suggestions?

[jenni]

I see a client every three weeks. She has a hypersensitive and very painful half dollar size area on her back. The location is the thoracic area, below her scapula by about two inches, and slightly medial than lateral in location to errectors. She gets a 90 min. so I have plenty of time to warm the back and I work slowly and as deep as I can, to her comfort level. Every time I get to this spot, it's so hypersensetive she jumps and catches her breath,etc. I've tried vibration, MFR in side lying postion, skin rolling,and TP therapy, the latter which she really cannot tolerate on this spot. I'm working the serratus posterior, lats, all rotator cuff muscles,and errectors. I also include the intercostals. She gets relief for a few days but then the pain slowly creeps back. I've suggested ACP to see if needles with stim. might offer more lasting relief. Any thoughts would be helpful. :?

 

[Wondrousburrito]

:roll: Which side is the pain on? It might be referral pain/sensitivity from kidneys, ureters, or spleen (if on left side). How much anterior work have you explored? Besides all the usual physical suspects and treatments, does your client feel like she was stabbed in the back? It might also be related to psychic trauma. Once your client is in a semi-hypnotic state you could "pull the knife out" and then "repair the wound." I had a client who told me she was shot in the back in a previous life time. I pretended to take the bullet out and put bandages over the wound to heal. Her chronic pain of 20 plus years and numerous therapists doctors etc had disolved and hasn't been back since. This was five years ago. Certainly rule out any other physical cause before trying this. Good luck.

 

[Wolfy Owns]

suggestions?

Thank you.

 

[ArmyChemo]

When I have had someone with that kind of extreme sensitivity in an area I have used strain/counterstrain techniques to get a successful release.

 

[Glee]

This could be a thoracic rib dysfunction. You mentioned it is 2 inches below the scapula, placing it at about T9 area, a common place due to slouching. Does your client have a rolled shoulder posture? Thoracic Outlet Syndrome?

 

[Clarence]

suggestions?

Actually, my client has one of the best postures I know. as far as slouching, most people admit to poor posture when I ask them about work habits. She is getting relief from lidoderm patches. She recently left her job and has another one so we'll see if that has an effect on the knots!

 

[Teala]

I'm still inclined to think it may be a thoracic rib dysfunction but without seeing the client and assessing, its hard to say. Send them to a chiropractor and get another opinion, unless you are capable of performing rib manipulations.

 

[Baconfat]

suggestions?

Sorry but bone manipulations are not in my scope of practice. She has seen a chiro. with no good results. I'm suggesting ACP.

 

[afosa_ragazza]

Damn, so much for that thought then. Sorry, tried to help.

 

[Latifa]

suggestions?

Thanks Jay, I appreciate your response, as well as the others. We can't fix everyone. I'm reminded of a quote I saw while going through cancer treatment. It applies to massage as well.

" It's a part of the cure, to wish to be cured."

Thank you all!

 

[Helpfull?]

It still sucks when you get stumped. Sometimes we forget what we can and can't do, but its human nature. When all you have is a hammer, everything looks like a nail.

 

[Wems]

Thank you all for your responses, yes, keep it within our scope of practice, refer out when necessary, as was part of the response.

Just keeping tabs on the subject, and please keep it to the subject at hand. We are all here to help eachother and new suggestions are always encouraged.

Thank you...
Forum moderator

 

[tooon68]

I will post a clarification in regards to the manipulation statement I made. It was not a suggestion to perform a high velocity thrust as per chiropractic adjustment, as this is without a doubt out of our scope of practice. However, oscillation mobilization, respiratory manipulations, and MET manipulations are well within a manual therapists realm, assuming instruction has been performed.

For example: Thoracic Rib cage respiratory manipulations as per the osteopathic model are safe and do not require a thrusting movement. However, a million dollar roll adjustment, is more of a thrust.

Sorry for the confusion.