In every issue of our journal you will find Case of the Month which we will select among submitted ones. Everyone who is using MEDICAL MASSAGE PROTOCOLs in their practice may submit their cases for the review and we will share with our readers the best one in every new issue.
MEDICAL MASSAGE vs MEDICAL MYSTERY
I would like to share with our readers a very unique case which was recently treated in our clinic. For this patient the medical massage actually cured the medical condition which was labeled as a medical mystery by several physicians. It worked when all other medical modalities failed. This case is for educational purposes only, and it doesn’t participate in our yearly contest for the ‘Best Case of the Month’.
Clinical History
The patient is 17 years old, completely healthy A-grade student active in school and after school programs (he is the leader of a rock band). In December of 2009 he had severe flu infection. Two weeks after what seemed like complete recovery without any other clinical triggers he developed a very unusual medical condition. The patient started to experience uncontrollable bi-lateral muscle contractions of the upper shoulders and neck muscles or shrug-type movements. Muscle contractions were very intense and both shoulder simultaneously and constantly jumped up. These contractions were uncontrollable and they continued even at night after the patient fell asleep from complete exhaustion.
The patient was seen by a family physician, internal medicine physician as well as two neurologists. For almost month and a half he was examined with all possible tests from a brain MRI to various blood tests. All tests confirmed that he was completely healthy, but the involuntary contortions did not stop even for a second.
The case became a complete medical mystery and the best diagnosis was proposed as ‘Essential Dyskynesia’ which means movement disorder of an unknown nature. The only way the involuntary contractions were controlled was by a cocktail of high a dosage of Benadryl and strong sedative medications. The medications helped to reduce the intensity of the involuntary contractions but they made the patient heavily sedated and he wasn’t able to attend school.
Neurologists told his parents that the nature of these contractions is unknown and they may disappear with time or they may stay with the patient for the rest of his life. He was simply sent home.
Clinical Symptoms
At this point the desperate parents brought the patient to our clinic for initial evaluation. Despite that we had phone conversation with the parents before appointment no one in our office expected to see how violent these contractions were. Both shoulders were constantly jumping and the patient didn’t have any control over contractions. It was difficult to believe but both shoulders constantly jumped up to the height of almost 3 inches!
The range of neck and shoulder movement was completely normal, but involuntary contractions continued even while the patient executed each movement separately. The palpation of the cervical and shoulder muscles showed complete chaos of their contractile function to the degree that myofibrills in one part of the muscle contracted in the completely opposite regime compared to the myofibrills in other parts of the same muscle. This was a completely bizarre clinical picture.
As I mentioned above the brain and spinal cord MRI didn’t find any abnormalities. Consider that we assumed that something happened in the lower motor centers in the spinal cord and that they lost control over the activity of proprioreceptors, first of all muscle spindle receptors.
Treatment
Session 1
We required the patient to stop any medications 24 hours before the first session. We considered several treatment options but there is no medical literature on the disorder like this one and no one had any idea of its origin. We decided to experiment with medical massage tools and techniques.
First we started with the application of permanent, fixed electric vibration on the motor points, i.e. areas where the nerves which innervate each affected muscle enters it. We hoped that electric vibration as a major inhibitor of the peripheral receptors would suppress the activity of muscle spindle receptors and help the motor centers regain control over voluntary muscle contractions. Unfortunately it didn’t work. To our surprise it actually increased the amplitude of the involuntary contractions.
Light repetitive effleurage strokes and gentle kneading in the inhibitory regime to relax the affected muscles and decrease the excitability of peripheral receptors didn’t work. Repetitive compressions on the tendinous parts of the affected muscles to activate Golgi tendon organ receptors didn’t do anything as well. At this point it looked like that this particular patient wasn’t going to get any benefits from medical massage.
Many years of clinical application of medical massage and manual therapy taught me to be patient and never give up if there is any single tool left and think outside of the box. Sometimes textbooks are wrong. I suggested my colleagues to try a stimulating regime of kneading in a very intense mode. It didn’t make any sense because the affected muscles were already overstimulated. Despite the “good luck with that” attitude I decided to try this final approach. To my complete surprise the intensity of the involuntary contractions on the side I worked visually decreased. Now I added a very intense, strong effleurage strokes and increased the intensity of the stimulating kneading techniques and with every second I felt lesser degree of contractions in the neck and upper shoulder muscles. I continued to push the intensity until I was completely out of breath and stamina. After almost 15 minutes of this marathon I stopped and to everyone’s shock including the patient’s parents he was lying on the table with a very light involuntary contractions. So now we had a basic idea it could be controlled without medication using medical massage.
