The Effect of Soft Tissue Release at the Thoracolumbar Junction in a Patient with Bilateral Leg Symptoms: A Case Report
Soft Tissue Release at the Thoracolumbar Junction
DOI:
https://doi.org/10.31661/gmj.v13i.3357Keywords:
Sympathetic Nervous System; Legs; Thoracolumbar; Manual Therapy; Myofascial Trigger PointsAbstract
Background: Manual therapists mostly see patients with bilateral leg symptoms. Pain, pins and needles, fatigue, heaviness, lower limb coldness, and loss of neurological conduction are the patients’ symptoms. It is hypothesized to be caused by the sympathetic nervous system. Few publications cover its pathophysiology, diagnosis, and treatment. Limited research has examined the consequences of soft tissue release at the thoracolumbar junction. This case describes STR in a patient with bilateral leg symptoms.
Case Report: A 39-year-old female presented with bilateral leg symptoms, especially the left leg, with more intensity at night. The symptoms started without a clear cause almost two years ago. She had clear low back pain 2 years ago. The sacroiliac joint and neurologic tests were normal. The examiner found some stiffness in the hip joint range of motion and SLR, especially on the left side. The patient reported some stiffness during active lumbar ROM, especially in rotation to the right and flexion. Palpation revealed tenderness in the piriformis, biceps femoris, and gastrocnemius muscles and L5, especially on the left side, and hypomobility in the thoracolumbar junction. The patient has been treated for 10 sessions with a 6-week multimodal approach consisting of STR, the Garston technique, and electrical stimulation in the thoracolumbar junction. The patient was assessed four times. She had a significant decrement in the Numerical Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), the Global Rating of Change Scales (GRC), and the Beck Anxiety Index following the interventions. She could do her personal activities and would sleep without the sedative.
Conclusion: T10 to L2 supply lower extremity sympathetic nerve fibers. This case study demonstrates that these treatments could help these clinical presentations. Interventions with STR need more research. Therapists should evaluate the thoracolumbar junction and SNS in individuals with bilateral leg symptoms without a dermatomal pattern.
References
Farooq MN. Lower thoracic syndrome. Pakistan Journal of Medical Sciences. 2017; 33(3): 767.
https://doi.org/10.12669/pjms.333.12340
PMid:28811812 PMCid:PMC5510144
Geerse WK. Bilateral leg symptoms-The T10 syndrome? Manual Therapy. 2012; 17(3): 251-254.
https://doi.org/10.1016/j.math.2011.08.003
PMid:21943505
Shahbazi M, et al. Effect of thoracic Kinesio taping on acute lumbar and leg pain in a pregnant woman: A case report. Sports Orthopaedics and Traumatology. 2021;38(3):326-33.
https://doi.org/10.1016/j.orthtr.2021.06.004
Karas S , Pannone A. T4 syndrome: a scoping review of the literature. Journal of Manipulative and Physiological Therapeutics. 2017; 40(2): 118-125.
https://doi.org/10.1016/j.jmpt.2016.11.002
PMid:28024663
Khatri S, Thakrar S, Vedawala N. EFFECTIVENESS OF FACETAL JOINT MOBILIZATION IN T10 SYNDROME. international journal of advances in orthopaedics. 2017; 1(1): 3-4.
Mellick GA, Mellick LB. Clinical presentation, quantitative sensory testing, and therapy of 2 patients with fourth thoracic syndrome. Journal of manipulative and physiological therapeutics. 2006; 29(5): 403-408.
https://doi.org/10.1016/j.jmpt.2006.04.003
PMid:16762670
Zunke P, et al. The effect of manual therapy to the thoracic spine on pain-free grip and sympathetic activity in patients with lateral epicondylalgia humeri A randomized, sample sized planned, placebo-controlled, patient-blinded monocentric trial. BMC musculoskeletal disorders. 2020; 21(1): 1-11.
https://doi.org/10.1186/s12891-020-3175-y
PMid:32209068 PMCid:PMC7093973
Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. Journal of Manual & Manipulative Therapy. 2009; 17(3):163-170.
https://doi.org/10.1179/jmt.2009.17.3.163
PMid:20046623 PMCid:PMC2762832
Yakşi E, et al. Does transcutaneous electrical nerve stimulation affect pain, neuropathic pain, and sympathetic skin responses in the treatment of chronic low back pain A randomized, placebo-controlled study. Korean J Pain. 2021; 34(2): 217-228.
