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: Cecchin Massimo
A 51-year-old male patient presented to the clinic. He works as a metalworker, a physically demanding occupation.
He has never practiced competitive sports, but he played amateur football from the age of 10 to 35, with a frequency of two training sessions and one match per week. He currently plays padel once a week.
Reason for consultation
The patient reported pain in the right shoulder, mainly localized in the postero-lateral region (RE-LA SC), which had been present for approximately eight months. The onset was insidious, with no identifiable triggering event, and no similar symptoms had occurred previously.
The pain is present daily and fluctuates in intensity throughout the day, ranging from 2/10 to 8/10 on the Visual Analog Scale (VAS). It is exacerbated by flexion and abduction of the upper limb, as well as by sleeping on the right side.
Over the past two months, the patient also began experiencing pain in the right elbow, localized in the lateral region (LA CU), again with no history of trauma. The intensity of this pain varies, being milder at rest (approximately 2/10) and increasing up to 6/10 during work activities or sports.
Medical history
The patient reported the following relevant past events:
- A right fibular fracture approximately 30 years ago, sustained during a football match following contact with an opponent.
- A significant traumatic event involving the right postero-lateral pelvic region (RE-LA PV) due to a bike fall, which occurred approximately 20 years ago.
No other clinically relevant information emerged from the anamnesis.
Motor verification
Motor verification of the right upper limb revealed a reduced range of motion (ROM) in flexion and extension along the sagittal plane, with pain becoming more pronounced at approximately 160° of flexion. A slight limitation was also noted in the final degrees of abduction in the frontal plane, while no significant abnormalities were observed in the horizontal plane.
Based on the clinical findings and the patient’s history, it was hypothesized that the origin of the dysfunction might be distal, possibly involving the right lower limb, which had been subjected to previous traumatic events.
Palpatory verification and treatment
Palpatory verification was conducted over TA and CX regions, focusing on the RE, ER, LA, RE-LA, and RE-ME segments.
It was therefore decided to treat the RE-LA diagonal across multiple regions on the right side: TA (RE-LA 2), CX, PV, TH, HU, CA, and CL.
Following initial treatment of the first three points (RE-LA TA 2 DX, RE-LA CX, and RE-LA PV DX), motor reassessment revealed an improvement in ROM in both the sagittal and frontal planes, although no immediate reduction in pain was observed.
At the end of the session, after completing the full treatment plan, the patient reported a significant reduction in pain and an overall improvement in joint mobility.