The Fascial Manipulation Method is a publication featuring actual case reports. This publication is dedicated to the deepening our understanding of the common dysfunctions we encounter in our clinical practice, how they present and how they can be treated with Fascial Manipulation. Professionals tell us their cases, accurately describing the patients symptomatology, the working plan they have chosen and the results obtained due to the treatment. The names of the patients have been modified for privacy reasons

Clinician: Carlotta Forner

DATA: D.G. 52 years old, employed, lindy hop dancer and attends a Pilates course once a week. She had pain in her right shoulder located anteriorly for 6 months and has complained of the cervical area for a month (frequent CP headaches and CL stiffness) and chest posteriorly.

Symptomatology is present all day and worsens during sports and at work, especially if forced to maintain static positions. On the VAS scale she reports an 8 out of 10 in the most acute moments; while currently it is 5 out of 10. The pain is mostly located in the biceps tendon area. From her  past history she does not report pain or antecedent problems located in this area. She has been treated by massage therapy, TECAR, and topical painkiller applications without any effect.

About 3 years ago she reports a traumatic event, which occurred during a dance performance causing a second degree injury to the medial twin left treated with massage therapy and stretching. which did not solve in normal physiology times. On a digestive level, she reports that she suffers from celiac disease, discovered about 10 years ago, and that before the diagnosis she often suffered from swelling of the supra-umbilical area and poor digestion (visceral sequence hypothesis?).

MOVEMENT VERIFICATION: Difficult and painful movements of the right anterior shoulder with patient in an upright position, especially near 90°.  Anterior, lateral and internal rotation of the humerus improved by changing the position of the scapula. By flexing and abducting the patient’s right shoulder in the supine position there was a decrease in painful symptoms and an increase in ROM.  Positive MoVe was present for neck movements, especially front / back and rotation in the standing position.

PALPATORY VERIFICATION: with supine patient I evaluated the TH segment and found the point of ir TH (R ***, L *) and the point of an-me TH (R ***, L **) very significant. I also evaluated LU and PV at the same time, finding LU1 R (**) and left (**). All the remaining points were not very responsive, therefore I decided to evaluate the control catenary and found CL R (***), ir CP3 R (***) and an-me CP3 sn (**), while the others points were unresponsive. Looking at the positive points I choose the AP catenary and I confirmed the hypothesis on hinges and tensioners by finding an SC R (**), an-me SC1 L (**), an-HU R (***) and an CA R (**) and also an CA R (***), all areas reported to be sources of pain during the day. Also palpated posteriorly SC-HU bilaterally with positivity of re-me SC R (**) and re SC L (**). Given the problem concerning the TA-L, I decided to also check the TA anterior and retro point, finding the re-TA-L (**),  re – me – ta L point (***) significant.

TREATMENT: I treated a very dense point an-me CL R and I also treated an-me TH R (from 2 to 3) and an SC R trying to remove tension upstream until reducing the density and the symptoms. After this first treatment I evaluated MoVE and found a reduction in the problem of stiffness at the cervical level and a reported modification of the painful sensation of shoulder movement. I continued the treatment of an HU R, re-me SC L and an-me CA R and I rechecked  the movements in an upright position with pain reduction  1/10 and AS ‘lighter’. Given the improvement of the symptomatology and the quality of the movement, I gave stretching exercises and recommended postures and precautions to be implemented during painful motion.

CONCLUSION: I saw the patient again after one week.  She reportes improvement of the symptoms with almost disappearance of pain except in some moments of tiredness and inattention. I’m going to recheck the treated points for density and check if in the previously treated tension line there are remaining pain points and wrinkled Given the lack of treatment in the first session of TA, I proceed to treat those points (taking into account the sport practiced) and make arrangements for a third session to be performed after 2 weeks after complete remission of the symptoms.

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