He Drew a Line
Our latest blog post provides a vivid example of a medical student incorporating the Fascial Distortion Model into their clinical awareness, much to the patient's benefit. Read on.
I volunteer as a medical student at a free medical clinic that offers osteopathic manipulative treatment. One of my patients, a 20 year-old male, presented with the chief complaint of inability to lift his arm higher than his shoulder—he couldn’t abduct more than 90 degrees. He had been t-boned in a car accident and for 4 months his right arm had been getting progressively worse. Imaging at the ER soon after the accident was negative. Besides being right handed, he picked fruit for a living and was worried about his livelihood.
Other than the car accident, the patient had no medical or surgical history, and he looked glum, as though doubtful anything could be done for him. However, the physical exam was promising, with normal upper extremity strength, sensation and range of motion in the left arm. I asked him where it bothered him when lifting his right arm. He drew a line along his deltoid and said that’s where it got tight. Aha! FDM!
I briefly explained FDM, obtained
consent, and treated the Triggerband. When he tried his arm again, he swore as it raised an additional 30 degrees of abduction.
I asked again, where does it get tight? This time he pointed at the distal tip of the deltoid. For those readers already trained in FDM, you know the conversation you have with the patient before someone’s first HTP treatment. Seeing the benefits of the first FDM treatment, he was more than willing to chance it. I set this up with my fingers on the triceps and one thumb in position over the HTP, the other bracing it. Feeling that this might take more than one attempt, I internally and externally rotated the shoulder until I found a position where it felt like the HTP was engaged by the tissue around it, kind of like a tightened down feeling. The first impulse moved something, but not enough. I quickly followed with a second and third attempt, finally feeling the tight bubble like structure subdued.
Treating that HTP produced a lot of gasping on the patient’s part, but when he raised his arm again he had an additional 30 degrees of motion. He was pretty happy about this. Now he said that his shoulder was tight. I did soft tissue techniques on his trapezius then counter strain on the levator scapulae which were noticeably hypertonic. That earned another 20 degrees of motion. We ended the session at this point with his right arm having nearly the same range of motion as his left arm. He was incredulous anything could be done for his arm short of surgery. And I was inspired by what could be accomplished with FDM.
Paul Matiaco currently attends PNWU-COM in Yakima, WA.