L4 fracture Hx, Harrington Rod, slight scoliosis (long)

[Toni Nicholas]

I had a client last week with some serious back/hip issues due to an MVA in 1988 (she was 16) that fractured L4 and resulted the development of scoliosis (during the healing process) which then resulted in a harrington rod being fused to the left of her spinal column to keep her spine straight.

She leads a very active life. She is a yoga instructor, personal trainer, runner, hiker and mom of 3 little ones. During her pregnancy with her last child she fell on the ice and landed on her left hip (2 years ago). Since then she says that she has had pretty severe hip and low back pain.

When lying prone it is very clear that her left hip is rotated backward and her left erectors and QL are severely shortened so much so that her upper body is torqued to the left and the rod in her back is actually now knocking the vertebrae above it out of alignment - it actually protrudes out.

Still, I digress. Upon palpating and working on her I find that her erectors are so tight they literally feel like bone. Her gluts and lateral rotators were tender but they appeared almost flacid (she is quite fit obviously) - I could easily palpate through them to her pelvis (she is very thin, however). Did not find any issues with her anterior thigh, hip, abs. Hamstrings were slightly tight. I worked for a full hour - full body and spent a good 20 minutes on her left lower back/gluts and erectors. She reviewed that she felt better after and slept better but, I barely made an impact on the erectors - still hard as rock by treatments end.

I guess my question is - does anyone have any experience with something similar? Have her erectors splinted for so long that this is how they will remain. I'm concerned for her as her whole torso is so severely torqued.

She does see a doctor regularly and her doctor recommended deep tissue massage. Probably should talk to the doc (with her permission) before the next massage.

Any words of wisdom?

 

[Wendi888]

mr. mush and i have both worked with a client that had a harrington rod.
after discussing your post, it would be most helpful if you could clarify some questions before we venture a guess.

1. how long passed between the fracture in 88 and the onset of scoliosis and how long after that was the rod inserted?

2. where exactly was the rod inserted? location of insertion scar? how much scar tissue are you finding in this area? what's its nature?

3. regarding the erectors, is it all of them from cervical to sacral involved as splinted? or some areas/ not others? how does the laminar groove feel? have you used distractive motion to determine if she's 'guarding' or 'gating'?

 

[eEz]

Thanks mush.

I'll do my best to answer your questions from my memory:

1) I'm not sure exactly how long between the fracture/scoliosis and rod insert but she spoke of it as all happening within the same time period - teen years.

2) The rod is anchored at the sacrum and goes up to about T7. Scar runs from sacrum to T7 or so left of the spinal column. I did not work directly on the scar tissue as she reviewed that it is sensitive/painful to pressure and she has shied away from massage in the past for fear of being hurt.

3) Erectors are splinted mainly in lumbar area. Thoracic area seems relatively "normal." Lamina groove on the left lumbar region could not really even be palpated - right side was fairly rigid. Again thoracic region more "normal." I did try to use passive motions and rocking without much sucecss. Her whole body is pretty guarded. Aside from these issues she also has had a significant amount of stress over the past several years...

I hope that answers your questions - any advice/ideas?

Thanks!

 

[cre8iv_cat]

sorry it took so long to reply.

overall, it seems that she has physically compensated for the dysfunctions she has developed over the years and minimized it to the affected regions.
this harrington is larger the most we have seen. you should definitely get a look at a copy of an xray, the latest if possible. the scar tissue in the area may release through dry skin rolling, but i'm not sure that there would be long-term effects. i would try to posturally assess the sections of back muscles to see which sides are over-stretched and which side are overcontracted. and work the laminar groove on both sides.
structurally speaking, chiros we have worked with have expressed that they are somewhat leary to work with harrington rods. if she was inclined to try to correct the anatomy, i would refer her to an advanced certified rolfer who has experience with scoliosis with rods.

on the other hand, she indicates she likes your work. intend to relieve her stress and see if that eventually allows you to get past the guarding... and perhaps some more detailed structurl work.

let us know how things go.

 

[RedSheepHerder]

thanks!

Thanks for your input and advice.

She actually offered to bring in her x-ray for her next appt. I am very curious to see what it all looks like.

Thanks for the reminder about the importance of work for relaxation/stress reduction. I think when people come in with a particular problem I can get so hung up on the problem that I forget about how healing the massage is in a more generalized way!