https://doi.org/10.3344/kjp.2021.34.2.217
PMid:33785674 PMCid:PMC8019954
Khadilkar A, et al. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews. 2008; 4:14651858.
https://doi.org/10.1002/14651858.CD003008.pub3
PMid:18843638 PMCid:PMC7138213
Lee JH, Lee DK, Oh JS. The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. Journal of physical therapy science. 2016; 28(6): 1852-1855.
https://doi.org/10.1589/jpts.28.1852
PMid:27390432 PMCid:PMC4932073
Gulick DT. Influence of instrument assisted soft tissue treatment techniques on myofascial trigger points. Journal of bodywork and movement therapies. 2014;18(4): 602-607.
https://doi.org/10.1016/j.jbmt.2014.02.004
PMid:25440215
Nishikawa Y, et al. Immediate effect of passive and active stretching on hamstrings flexibility: a single-blinded randomized control trial. Journal of physical therapy science. 2015; 27(10): 3167-3170.
https://doi.org/10.1589/jpts.27.3167
PMid:26644667 PMCid:PMC4668158
Jeganathan A, Kanhere A, Monisha R. A comparative study to determine the effectiveness of the mckenzie exercise and williams exercise in mechanical low back pain. Research Journal of Pharmacy and Technology. 2018; 11(6): 2440-2443.
https://doi.org/10.5958/0974-360X.2018.00450.X
Chu J, et al. Peripheral response to cervical or thoracic spinal manual therapy: an evidence-based review with meta analysis. Journal of manual & manipulative therapy. 2014; 22(4): 220-229.
https://doi.org/10.1179/2042618613Y.0000000062
PMid:25395830 PMCid:PMC4215103
Kingston L, Claydon L, Tumilty S. The effects of spinal mobilizations on the sympathetic nervous system: a systematic review. Manual therapy. 2014; 19(4): 281-287.
https://doi.org/10.1016/j.math.2014.04.004
PMid:24814903
Amoroso Borges BL, Bortolazzo GL, Neto HP. Effects of spinal manipulation and myofascial techniques on heart rate variability: A systematic review. Journal of Bodywork and Movement Therapies. 2018; 22(1): 203-208.
https://doi.org/10.1016/j.jbmt.2017.09.025
PMid:29332747
Sillevis R, et al. Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial. Journal of Manual & Manipulative Therapy. 2010; 18(4): 181-190.
https://doi.org/10.1179/106698110X12804993427126
PMid:22131791 PMCid:PMC3113268
Ughreja RA, et al. Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: A systematic review. Complementary Therapies in Clinical Practice. 2021; 45:101477.
https://doi.org/10.1016/j.ctcp.2021.101477
PMid:34507243
Cathcart E, et al. Immediate biomechanical, systemic, and interoceptive effects of myofascial release on the thoracic spine: a randomised controlled trial. Journal of bodywork and movement therapies. 2019; 23(1): 74-81.
https://doi.org/10.1016/j.jbmt.2018.10.006
PMid:30691766
Chen WL, et al. Effect of back massage intervention on anxiety, comfort, and physiologic responses in patients with congestive heart failure. The Journal of Alternative and Complementary Medicine. 2013; 19(5): 464-470.
https://doi.org/10.1089/acm.2011.0873
PMid:23186129 PMCid:PMC3651680
Saracutu M, et al. The effects of osteopathic treatment on psychosocial factors in people with persistent pain: a systematic review. International Journal of Osteopathic Medicine. 2018; 27:23-33.
https://doi.org/10.1016/j.ijosm.2017.10.005
Crofford LJ. Chronic pain: where the body meets the brain. Transactions of the American Clinical and Climatological Association. 2015; 126: 167.
Devantéry K, Morin M, Grimard J, Gaudreault N. Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized before-and-after Experimental Study. Bioengineering (Basel). 2023;10(3):332.
https://doi.org/10.3390/bioengineering10030332
PMid:36978723 PMCid:PMC10045407
Shewail F, Abdelmajeed S, Farouk M, Abdelmegeed M. Instrument-assisted soft tissue mobilization versus myofascial release therapy in treatment of chronic neck pain: a randomized clinical trial. BMC Musculoskelet Disord. 2023;24(1):457.
https://doi.org/10.1186/s12891-023-06540-5
PMid:37270471 PMCid:PMC10239038
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