Fall 2010 CLINICAL INFORMATION FOR THE GT PROFESSIONAL In This Issue CASE REPORT Achilles, Plantar Pain By Terri Angelo, MA, ATC, Summa Health System, Akron, OH Page 1 CASE REPORT Treating Meralgia Paresthetica During Pregnancy: GT is Low-Risk Care Option By Carla Cupido, DC, Vancouver, B.C Page 1 TECHNIQUE SPOTLIGHT Framing By GT Clinical Advisor Jackie Shakar, DPT, MS, ATC, CMT Page 4 CASE REPORT Season Started Successfully after GT Intervention By Terri Angelo, MA, ATC, Summa Health System, Akron, OH On Aug. 18, 2008, just a couple of weeks before the start of the NFL season, a 45-year-old NFL to us with a diagnosis of right Achilles tendinosis with director to check his orthotics and to start the Graston Technique® as part of his treatment. Continued on page 2 CASE REPORT Treatment of Bilateral Pitting Edema of the Ankles Secondary to Obesity and CASE REPORT By Karson Mui, DC, Mui Chiropractic and Wellness Center, West Newton, MA Page 5 By Carla Cupido, DC, Vancouver, B.C Marketing Efforts Yield Results for Rehab Center By Amy L Grabowski, DC, NOVA Pain & Rehab Center, Arlington, VA Page 6 2010/2011 M2–Advanced Training Dates and Locations Page 7 Instrument, Stroke Videos and Marketing Materials Added to Preferred Provider Section Page 7 GrastonTechnique.com History Three years before this bout of right Achilles pain/tendinosis, this patient had a diagnosis of bilateral achilles tendinitis and right plantar fasciitis. At that time, the patient presented with tight gastroc/ soleus and had pain with running on his treadmill, which is what he used to get into shape for the upcoming season. Treating Meralgia Paresthetica During Pregnancy: GT is Low-Risk Care Option History A 37-year-old woman presented with right-sided anterior and lateral thigh pain, paresthesia and tightness. The patient was six months pregnant at the time of her initial appointment. Concerns related to her pregnancy were previously ruled out by the patient’s medical physician. Symptoms commenced insidiously two months into the patient’s pregnancy and were most aggravated with rightsided sleeping, prolonged airplane travel and standing for long durations. The patient’s occupation required her to stand continuously for multiple hours while delivering presentations; therefore her condition was persistently aggravated. Mild relief was noted with movement and sitting. The patient participated regularly in kickboxing before her pregnancy and has since committed to other less aggressive forms of exercise. Examination Upon observation, primarily because of the patient’s pregnancy, her lumbar lordosis was exaggerated, increasing her anterior pelvic tilt. Range of motion testing produced a sensation of pulling through the right thigh with lumbar extension, as well as right- and left-sided lumbar Kemp’s tests. Orthopedic testing only revealed a positive right-sided Ely’s test. All testing for nerve root and discogenic diagnoses were negative. were intact. Continued on page 3 Page 3 The EDGE Treating Meralgia Paresthetica During Pregnancy Continued from page 1 Anterior and lateral thigh tenderness was noted upon palpation, as was iliotibial band and quadriceps hypertonicity. Discomfort was observed upon palpation of the right femoral triangle. Diagnosis Meralgia paresthetica, also known as BernhardtRoth syndrome or lateral femoral cutaneous nerve (LFCN) entrapment. LFCN Review The LFCN originates from the lumbar plexus from nerve roots L2-4 (depending of course on your anatomy source). The nerve travels the lateral border of the psoas, navigating under the lateral aspect of the inguinal ligament. The most common entrapment site is 1cm medial to the anterior superior iliac spine.1 Treatment The patient’s plan of management included two included Active Release Technique (ART),® myofascial release with a VibraCussor® and Graston Technique® to the right iliotibial band, vastus lateralis, rectus femoris and sartorius. ART® was also performed on the patient’s right iliopsoas, obturator externus and pectinius. Ascites and obesity can also cause mechanical stretch resulting in MP. Extrapelvis causes include trauma around the ASIS from belts, tight clothing and the seat belt in an MVA. Mechanical factors include prolonged sitting or standing and leg-length discrepancy resulting in a pelvic tilt. MP can also present as a polyneuropathy or as an isolated neuropathy with diabetes. This patient was a prime candidate for MP, considering she was pregnant and she spent large amounts of time both standing during long presentations and sitting on an airplane for work. Conclusion From the GT clinician’s perspective Graston Technique® offers a low-risk conservative care option for the treatment of MP. Low-risk treatments that can also prove to be diagnostic may in fact prevent the necessity of more invasive and time-consuming diagnostic testing. Avoiding drug prescriptions and of course surgery are two more enticing reasons to attempt success with GT treatments. Resources 1. Carai A, Fenu G, Sechi E, Crotti FM, Montella A. Anatomical variability Clin Anat. Apr 2009;22(3):365-70. Clinical Outcome After the initial treatment, the patient’s perceived tightness improved by 15% and the frequency of discomfort was decreased by 10-15%; however, when the pain was experienced, it was approximately 5% more intense. After this report, over the course of treatment, the patient consistently noted decreased pain, numbness and frequency of symptoms. On the 10th appointment, despite still delivering long work presentations, the patient reported the pain so infrequent that she was unable to correlate it to anything anymore and the numbness had almost completely dissipated. When promoting Graston Technique® on your clinic/practice website, don’t forget to take advantage of providing a link to GrastonTechnique.com. Discussion Meralgia paresthetica (MP) can be caused by intrapelvic, extrapelvic and mechanical factors. Intrapelvic origins include pregnancy, abdominal Talk to your webmaster to ensure when visitors exit the GT site, they automatically come back to your website! and in some cases abdominal aortic aneurysm. MARKETING tip