A Clinical Case for Neuromuscular Therapy - Essay Example

Theoretical Aspect Mr. Burns has been undergoing severe pains for the last three years, though his conditions has been stabilizing regularly Mr. Burns health conditions have not improved whatsoever. His symptoms includes, experiencing horrible and very high temperatures in his hands, sensation of swollenness, worsened hand symptoms as a result of massage, pains with a nerve origin for instance, the tingling and numbness of hands leading to throbs. Though under supportive relationship Mr. Burns is emotionally affected implying unstable mental state. The fact that he cannot continue with his career in writing seems to affect him most, the poor sleeping patterns means that he never acquires enough sleep thus unstable psychological state. He is a demoralized man who after visiting several neurologists and healers he has not been able to get any assistance, worse still some experts has worsened his conditions i.e. the teacher from Alexander who improvised a method of laying the patients head on a book in the ‘best’ position an idea that failed to bear fruits. To assist Mr. Burns I will be guided by the above brief medical history. The pain that Mr. Burn is undergoing may be caused by many factors but for the purpose of this study I will mainly concentrate on the knock after a football match. Body tissues contract after ‘physical knocks’, tissues may have stayed contracted, restricting the body’s functioning and giving rise to the problems suffered by Mr Burns over the years. I would like to consider whiplash as a possible cause. It may be the case that there was previous history of an underlying accident or the football injury may have itself been the cause. Chaitow (2003:175) suggests that whiplash-type injury may trigger fibromyalgia, the reason for this may lie in the role of the rectus capitis posterior minor muscle, part of the suboccipital group. Symptoms can range from neck and arm pain to chronic headache, dizziness and imbalance all of which Mr Burns exhibits. When whiplash-type injury triggers fibromyalgia the resultant effect is a repetitive spine injury a thing that is exhibited in Mr.Burns present symptoms (Chaitow 2003:171) This case is similar to that of the football player from high school since both Mr. Burns and the player experienced abnormal hands sensations, stenosis of the cervical canal and oedema of the spinal cord with both being barred from participating in any contact sports to avoid further injury to their spinal cords. Their problems appears to have a similar causes i.e. after a football match a clear indication that whatever is affecting one person is similar to the other persons health woes and similar medication can be applied in their treatment therapy. Another factor to consider is Mr Burns’s body height and long sitting hours particularly in a ‘compromised’ position may have led to further postural imbalances. The prolonged hours of computer keyboarding that Mr. Burns used to spend may depict a likely cause for his current conditions. Ten hours or more of continued sitting at a computer clearly indicates that Mr. Burns was bending his back for a long period, straining his body. This may have resulted in a low blood supply to the muscles, tendons and connective tissues culminating into the patient’s hypersensitivity to touch. Mr. Burns could be a victim of ischemia (Servi, 2001). It is clear that Mr Burns’s normal sitting posture shows dysfunction. It is possible that the ‘two week’ stiff neck period undergone by Mr. Burns interfered with his mode of breathing and the locomotion system of his cervical spine. Subsequently he may have suffered stress that would have shortened the scalene muscles which play an important role in rib elevation while breathing and also balancing of the cervical spine. The shortening of scalene muscles may have lead to the tightening of the muscle fibres thus developing trigger points around the muscle bellies. Trigger points may be a feature behind the pains suffered by Mr. Burns since their work is to relay pain to the entire body parts. (Servi, 2001) The brachial plexus supplies the upper extremity and derives from the cord at the cervical level, any such nerve root impingement of the cervical intervertebral foramina could produce both local symptoms and neurological effects on the entire extremity. (Chaitow 2003:171) According to Field et al (2003), shortened scalenes may amount to the interruption of the median nerve making the brachial plexus to be more defenceless in the carpal tunnel. Since the scalenes and brachial plexus are anatomically intertwined i.e. the epineurium of C4 to C6, which is the outer coat of the nerve, is partially attached to the scalene muscle group and any continued contraction of the scalene muscles could have aggravated the nerves. This is a clear indication that Mr. Burns’s present predicament has been worsened by the trigger points. The fact that the scalenes and the brachial plexus are entangled may explain why the patient has problems with the nerves most particularly as a result of the shortened scalenes. Mr. Burns’s injury may have tightened specific muscles and weakened others resulting in general body imbalance. Such alterations may have been the cause for musculoskeletal complications. When such conditions are experienced associated for an extended period of time then it will automatically compel increased demand that the system may fail to adapt to leading to further breakdown. Mr Burns sensitivity to movement and associated effects may indicate a possibility of kinesiophobia which is defined by Chaitow and Delany (2000) as the irrational, debilitating and excessive fear of physical activities and movement emerging from a feeling of susceptibility to agonizing injury. Mr. Burns may be suffering from conditions of nerve origin which affects the nerves. When the median nerve and other nerve structures are affected the effect is global i. e. It affects every part of his body that makes it impossible for Mr. Burns to participate in any physical exercise. This in return has caused general body tiredness following the fact any activity or accident that may affect