques will bring you ultimate clinical success.
SOMI’s Medical Massage Certification Program
If our readers are looking for ultimate solutions in complicated clinical cases, consider joining SOMI’s Medical Massage Certification Program. We will offer two upcoming Live Webinars: Medical Massage Techniques on July 19-20 (8 CEUs) and Medical Massage Theory and Soft Tissue Evaluation on August 2-3 (8 CEUs). Here is the link for further details: https://www.scienceofmassage.com/seminars/
To learn more about SOMI ‘s Program, please click here: https://www.scienceofmassage.com/medical-massage-certification-program/
ABOUT THE AUTHOR
Here is a link to Dr. Ross Turchaninov’s bio: https://www.scienceofmassage.com/editorial-board/
Category: Case Studies