In every issue of our journal, you will find a Case of the Month, which we will select from among the submitted cases. Everyone who is using MEDICAL MASSAGE PROTOCOLS in their practice may submit their cases for 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 have been privileged to participate in some of them. His clinical skills are outstanding, and I was able to successfully test some of his recommendations on my patients.
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 shown 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 fresh eyes, 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 break away from established views and develop a clinically effective MEDICAL MASSAGE PROTOCOL that is unique to 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 in the left side of the lower back. Sitting and/or changing from a sitting to a standing position triggered intolerable pain. Walking slowly for up to 15 minutes reduced the intensity of the pain, but walking for longer than that would once again increase it. Two to three days before her period, the intensity of the pain dramatically increased, forcing her to spend a few days in bed. The patient had been practically disabled for four months prior to her visit to our clinic.
PATIENT HISTORY AND CLINICAL EXAMINATION
Initially, this pain wasn’t severe, and the patient had it periodically. She described the pain as intermittent, and it was a minor irritant. A pediatrician, a children’s orthopedic surgeon and, more recently, gynecologists had concluded that her pain was myofascial in nature.
Over the previous five years, the pain had gradually increased in intensity and become chronic. The last four months had been especially difficult, because the pain had become constant. She couldn’t work, and her day-to-day 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 a 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 painkillers didn’t block the pain, but a high dosage of corticosteroids provided some relief from her pain.
After an intense flare-up, her pain management physician recommended surgery to insert electrodes in the spinal cord to prevent pain stimuli from reaching the brain. However, the Pain Management center’s psychiatrist insisted that such treatment be postponed and that antipsychotic medications, as well as psychotherapy, 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 on 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 had any abdominal (including gynecological) surgery. The answer was “Yes”. Her appendix had been removed when she was 12 years old. Just out of interest, I asked if a CT with contrast had been done. The answer was “No”. The day after my conversation with the physician, I had the opportunity to examine the young lady in my office.
During the 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 was of moderate intensity, without the 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 to various degrees. Regardless, these symptoms didn’t match the intensity of the lower back pain, associated with Lumbalgia.
Before applying the 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 gave great hope for successful rehabilitation.
After the application of abdominal drainage techniques, she reported a significant decrease in 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 postsurgical 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. This facilitates 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 means 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 Bowel Syndrome, Constipation), as may abnormalities of the genitourinary 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 lymphedema. The second goal is to improve the inner organs’ function and reduce abdominal and lower back pain. The next targets of AM are to address existing adhesions and affected inner organs using visceral massage techniques.
MEDICAL MASSAGE PROTOCOL
I started with 12 to 15 minutes of massage in the lumbosacral area, combining basic therapeutic massage techniques with the subsequent application of Connective Tissue Massage. I finished this part of the session with lumbar muscle mobilization, spending 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 back pain, but she still experiences anxiety attacks, which are becoming rarer. 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 had followed my advice, and it has already been a month since she returned to work practically pain-free. Now she feels her fiance is ready to propose.
Category: Case Studies
Tags: JMS 2011 Issue #3
