The Fascial Manipulation Method is a cycle of articles dedicated to the understanding of themost common dysfunctions we meet during our clinical practice, specifically theirmanifestation and treatment with Fascial Manipulation. FM specialists report clinical cases,accurately describing their symptomatology, the chosen work plan and the resultsobtained, thanks to the treatment. For privacy reasons, the names of the patients have been changed.

Clinician: Paolo Chesani

B.A. is 61 years old. Job: innkeeper. She does only minimal physical activity.

For 25 days she has suffered from pain (8/10 VAS) in the left lumbar area, referring to the antero-medial area of the left thigh to the middle third, inclusive. The acute pain appeared after walking in flat shoes and also changing a keg of beer.
The patient relates a past history of low back pain (4/10 VAS) for the last 45 years, a symptomatology that originally appeared without any apparent cause. During the anamnesis it comes out that, in her youth, she suffered from recurrent cystitis for about 10 years, which then waned; age concomitant with the appearance of lumbar symptoms. In addition to the lumbo-cruralgic symptom, the patient tells of minor pains, described as discomfort, which also appear on the left knee with the frequency of once per week.
During the interview, the patient does not confirm problems related to the extremities but says that for a long time she suffered from night cramps that appear in the posterior region of the leg, bilaterally and with prevalence on the left leg. Another symptom that she described as urinary frequency, which always appears at night, forcing her to get up with a frequency of 3 times per night. I therefore assume that there is a viscero-somatic (urinary) component.
We continue with questions relating to any surgery and B.A. says she underwent surgery on her left knee for a “cleaning of the lateral meniscus”. She does not clarify why this pain had occurred.
I ask the patient to perform movements useful for evaluating the lumbar and knee segments. The more painful movements for the lumbar segment are those of antemotion of the trunk and of extrarotation of the right, emulating that of the left, extrarotation. Pain always appears on the same left lumbar line. The movement verification of the left knee reveals that the posteromotion is painful and rigid.
On palpation verification of the trunk, a compromise of the anterior lateral catenary is revealed mainly on the left with elements of the left oblique. Palpation of the hinges (coxa segment) does not reveal decisive densification. The palpation ends with the palpation of the anchors, the left tali is densified in the ante-latero point.
At the end of the palpation verification we can therefore confirm the Latero-Lateral plan as our work plan.
We perform fascial manipulation of the left ante-latero pelvi, the left ante-latero thora and the left ante-latero tali.
After manipulating the anterior points, we treat the right latero-lateral pelvis and the left thigh at the height of the distal third, laterally.
On re-evaluation of the antemotion motor verification of the trunk, the patient describes the symptomatology asno longer as painful but as a “tension”. The rotation of the trunk remains painful but with an increase in ROM before the appearance of symptoms.
The pain, which showed itself in the antero-medial third of the thigh, is greatly decreased (3/10 VAS).
We set an appointment for the following week. In addition, I ask her to pay attention and understand how and if the nocturnal urinary frequency is changed and to note if the cramps that affect her during the night change.

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