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: Dazzan Enrico
ANAMNESIS:
A 39-year-old real estate agent, former volleyball player, presents for evaluation.
She reports right-sided pain at the base of the cervical spine for the past 10 years, with an intermittent course and a perceived VAS ranging from 0 to 7/10, without a reported traumatic onset.
She also reports a clicking sensation in the right scapulothoracic joint for the past 5 years, described as non-painful but very bothersome, associated with a feeling of shoulder instability.
Occasionally, she experiences vertiginous episodes for the past 10 years, particularly when turning her head to the left combined with extension.
She denies any cervical spine or other trunk trauma.
Additionally, she reports pain in the right iliac fossa for the past one and a half years, intermittent, with VAS ranging from 0 to 7/10, not apparently associated with specific movements or circumstances.
Past medical history includes: pregnancy with cesarean delivery 4 years ago, right great toe trauma 10 years ago, and fracture of the 3rd finger of the right hand 25 years ago.
MOTOR VERIFICATION:
Cervical spine inclination contralateral to the symptom (to the left) evokes pain and shows a markedly reduced ROM compared to the contralateral side and normal physiology of the region.
The scapulothoracic clicking is perceived during both active and passive scapular protraction/retraction.
Forward trunk flexion elicits pain in the right iliac fossa.
PALPATORY VERIFICATION:
Given the multiple regions involved, this session focused primarily on the upper body, palpating the DI, CA, SC, TH, and CL segments, as the earliest trauma involved the right hand 25 years ago, potentially originating dysfunction in the shoulder girdle and neck.
The following points were identified as most significant:
LA DI RT **, ER CA RT **, ME SC RT ***, LA SC RT and LT ***, IR SC RT **, AN SC RT and LT ***
TREATMENT:
Due to the predominance and degree of tissue roughness and symptom provocation, I chose to treat the frontal plane.
- ME SC RT: very painful, with irradiation after 3 minutes toward LA SC RT and downward along the forearm to the 1st ray of the right hand. Treated until densification resolved, with substantial reduction of irradiated symptoms.
- LA SC RT: painful, with irradiation toward ME SC RT and the right lateral occipital area. Treated until resolution.
- I then continued palpation of the frontal plane in segments LU, PV, GE, and PE to evaluate potential contributions from the abdomen or lower limbs given the past history, identifying:
- ME GE RT ***: local symptoms during treatment until resolution.
- LA PV RT ***: local symptoms during treatment until resolution.
- LA TA LT ***: irradiated symptoms to the foot until resolution.
CONCLUSIONS:
Post-treatment motor verification showed a marked improvement in cervical spine ROM during lateral inclination, which no longer provoked pain. The scapulothoracic clicking was partially reduced during both active and passive mobilization. However, pain in the right iliac fossa during forward trunk flexion persisted.
Further treatment sessions have been planned, given the overlap of long-standing, multi-regional dysfunctions.