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: Pezzo Ilaria

David is a 30-year-old physiotherapist who has played football for several years. His chief complaint was pain in the posterior lumbar pelvic area mostly on his left side. He has had this recurrent complaint for a year and at least one time per month using a numeric rating scale (NRS of 0-10) his discomfort was at the level of (NRS-1).  For the past week he had increased pain with an NRS-6.

Movement testing revealed his most pain on lumbar extension occurring in the left central lumbar area. Lumbar flexion also caused circumscribed pain in the same area.  Pain increased in the evening and improved when lying. For about 10 days, there had also been an anterior pain in the left hip, NRS-3, which was aggravated by hip abduction and flexion against resistance.  David also reported that 12 years ago he tore the anterior cruciate ligament of his right knee requiring an operation.   He required a second operation on the knee that was complicated by an infection. Twenty years ago, he severely sprained his right ankle which he remembers required a prolonged time to heal. He also stated that 22 years ago he had to wear a night device to relieve lower back pain.

I evaluated lumbar motion in all ranges of motion.  Pain occurred in the sagittal plane mostly in extension, with less pain in lumbar flexion although there was limitation of motion in lumbar flexion.  There was normal range of motion and freedom of symptoms in the frontal and horizonal plane.
Then, I tested the right knee in an open kinetic chain which was negative for weakness or pain. I also tested the right knee in a closed kinetic chain by having David perform lumbar extension with each knee, left and right monopedic. Weight bearing on the right lower limb created right knee pain.
I then moved on to the ten sequence palpatory verification of the bilateral lumbar and pelvic segments and both knees.  The horizontal plane expressed the most rough and stinging points. Then, I proceeded with longitudinal palpation of the sequences of intrarotation and extrarotation of both lower limbs up to the lumbar area and I found the points that had the greatest roughness associated with a painful sensation: IR-PE-rt, ER-GE-rt, IR-PV-rt, IR-LU-lt and ER-LU-lt.

At the end of the treatment forward flexion of the lumbar spine was more fluid and freer and the pain during extension was described as more punctiform and centralized.

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