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.
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I recently met Curt Lezanic during one of the medical massage seminars, and greatly appreciate his willingness to learn and practice medical massage as well as his professional abilities. We consider his contribution to the Case of the Month section of JMS exceptional.
This article is an excellent illustration to accompany the article on clinical interview published in this issue of JMS. As you will read below, Curt’s knowledge and attention to the client helped him, as a practitioner, avoid the erroneous assumptions and diagnostic traps made by health practitioners before him. Previously, everyone focused on the local symptoms, in this case pain in the area of greater trochanter, while the real cause was in the lower-back area. Please notice that Curt’s client had no complaints about pain or tension in the lower back and, consequently, no one paid any attention to this area. As a result, irritation of L4 spinal nerve, which is normally responsible for the innervation of greater trochanter, was unsuccessfully treated by several health practitioners as Trochanteric Bursitis. Simple application of the correct MEDICAL MASSAGE PROTOCOL cured Curt’s client from very intense hip pain.
This case proves, one more time, an important clinical fact many practitioners miss. In many cases, local treatment protocol is not a clinically effective choice to provide stable clinical results.
MEDICAL MASSAGE vs UNBEARABLE HIP PAIN
My client is a 65-year-old female. She has been suffering with pain in the area of left trochanter for about a year. She walked with a pronounced limp and was in constant severe pain. She had seen several physicians and had two MRI’s of the hip. The results of the MRIs showed the following:
6-21-11: Insertional guteal tendinosis with partial thickness tearing of the gluteus minimus insertion.
9-19-11: Mild uptake left greater trochanteric consistent with mild greater trochanteric bursitis.
She was given steroid injections to the trochanteric bursa to relieve the pain. She was also prescribed muscle relaxants. Initially, she felt an approximate 80% reduction of pain intensity but that result was short-lived. She underwent another MRI that showed some tendinitis in the gluteus medius and minimus that, as I read in the finding, showed no significant change from the previous MRIs. She refused any additional injections due to the short-lived pain relief. I was asked by her doctor to “see what you could do to relieve her hip pain.”
When I examined the client, she had a pronounced limp and was in a lot of pain. During palpation of the left greater trochanter area, she jumped when I barely touched the trochanter and reported very intense pain sensations.
Due to the intensity of her pain in the area of the greater trochanter, I decided to use Segment Reflex Massage to see if that would reduce her hip pain. I had her lie in the prone position. I noticed that she had about an eight-inch surgical scar on her lower back that extended from her sacrum to her to last rib. I asked her about the surgery that had resulted in the scar. She informed me that in the 1960’s she had undergone two back surgeries that fused L3-L4 and L4-L5 vertebral segments. I also found that the paravertebral muscles on each side of her spine were in intense spasm.
I began to work the paravertebral muscles using the Big Fold Technique and later transitioned to the application of General Technique of relaxation of paravertebral muscles. I performed this treatment on paravertebral muscles on both sides of the spine. Following this procedure, I again palpated the area of greater trochanter and despite the fact that this area was still sensitive, the reduction in pain was very much appreciated by the client. I asked her to walk. Her limp was almost totally gone, and she reported the pain had almost vanished.
We scheduled a second visit five days later. When the client arrived, she exhibited no limp. She did have some pain in the area of the greater trochanter but reported it as mild. I palpated the area around the trochanter using “normal” pressure. The intensity of her pain response was significantly less when compared to the first session.
I worked on her back again using combination of Big Fold and General Techniques. At the end of the session, the client reported no pain while walking or moving the leg in any direction. I palpated the area around the trochanter. The client reported almost no pain. We scheduled a third visit about five days after the second visit.
The client arrived for her third session. She exhibited no limp while walking. She reported that this was the best she had felt in a long time. I palpated the area around the trochanter using normal pressure. The client reported very little discomfort. I observed that the paravertebral muscles were now in a very relaxed state. I would classify them as almost normal. I repeated the same protocol to the back as described above. After the treatment, I palpated the area around the trochanter using normal and later above-normal pressure. The client reported that there was no pain whatsoever and she continues to walk with no limp.
We have scheduled another follow-up session for next week. Given her progress, I would expect her to arrive pain free and, more importantly, I believe that she is now in a stable condition.
Curt Lezanic received both a Bachelor of Science and a Master of Science degrees in education from Kearney State College, now known as the University of Nebraska at Kearney. His teaching experience includes junior high and senior high teaching in public education and faculty positions in higher education. Administratively, he has worked as a department head, dean and campus director primarily at the community college level.
In the early 1990’s, Curt returned to the classroom as a student to pursue massage therapy. He worked for several years at a local resort/spa as a contract massage therapist and developed a local clientele. In 2009, Curt was approached by Dr. Scott Campbell. Dr. Campbell asked Curt to work with several of his patients who were experiencing various muscular/skeletal issues. Over the next several months, what had begun as a part time on call relationship with Dr. Campbell grew into what was becoming a full time commitment. In 2010, Curt retired from the college where he had worked for twenty two years and established his massage practice at the office of Dr. Scott Campbell in San Antonio, Texas.
Category: Case Studies