the nerve structures plus the median nerve will definitely lead to general body fatigue where the patient shows clearly that Mr. Burns could have suffered oedema of the cervical cord paraesthesia of the upper extremity, burning hand disorders and also stenosis. A combination of all these ailments confirms that Mr. Burns is undergoing pains and he is not comfortable in most of his resting positions a thing that calls for urgent and specialised treatment approach. The fact that he has problems while wearing certain clothes due to the pains he experiences around his neck may have translated that his neck was injured and for three years the neck had to develop pressure sensitivity. Failing to participate in contact sports could also mean that Mr. Burns may have injured his spinal cord while in that football match, the sensations (upper – extremity) are clear indications that the patient may have acquired some cervical pathology. This means that Mr. burns could have suffered major bruises at C- 2 to C -3 of his spinal cord and considerable stenosis of his spinal cord at C – 2 to C – 3 along with a small congenital canal from C – 2 to C – 6. All this could have attributed to the burning hands disease, cervical stenosis and oedema the syndrome that bars Mr. Burns from participating in any future sports event. The spinal cord runs from the brain to the lumbar spine and passes through the cervical spine. The cord is very vulnerable to traumatic injury in various ways and becomes ischemic due to cervical spinal stenosis, a narrowing of the neural canal, this may be exacerbated by osteophyte formation (chaitow 2003:171). It is highly possible that my patient is suffering from neurapraxia of the cervical cord that normally occurs as a result of severe mechanical deformation suffered in the spinal cord. Hyperextension or hyperflexion of the spine in the region of stenotic canal of the cervical may have caused an impulsive decrease in the diameter (anteroposterior) diameter of the canal leading to the compression of the spinal cord commonly referred to as the pincers mechanism in clinical terms. His conditions could be aggregated by the fact that he has stayed for a long period of time (three years) without any applications of fine movements to the patient’s cranial and other bones around the spinal. Applications of such movements would be very beneficial in harmonizing the central nervous system an idea that would have accelerated the recovery process of our patient. This would encompass the general evaluation and monitoring of the cerebrospinal fluid movement which could be restricted by the knock suffered by Mr. Burns three years before the therapy application, body pains and the general tension in the nervous system. The therapy would have ensured proper optimisation of the cerebrospinal fluid movement via the spinal cord consequently returning the skewed bones to their former position. This would have ensured that the passages of the nerves would no longer be blocked since the craniosacral therapy would tenderly work with the skull, fascia, diaphragms and the spine. Treatment approach I would employ all the necessary measures when designing the appropriate treatment for my patient. My global focus would lie on releasing the body’s tensions which may free up energy which the body may have been previously using to hold itself in contraction, therefore increasing the level of energy available. First and foremost I would take a very detailed case history to build up an in depth background to help me know how best to treat Mr burns. I would be aware this may be frustrating for the patient as I am sure he has had to explain on many occasions his history, I would be aware of this. I would be listening for key information which may not have been picked up on initially perhaps a previous accident that Mr Burns has forgotten about which may be relevant. I would discuss with Mr Burns how many sessions I would intend to have with him, initially starting at a slow pace reassessing this as time goes on according to any progress that is made. It is clear to me that Mr Burns’s system is much overloaded, I would take this into consideration and initially starts with very little intervention in the first few sessions as I Mr Burns system is not able to cope with much adaptability. Any changes I make are only useful if MR Burns system is able to take it on and re educate itself. As his condition is chronic I will tend to work generally giving constitutional treatments. Globally I will try to look for areas where there are no movements and try to bring movement back to these areas, challenging the system to regain what it has lost. When pain is felt the patients loses proprioception, bringing movement back may help to desensitize the area, overriding pain and bringing back fine motor control. Since massage is a proved pain killer (Katz 1998) I may consider using massage and rocking to help me to get a sense for Mr Burns’s tissues i.e. is there tightness, stickiness, can I feel restrictions, do the tissues have preference to what direction they wish to go in and so forth. I would avoid the arms and hands to avoid worsening the hand symptoms; I would ensuring that his neck is not subjected to any pressure, always working in the threshold of what the patient can tolerate. At any time I place my hands on my patient’s body I would instruct him to report any change of feelings. A key area I would like to start working on would be to help Mr Burns to find positions to sleep which did not aggravate his hand symptoms. I would take my time with this as I feel this would be hugely beneficial to his condition, also in regards to positions in which I would be able to treat Mr Burns during our sessions together. Following this I would search through Mr Burns’s tissues systematically using Neuromuscular technique (NMT) identifying and recording areas of dysfunction on a body map. Once the sleeping had been address I would concentrate on Mr Burns’s breathing dysfunction, maybe working with him by using some anti-arousal breathing techniques. As well as increasing oxygen to the areas of the body where needed may help in easing his anxiety and benefit