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.

A 52-year-old Pilates practitioner presented with severe low back pain radiating to the scapula on the right side. The pain had worsened over the past 2 years, but had started 10 years earlier, without any apparent trauma. At the time of presentation, she reported pain intensity of 7/10 on the NRS scale, peaking at 10/10 NRS. Symptoms worsened after menopause, particularly when sitting and with right back rotation.
She also reported bilateral frontal headaches for 2 years, ranging in intensity from 0/10 NRS to 7/10 NRS, occurring approximately twice a month, particularly after meals.
She also reported plantar fasciitis-like symptoms in both feet, which had begun a year earlier and were more severe in the morning when taking first steps.
She had previously undergone a hysterectomy (10 years earlier) for endometriosis. From a surgical point of view, she underwent a scheduled cesarean section, which occurred without complications.

During the visit, she was asked to perform the movement verification of the lumbi segment (LU), which was impaired in the backward extension due to the onset of pain. However, the most painful movement was during rotation on the right side.
Although the patient presented a clear painful movement, her clinical history supported a viscero-somatic origin of the lumbar pain, probably linked to adhesions related to endometriosis and the hysterectomy surgery.
A dysfunction of the endocrine system was therefore hypothesized, without involvement of the hematopoietic system.

Palpation of the trunk catenaries showed densifications in an-me-pv 2 bilaterally (very painful to the touch). Palpation of the control catenary did not show any significant densification. At the trunk level, the most densified line was the anteroposterior one. Palpation was continued also at the level of the pivots in an-me SC, HU, CX and of the distal tensors in an-me CA and TA. The an-me-ta 2 point was extremely sensitive and rough to palpation (the patient denied trauma and sprains of the ankles). The reduced sliding of the fascial planes in the an-me-ta 2 points supported the hypothesis of a viscero-somatic disorder: the rigidity of the ankle retinacula was the result of a compensation for the stiffness of the abdominal fasciae. In addition, this stiffness of the ankle retinacula could also explain the plantar fasciitis-like pain during the “first steps” in the morning, which the patient had reported in her anamnesis.
Expanding the palpation to the associated points did not reveal any other points to be treated.

The treatment began with manipulation of the an-me-ta 2 point on the right, which was extremely painful at the beginning, but dissolved in a short time. Already after treatment of the first point, the patient reported half of the initial pain with an intensity of 4/10 NRS and the extension and rotation movements were smoother and less painful. The next point treated was an-me-ta 2 on the left, which resolved in a similar time frame to the contralateral one. After treating the second point, the patient no longer reported any pain and motor verification became negative. Palpation of an-me-pv 2 was no longer painful and did not exacerbate any symptoms. The patient expressed great gratitude for the treatment received, being surprised by the fact that the pain in the lumbar region was related to stiffness in the ankles.

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