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: Bregola Efrem
M.R. presented to the outpatient clinic with right thoracic pain, predominantly localized in the postero-lateral region (RE-LA TH right).
Medical History
The following elements emerged during the anamnesis:
- The primary pain (Do-max) has been present acutely for approximately three months, although it first appeared three years ago. Currently, the pain is nearly constant and intensifies in the anterior thoracic region (AN TH). It is also present during nighttime.
- As for previous pain episodes (Do-prec), the patient reports right antero-lateral thoracic pain (AN-LA TH right) that began about four years ago and resolved the following year. This pain was continuous but did not worsen with movement.
- Approximately seven years ago, she sustained a right rib contusion following a fall.
- She also reported a severe episode of pneumonia four years ago, lasting approximately one month, coinciding with the onset of anterior thoracic pain.
- In the past few months, she has been experiencing occasional gastroesophageal reflux with retrosternal burning sensation.
Hypothesis
Based on the collected data, the working hypothesis is a dysfunction of the thoracic tensostructure (TH). This dysfunction may be related to the prior trauma and/or to inflammatory and functional alterations that affected the same anatomical region.
Motor Verification
Motor verification revealed pain during anterior thoracic movement (AN TH), while all other movements were pain-free.
Palpatory Verification
Palpation of the thoracic region revealed the following findings:
- Tenderness and fascial thickening (“rugosities”) affecting the laterolateral tensors (LL), particularly at AN-LA TH2 right and AN-LA TH1 left.
- In prone position, bilateral fascial thickening was detected in the RE-LA TH region, with marked tenderness upon palpation of LA TH right.
Treatment
Treatment was initiated in the supine position, focusing on AN-LA TH2 right and AN-LA TH1 left. These areas were alternately treated until a release of fascial thickening was achieved. The patient was then placed in the prone position, and treatment was applied to the bilateral RE-LA TH regions and LA TH right using the same technique.
Post-Treatment Evaluation
At the end of the session, motor verification showed a marked reduction in anterior thoracic pain (Do-max). A follow-up visit was scheduled for one week later to monitor clinical progress and assess the treatment’s effectiveness.