the depression he suffers from. (Chaitow, 2003) …… Presuming Mr B is suffering from chronic RSI I would expect the system to be very inflamed therefore I would do little or no work in the local area. I would prefer to work globally, considering that at some level all the tissues are connected to one another , so working from the waist up to the latissumus muscle releasing these tissues whilst checking in for the clients experience, further working up to the shoulder, possible including the pectorals on the front. I would see the client’s response to this, I would not expect changes after one treatment but gradually over the course of the treatment. With regards to treating the whiplash I believe Mr Burns may have been a victim of Chaitow (2003:175) suggests an approach of NMT, Muscle Energy Technique (MET), Positional release technique (PRT), Myofascial release technique (MFR) and massage as well as rehabilitation methods as he believes these offers the best opportunity for successful treatment. According to Finando (2005) exercises involving the gliding of the tendons can be very resourceful in curing the noted symptoms. Such exercises are aimed at maximizing and restoring median nerve excursion via the carpal tunnel. Fig.1.0 A diagram of the brachial plexus showing the medial nerve I would consider deactivating any found trigger points (TPs) as a treatment protocol using Integrated Neuromuscular Inhibition Technique (INIT). I am also aware that there is opposing information which suggests that it may not be useful to reduce trigger points activity as some research suggests that TPs may be the body’s way to hold muscles in a shortened position with out using up ATP. (Mense and Simons, 2001) My aim would be to avert the trigger points and gradually reduce their ability of irritating and spreading pain to the rest of the body. (Mense and Simons, 2001) Using a patient centred approach I would check in with my client on a regular basis, before the treatment, during treatment and after treatment, as to know the progress and attend to him effectively. While pain management remains dependent on its root cause Mr. Burns fatigue condition may be properly checked through practicing the taking of some rest periods during the day which should be on regular basis, shunning an instances of muscular overuse, techniques of energy conversation and change of lifestyle. I would be very supportive in helping my patient all these approaches that would in return help him to overcome fatigue. (Chaitow, 2002) I may consider introducing some craniosacral therapy to Mr. Burn as I believe this is a very non invasive technique which I feel may be beneficial, I would intent to provide an opportunity for the body to let go of restrictive patterns which have developed. I may start by integrating only a few minutes at the beginning and the end of our sessions to see how Mr Burns reacts to the treatment. I would hope to facilitate the body’s vital force to manifest and bring about intrinsic changes and reorganisation. Application of Craniosacral therapy may help Mr. Burns in the release of cranio-sacral fluid blockages through very moderate and light touching of his joints in the various parts of his body so as to stimulate and balance his health. If we felt the cranio was having a beneficial effect on Mr Burns’s health I may consider referring him to a therapist with more experience than myself. I would hope the cranio therapy would help Mr. Burns by easing away the suffered neck pains, headaches and associated symptoms. (Liebenson, 2002) I feel it may be relevant to encourage the partner of Mr Burns to participate in some of the sessions, training her in certain aspects of treatment e.g. massage before bed to help relaxation. This may be rewarding for both of them working together as a team, having a positive effect on Mr. Burns conditions. I would not be aiming to offer quick fix for, but I believe if we worked together as a team we could overcome some of the obstacles that are currently stopping Mr Burns moving forward with his life. I would hope the application of both the neuromuscular therapy and craniosacral treatment along with advice in lifestyle changes to produce good results and stabilize my client’s body health. References Chaitow, L. (2002): Positional Release Techniques. Second edition. Churchill Livingstone. Pg, 42-89 Chaitow, L. (2003): Modern Neuromuscular Techniques. Second Edition. Churchill Livingstone. Pg, 63-120 Chaitow, L. and Delany, J. (2000) Clinical Application of neuromuscular techniques. Churchill, Livingstone. Pg, 19-54 Field T, Delage J, Hernandez-Reif (2003): Movement and massage therapy reduce fibromyalgia pain. Journal of Bodywork and Movement Therapies. January. 7 (1), 49-52. Finando D, Finando S (2005): Trigger Point Therapy for Myofascial Pain. The Practice of Informed Touch. Healing Arts Press. Pg, 66-124 Haynes, W. (2004): Core Stability and the Unstable Platform Device. Journal of Bodywork and Movement Therapies. 8, 88-103. Hendrickson Thomas (2003) Massage for Orthopedic Conditions. Lipincott Williams & Wilkins. Pg, 65-89 Humphreys K. Delahaye M, and Peterson C (2004): An Investigation into the Validity of Cervical Spine Motion Palpation Using Subjects With Congenital Block Vertebrae as a ‘Gold Standard’. BMC Musculoskeletal Disorders. 5:19. Katz A (1998): The Needs of a Patient in Pain. The American Journal of Medicine. July 27. 105 (1B), 2S-7S. Liebenson, C. (2002): Functional Reactivation for Neck Pain Patients. Journal of Bodywork and Movement Therapies. January. 6 (1), 59-66. Mutarana, H and Varela, F. (1992) The Tree of knowledge. The biological roots of human understanding. Shambhala publications. Pg, 147-208 Mense, S. and Simons, D. (2001) muscle pain: understanding it’s nature diagnosis and treatment. Lippincott Williams & Wilkins. Pg, 15-42 Servi, J. (2001): Abnormal Hand Sensations After a Football Tackle. The Physician and Sports medicine. October. 29 (10). Sutherland. W. (1988): The Cranial Bowl. Self-published, 1939. Reprinted by the Cranial Academy. Pg, 70-102 Werner, R. (2002): A massage Therapist Guide to pathology (2nd edition) Lippincott Williams & Wilkins. Pg, 69-134. Read More