In every issue of our journal you will find Case of the Month which we will select among submitted ones. Everyone who is using MEDICAL MASSAGE PROTOCOLs in their practice may submit their cases for the review and we will share with our readers the best one in every new issue.
I have been fortunate to know Mr. B. Prilutsky for many years. During this time I have observed his clinical and educational projects and was privileged to participate in some of them. His clinical skills are outstanding, and I was able to successfully test on my patients some of his recommendations.
Usually if I get a call from California with a plea to help a patient in our medical massage clinic I always recommend Boris’s clinic in California and I have never heard from these patients again. If Boris feels he will be able to help me he almost always fulfills his promise.
What is interesting in this case is the excellent clinical thinking and reasoning showed by Boris while he evaluated the patient. While everyone was knocking on the same door month after month of unsuccessful treatments Boris decided to look at the same patient with a fresh look, and this unbiased approach allowed him to arrive at a completely different conclusion. This is what medical massage is all about. It is not only what the practitioner learns during his or her lifetime; it is also the ability to fly away from the established views and develop one clinically effective MEDICAL MASSAGE PROTOCOL which is unique for each patient, especially in complicated cases.
ABDOMINAL/VISCERAL MASSAGE IN CASES OF SEVERE BACK PAIN
Patient female, 26 years old. Works in finance. Single, but in a committed relationship.
MAIN COMPLAINTS
Severe pain at left side lower back. Sitting position and/or changing from a sitting to standing position triggering intolerable pain. Walking slowly for up to 15 minutes has reduced the intensity of the pain, but walking for longer than that would once again increase it. Two-three days before her period the intensity of pain dramatically increased, forcing her to spend a few days in bed. Patient was practically disabled for four months prior to her visit to our clinic.
PATIENT HISTORY AND CLINICAL EXAMINATION
Initially this pain wasn’t severe, and patient had it periodically. She described pain as intermittent and it was minor irritant. A pediatrician, a children’s orthopedic surgeon, and lately gynecologists have concluded that her pain is myofacial in nature.
Over the last five years the pain has gradually increased in its intensity and become chronic. The last four months were especially difficult, because the pain became constant. She couldn’t work and her day-today life was greatly affected. The patient became depressed, anxious, and mentally exhausted.
In a desperate attempt to help her primary care physician referred her to the Multidiscipline Pain Management Center in the hope of addressing her condition with combination of acupuncture, chiropractic adjustments and physical therapy. This approach failed and her pain and disability increased. The pain became so intolerable that she was hospitalized. Strong pain killers didn’t block the pain, but high dosage of corticosteroids provided some relief from her pain.
After an intense flair up her pain management physician recommended surgery of electrodes insertion in the spinal cord to prevent pain stimuli reaching the brain. However, the Pain Management center’s psychiatrist insisted that such treatment be postponed and antipsychotic medications, as well as psychotherapy, should be tried first.
The patient was referred to our clinic by a physician who was Board Certified in Physical Medicine, and who had been invited to consult the patient when she was hospitalized. While I was talking with the physician, she informed me that all necessary tests, including CT and MRI, had found no significant spinal or abdominal abnormalities.
I asked if the patient had any abdominal (including gynecological) surgery. The answer was “Yes”. Her appendix was removed when she was 12 years old. Just out of interest I asked if the CT with contrast which was done. The answer was “No”. The day after my conversation with physician I had the opportunity to examine the young lady in my office.
During examination of her lower back, she reported increased local pain when pressure was applied over her left back and left gluteal area. However, the pain had moderate intensity without obvious presence of acute trigger points in the lower back and gluteal muscles Resting muscle tone on the left side was significantly higher, and the fascia exhibited areas of tension in various degrees. Regardless, these symptoms didn’t match the intensity of the lower back pain, associated with Lumbalgia.
Before applying MEDICAL MASSAGE PROTOCOL for cases of Lumbalgia, I decided to start with abdominal massage in order to accelerate venous and lymph drainage. These techniques are gentle and always feel pleasant. After a few minutes of the application of drainage techniques she began to cry. My first thought was that my therapy had increased her pain intensity, and I asked her about it. She replied, “No, it didn’t increase my pain.” At this moment, it was obvious to me that she had released psychological tension and suppressed emotions. This is very common in patients who suffer from intense chronic pain, and such a reaction was great hope for successful rehabilitation.
After application of abdominal drainage techniques she reported a significant decrease of pain intensity. I asked her to sit up. To our great surprise, the pain didn’t come back as she sat still for more than 10 minutes. At this moment it seemed clear that her severe back pain was a result of significant venous stasis and lymphedema in the abdominal cavity. Shortly after her visit to me her primary care physician ordered a CT scan with contrast. This test showed significant adhesions and abnormal and abundant post surgical scar tissue in the lower abdominal cavity. This CT test finding increased my confidence, and we began a treatment course using abdominal massage as the main therapeutic tool.
ABDOMINAL MASSAGE (AM). GENERAL INFORMATION
AM starts with the gentle mobilization of the anterior and lateral abdominal walls. These facilitate the more efficient application of drainage techniques, as well as various visceral massage techniques that target the internal organs located in the abdominal and pelvic cavities.
At least 35% of the total arterial blood supply is provided to organs within the abdominal cavity. This mean that the same quantity of venous blood must naturally be drained from the abdominal cavity, If drainage is impaired, venous stasis develops and various functional abnormalities may manifest (e.g. Diverticulosis, Irritable Bowl Syndrome, Constipation) genito-urinary system (e.g. Infertility, PMS, Prostatitis) or pre-existing pathological conditions may worsen.
The first goal of AM is to eliminate venous stasis and reduce the Abdominal Lympdema. Secondarily to improve the inner organs’ function and reduce abdominal and lower back pain. The next targets of AM are to address existing (?) so adhesions and affected inner organs using visceral massage techniques.
MEDICAL MASSAGE PROTOCOL
I started with 12 to 15 minutes massage in the lumbo-sacral area combining basic therapeutic massage techniques with a following application of Connective Tissue Massage. This part of the session I finished with lumbar muscle mobilization using at least 50% of the time on the application of kneading techniques.
The next target was the lateral abdominal walls I spent around 7 minutes on their mobilization. I spent up to 15 minutes on the mobilization of the anterior abdominal wall and pelvic region. The successful mobilization of the abdominal wall allowed me to efficiently apply abdominal drainage massage techniques, and finally work on the adhesions in the left lower abdominal quadrant for another 10 minutes.
Her lower back pain was almost gone after the first five treatments. In total she received 15 sessions of medical massage. I added stress reduction massage for the back and upper neck to the last 5 sessions. Currently she doesn’t have any lower or back pain, but she still feels anxiety attacks which are becoming more rare. I continue to see her weekly for full body stress management massage, and I still include AM in the treatment. I believe that 5 to 6 weeks of such maintenance will break the vicious circle of stress her body has accumulated during her ordeal, and she will be able to completely recover and have a completely normal and pain free life.
As soon as it was obvious that she was on her way to recovery I insisted that she refuse to go on disability and go back to work. She was reluctant at first but she was glad that she followed my advice and it is already a month since she has returned to work practically pain free. Now she feels her fiance is ready to propose.
Category: Case Studies