Considering the fact that the patient responded astonishingly well to the stimulating massage techniques I decided to add Postisometric Muscle Relaxation and asked the patient to sit quickly and immediately drop his head as soon as he sat up. I used PIR for each group of cervical and upper shoulder muscles and after the end of the therapy he didn’t have any involuntary contractions as well as muscle twitching under the skin. It was heart wrenching moment for entire family. No one could believe that massage could do something like that.
I said to the patient and his parents that the involuntary contractions more likely would come back and they needed to pay attention for how long the treatment would work. We discussed other modalities such as hot showers, swimming in the pool, etc.
Session 2
The patient came back very encouraged. The involuntary contractions came back in approximately 45 minutes after the end of the first treatment, but they came back as half strong when compared to the time before the first session. Now I was sure that we had found the solution and I used the same protocol which we had composed during the first session. Basically it started to work immediately. Even the first 10 minutes of treatment completely eliminated the involuntary contractions.
Hot showers helped the patient but light repetitive exercises and even gentle swimming didn’t do anything and in his opinion even slightly increased the amplitude. We stopped further experiments there and decided to use a combination of medical massage techniques daily with self-stretching at home.
Before the beginning of the second session I taped the involuntary contractions and I also tapped the result of the second session (see video below). The first part of the video shows the patient before the beginning of the second session. What you will see in the video is 50% of the original amplitude of the involuntary contractions the patient had before the first session.
Unfortunately I didn’t have camera in the office to record the original clinical picture. Now imagine for a second that the patient had these unstoppable contractions 24 hours a day for more than a month without any hope of getting rid of them.
Sessions 3-6
Each session was based on the same protocol. From day to day the intensity of the clinical symptoms subsided and before the 6th session the patient was able to completely control the involuntary contractions which had very small amplitude. As soon as he felt even slight muscle twitching he started to stretch the vulnerable muscle and his parents immediately start to apply massage strokes we taught them in the clinic. After the 6th session we gave the patient a one week break to estimate the stability of the clinical results.
Session 7
Same protocol was performed. During the week break the patient had only two instances of slight muscle twitches and he was able to easily control them. At this point we agreed that he should go back to school and gave him a break for two weeks.
Session 8
The final session was more than month ago. Parents informed us that there is no clinical symptoms of involuntary contractions and the patient had completely recovered and had gone back to his normal physical and school activities.
Recently his parents had called and informed us that they had went to the Clinic of Movement Disorders in Barrow Neurological Institute, which is one of the leading authorities in modern neurology. According to the parents the physicians in the clinic confirmed the very unusual nature of this abnormality. Yet the patient did not exhibit any symptoms and the neurologists asked us to send the video you just saw. However, the biggest surprise for the neurologists was the fact that massage therapy cured such an abnormality without any medication.
There is reasonable question what may cause this condition in the first place. I developed the following theory. As a result of severe viral infection (high temperature, intoxication with viral load and metabolite products etc,) the muscle spindle receptors developed the severe condition of hyperirritability. In such cases they started to react to any, even very small stimuli and their excessive stimulation produced an overwhelming flow of information to the lower motor centers in the spinal cord. Their overstimulation led to the condition when the lower motor centers lost control over the activity of the proprioreceptors. As soon as the condition of hyperirritability of muscle spindle receptors was eliminated by MEDICAL MASSAGE PROTOCOL the clinical symptoms subsided and the lower motor centers were able to regain their normal control over the proprioreceptors.
In a simple analogy imagine the virus which infected the large computer network and each individual computer (i.e., muscle spindle receptors) starts to generate huge amount of useless information and sent it to the mainframe computer (i.e., motor centers in the spinal cord). In such case the mainframe computer sooner or later will be overwhelmed and will finally crash. To recover the entire network, the normal work of individual computers must be restored first. Only after that the main computer will be able to regain ability to process information. This is how medical massage solved the medical mystery.
I decided to share with our readers the case of ‘Medical Massage vs Medical Mystery’ for several reasons:
1. To show the clinical potential of massage therapy and how massage therapy can change the client’s life in cases when all other modalities failed
2. To illustrate that medical massage is a concept rather than a fixed method which is mistakenly presented by many educational sources on medical massage. Scientifically based medical massage includes various methods, techniques and approaches. These ‘tools’ can be combined to find the most effective clinical combination. In many, especially difficult cases, such a combination is unique for each client.
3. To prove that the practitioner doesn’t need to be afraid to try any possible scientifically based methods and techniques and freely combine them for their clients’ health benefits. In the worst-case scenario your treatment won’t work, but in many instances the experiments with different medical massage techniques will bring you ultimate clinical success.
Category: Case Studies