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: Fantoni Ilaria
Today I want to present the clinical case of M.T., a 47 years old woman, office worker, who practices cycling and running (4 workout per week).
She arrived at the clinic with right hip pain radiating to the knee, appeared 6 months before, without trauma. She referred pain rate as 3/10 on NRS scale at rest, that increased up to 5 when changing position (e.g. getting up after prolonged sitting), standing for a long time, walking or sitting down.
As concomitant pain she reported pain in the right Achilles tendon, that lasted for 4 months, exacerbated by walking and especially by running.
As for previous traumas, she reported a fracture of the body of the L1 vertebra 10 years earlier (falling from the bike), treated with kyphoplasty (she denied low back pain during the visit).
20 years earlier she also underwent arthroscopic selective medial meniscectomy of the right knee (meniscal injury reported after sprain trauma). She reported numerous bilateral ankle sprains for over 25 years. She denied other pathologies and did not take any medications.
To summarize in a schematic way:
PaMax: CX-GE LA RT 6 M ? NRS 3-5/10
PaConc: TA RE RT 4 M ? NRS 3/10
Trauma: LU RE BI 10 Y (L1 fracture), GE ME RT 20 Y (meniscal injury), TA AN LA BI 25 Y (ankle sprains)
Hypothesis: repeated ankle sprains lead to ascending compensation up to hip region (pv-cx). We can assume also a possible role of the vertebral fracture with consequent descending compensation to the hip. During the motor verification the therapist should evaluate CX and TA segments (hip and ankle ROM). I observed pain when mobilizing the right hip, particularly in external rotation, with also a ROM limitation in external rotation. Patient referred pain in the Achilles tendon when walking, particularly on both heels and toes. This motor verification confirmed the initial hypothesis.
VeMo: I evaluated CX and TA. I observed pain when mobilizing the right hip, particularly in external rotation. A limitation of the ROM in external rotation was observed. Pain in the Achilles tendon when walking, particularly on the heels and toes.
I palpated coxa and talo’s CC and CF and found the horizontal plane as the most densified.
During the first treatment session the following point were manipulated: er-cx bi, er-ta right, ir-cx left, ir-ge right, anme-cx right. At the end the pain was slightly reduced, and the right hip showed more fluid movement.
After 2 weeks M.T. reported only temporary improvement and hip pain recurred within a week, so I decided to change the treatment plan, according to palpatory verification which highlighted a greater alteration in the frontal plane. La-pv bi, me-cx bi, la-cx right, me-ta right were manipulated in the second session. Patient reported improvement after the session, with a clear reduction in pain.
At telephone follow-up after 10 days patient reported absence of hip pain at rest, with only a slight pain at the highest degrees of external rotation (NRS 2/10), while the pain in the Achilles tendon disappeared.