This clinical case was sent to JMS by our current student Luis Carreras, LMT, from Mobile, Alabama. His previous training and teaching experiences allowed Luis to quickly absorb SOMI’s materials and immediately use them in his clinical work.
The importance of this case in the correct vision of somatic rehabilitation Luis used so well. He correctly identified triggers of somatic abnormalities, including visceral pathologies, and created a treatment plan unique to the patient. By pure coincidence, this case is a perfect clinical illustration to our Part 3 article about reflex zones formation published in the current issue of JMS:
Luis’s submission is a great example of what we envisioned therapists do after SOMI’s Medical Massage training: the ability to absorb clinical material but use suggested data creatively since no two patients have precisely the same clinical pictures. Correct identification of variants in the clinical picture combined with free clinical thinking is the foundation for a successful treatment strategy. This clinical case is an excellent illustration of that!
Dr. Ross Turchaninov, Editor in Chief
CHRONIC VISCERA-SOMATIC DISORDERS
by Luis Fernando Carreras Perez
A fifty-one-year-old male patient came to our clinic with complaints about severe lower back pain (8-10 levels), radiating to both posterior legs with each step. Recently it became so bad that he started to use the walker. He cannot drive anymore, and his sister drove him to the appointment.
The patient has an overly complicated previous medical history. He had two kidney transplants in 2002 and a second in 2014, gallbladder removal in 2003, and open-heart surgery in 2012. Also, the patient had severe Diabetes, which triggered Gastroparesis (i.e., partial paralysis of the stomach). As a result of his stomach’s malfunction, he developed significant muscle atrophy. He lost 105 lbs in less than a year.
The patient can’t keep himself straight, and right-side Scoliosis is visible. Considering his medical history’s complexity, I expected a clinical combination of local and reflex changes in the soft tissues. Evaluation of reflex changes in the soft tissues I based on clinical presentations of viscera-somatic and viscera-motor reflexes according to Glezer/Dalicho Zones.
The intensity of cutaneous reflex zones was evident from the first look on the patient’s back. He had rush along T5-T9 dermatomes which matches with stomach innervation by T4-T9 segments of the spinal cord.
The patient also exhibited an Excessive Red Dermographism reaction in Glezer/Dalicho zones matching stomach and gallbladder dysfunction. Excessive Red Dermographism reaction within Glezer/Dalicho zones associated with stomach abnormalities is a direct indicator of reflex zones built up in the soft tissues, especially the skin and fascia. It results from misbalance within the autonomic nervous system, which controls functions of the stomach and soft tissues that share the same level of innervation.
The patient also exhibited tension in the connective tissue structures in the skin and superficial fascia (i.e., active Connective Tissue Zones of the first and second level).
Examination of the skeletal muscles indicated active trigger points, hypertonus, and myogelosises in paravertebral muscles, especially on the level T4-L2, left Quadratus lumborum, trapezius, both rhomboids, and levator scapulae muscles. The patient also exhibited positive Wartenburg’s Test, indicating and tension in the right anterior scalene muscle.
The periosteal reflex zones were detected in the spinous processes of thoracic vertebrae and an occipital ridge.
Medical Massage Therapy
Pain in the soft tissue (local hyperalgesia) was very intense, and I decided to start with the inhibitory regime of massage therapy to suppress the overactive pain analyzing system. I used repetitive effleurage techniques in the direction of lymph drainage combined with light electric vibration and hot stones application. It gradually reset nociceptors (i.e., receptors of pain analyzing system) in the affected soft tissues and slowly restored the patient’s pain tolerance threshold.
Restoration of pain threshold allowed me to apply very slow frictions gradually and later skin rolling. I used skin rolling within Glezer/Dalicho Zones in the directions of Connective Tissue Massage. I finished the first 30 minutes with a combination of electric vibration and hot stones on the back.
These preparations allowed me to desensitize the peripheral sensory system and significantly decrease his brain’s overload. Now the patient’s body allowed me to apply Medical Massage techniques in the full protocol.
I started with decompression of the paravertebral muscles, gradually eliminating active trigger points and hypertonus there. I used classic steps of MM: kneading in the inhibitory regime + fixed electric vibration + ischemic compression + Postisometric Muscular Relaxation and passive stretching.
The same protocol applied to the left Quadratus lumborum, trapezius, and right levator scapulae muscles. At the end of the session, I addressed the patient’s Scoliosis with appropriate stretching and balancing techniques. After the first session, the pain intensity dropped decrease from 10 to 2! After three following sessions, the pain level was stable on the level 1-2.
During the next set of sessions, I started to mix in Medical Massage protocol components to decompress the sciatic nerve since peripheral neurological symptoms still bothered the patient.
After eight Medical Massage therapy sessions, the patient was able to start physical therapy to recover lost muscle mass and strength. I used three more sessions while he was in PT to help him with muscle soreness after the exercises. Currently, the patient finished his PT and finally can walk without any support.
The patient got back his appetite and regain 30lbs! The patient’s gastroenterologist registered great improvement in his Gastroparesis due to restoration of gastric peristalsis!
I want to express professional gratitude to Science Of Massage Institute and our teacher, Dr. Ross Turchaninov, who shared these incredibly valuable Medical Massage protocols, taught us fundamental clinical skills, and helped me in my practice!
Luis Fernando Carreras Perez was born in Cuba, where he earned an athletic scholarship in Olympic weightlifting and graduated from Las Tunas University with a bachelor’s degree in Physical Education and Sports Science.
From 1999-2005, he worked as a head coach for strength training and as a swimming coach for the Cuba Olympic swimming center while teaching at the same University.
From 2005-2006 he worked in Mexico as the first sports and medical massage therapist in the state of Coahuila. He also worked in a medical clinic as an acupuncturist and medical massage therapist.
In 2007 Luis moved to the USA. Currently, he works as an instructor at Blue Cliff Career College in Mobile, Alabama, and he is the owner of the Myophysio Medical & Sports Massage Clinic.
Category: Case Studies
Tags: 2021 Issue #1