By Karen Mooney, PhD, CMMP, Florida
I am presenting this case to stress several important points: first, the recognition of the potential integrative role of Medical Massage in a patient’s treatment plan; and secondly to demonstrate that the levels of healing and the timeline cannot be hurried and sometimes require consistency and persistence.
Six months after a spinal laminectomy surgery (L4-L5-S1) the 67 year-old male retired insurance agent presented with chronic ‘lower back’ pain (10+) supposedly related to a C-type scoliosis with a rotation. He had a slight head tilt to the right and not only could he not stand in a full upright position, the rotation caused a twist that projected his right shoulder and pelvis forward about 6 inches when he walked. He reported that after back surgery the incision did not heal because of infection. He was on antibiotics and his wound had to be reopened and packed with gauze and local antibiotics until it would slowly heal from the inside outward.
His medical history included a diagnosis of diabetes in 1984 and a “widow maker heart attack” with a bypass surgery 3 years before the back surgery. The list of medications at that time included: Glucotrol XL 20 MG 2 per day, Altace 10 MG 1 per day, Avandia 4MG 1per day, TRICOR 45 MG 1 per day, Lipitor 40 mg 1 per day, coated Aspirin 81 MG 1 per day, Neurontin 300 MG 1- 3 times a day, Mobic 7.5 Mg 1 per day.
The patient recounted his daily routine as waking in pain, struggling to his recliner before breakfast to apply hot packs, breakfast, and back to the chair with more hot packs. He could only walk to the mailbox on his best days. His weight went from 225 to 250 (h 6”2”). He could not participate in any of the activities he enjoyed and was quite depressed.
After assessment, we discussed a plausible treatment plan. His top priority was pain reduction. To address the pain and the pathology we began a protocol for Lumbalgia (Medical Massage textbook, Volume I p.240) focusing on the quadratus lumborum, the erector spinae, and the rotator spinae muscles. I worked layer by layer reducing tension in the skin, superficial and deep fascia, skeletal muscles (on different levels) and periosteum.
Initially the patient came 2x/week for 6 weeks for this phase of the treatment. The first few weeks his tolerance for pressure increased as the pain level decreased. He was able to reduce his hot pack/ recliner chair routine to less time. The progress was slow but steady. He often said it took many years to develop those dystrophic changes in his body so he was willing to commit to some time to heal. With this commitment and attitude and the quality of the Medical Massage protocol, his progress continued. The patient changed his daily routine slowly as the pain threshold altered. After the first 6 weeks he was able to do some chores and help with the cooking.
We took a two week break to remove my therapy as a factor and re-evaluate the real picture, then resumed treatment, continuing with the same protocol only at a deeper, more intense level. During one session about 4 weeks into this session his spine made a self-adjustment and snapped like a gunshot. This was the first of many such releases of the tension in the lower back muscles.
Because he was adding additional exercise to his life he was experiencing some discomfort from using different muscle groups. We addressed these issues as they emerged. After 6 months of treatment he was standing at his full height and the forward thrust of the right shoulder was at 3 inches.
His days now included yard work and time on his boat for some fishing. He still experienced pain at home but it was quickly managed with the hot pack and a little Ben Gay. His treatments now became focused on those groups of muscles and addressing daily aches and pains.
During the time he was receiving treatment and starting to feel better he decided to consult a nutritionist for some ideas on controlling the diabetes. His A1C was 9.0 and he was taking 30 units of Lantus for diabetes. With the exercise he was now able to do and the carb control diet he followed faithfully he slowly reduced the Lantus and finally did not need it anymore. He wrote “A1C 5.9- change in meds, No Lantus!”
That next summer he attended his 50th high school reunion and was voted the “healthiest looking.” The twist in his spine was almost imperceptible. He now weighed 225lbs and was living a very active life. The cholesterol and diabetic medications were eliminated; he was hopeful rather than depressed; and he understood the power of the mind-body to heal.
Then he experienced another setback – he was diagnosed with prostate cancer. The surgeon was encouraged because of the patient’s good physical condition and optimism. He recovered quickly from the surgery with no incidence.
On a note, he wrote when asked for permission to describe his journey to good health he wrote: “After back surgery incision did not heal in the inside, had to reopen and pack with gauze so it would heal from the inside outward. About 6 months later I met you, I couldn’t stand up straight. After about 1 year of twice a week treatments I was able to stand straight, pain free. Thanks to you I can golf, ride a bike, fish, work in the yard, and lead a normal life for a 71 year old!”
A therapist’s note: a possible cause of the scoliotic pattern and muscle pathology for this patient was working for years from his office chair on wheels. From the daily pushing and pulling repeatedly to different work stations he developed a repetitive overuse pattern. This resulted in the rotation and scoliosis and herniated discs- then surgery. During this time, he developed other health issues.
The question then is how much of this could have been avoided with early intervention? This case emphasizes the importance of a whole-body approach to recovery – at any age. The Medical Massage treatment in this case initiated and supported an almost complete recovery for this patient.
Dr. K. Mooney is our former student and the first massage therapist in the USA to receive a PhD for studying the clinical effect of Medical Massage. The study examined Medical Massage Protocol on patients with Fibromyalgia. Readers may learn more about Dr. Mooney and her work from an interview she gave once to the Journal of Massage Science: https://www.scienceofmassage.com/2015/04/person-of-the-month-issue-2-2015/
We think Dr. Mooney’s submission is very important because it reflects two major aspects of Medical Massage:
1. Medical Massage is a highly effective method of somatic rehabilitation which in many cases gives stable clinical results when everything else failed.
2. It is a mistake to constantly look for the quick fix. Somatic rehabilitation requires knowledge, skills and patience on the therapist’s and patient’s sides to achieve stable clinical results. The integrative nature of the Medical Massage concept which is a combination of highly effective methods and techniques allows you to do exactly that.