Treating (somebody with) polymyalgia with ideomotor movement

[Diane]

Interesting new patient this morning, brought limping in by another patient I treated just last week. The new one, (I'll call her Betty, not her real name), was having major pains in her shoulders and hips for several weeks. She just woke up one day and there they were, and she could hardly move. Just a week ago she was discharged from hospital where she had been for a few days while tests and imaging were conducted. They couldn't find anything much wrong. They dxed her with polymyalgia (http://www.arthritis.ca/types%20of%20arthritis/polymyalgia%20rheumatica/default.asp) and put her on prednisone.

Fortunately, no temporal arteritis. No headaches. Funny thing though, the prednisone didn't really help the pain. It should have improved the situation instantly if it were actually polymyalgia. Bit of a clue.

History, retired prof, community activist, recently moved to the city, got the pain about a day after moving. Interesting.

Had a lung resection in 1982 for ca - part of lower R lobe removed. Had a hysterectomy the year before. Developed right brachial plexus pain after the lung surgery, because of the position they had her arm in for a long period of time. Took a long time to recover. In 79, was in a bad MVA, left kneecap shattered, it was removed. Has HBP, under control with two meds, and diabetes, under control. Is really concerned about being on prednisone along with being diabetic. Especially when it seems not to be affecting the polymyalgia the way it should be. Sitting there while she talked it was apparent that sitting really hurt. She fidgeted and several times went to cross her right leg over the left, then realize she couldn't. I took a look at her general range and apart from obvious pain and subsequent lack of range from that, she could do everything and wasn't stuck in any direction.

I told her about the way the nervous system is set up, with the non-conscious in charge of everything especially dealing with threats to its own survival. Told her we would work to let it move her, see if it could find a way to move itself out of what it perceived as a threatening situation, get more O2 into itself/its tendrils everywhere. She took it all on board without hesitation, moved very easily, for a good five minutes. After I asked her if she had experienced the CoC, one at a time, and where. She had experienced all four Cs in one part or other. I asked her to do this a little bit frequently, every hour for a few minutes or even just 30 seconds. She was more than willing to do that.

I went on to treat her sides, and a bit of her right hip over the trochanter with DNM, which gave her a lot less perceived restriction to movement of her arms, and when she sat afterward she could sit comfortably. She felt considerably better when she left. I don't know what the deal is - maybe she was misdiagnosed. But she certainly figured out fast how to downregulate.

Or maybe it's that SC and ideomotor movement and DNM are brilliant approaches, especially when combined. :D:thumbs_up

She's coming back next week, so I'll update.

[Sarah]

Probably both are true Diane. Thanks for the case example. It is interesting to postulate how stress can lower one's adaptive potential. Given that most of us exist in a state of low-level sympathetic drive all the time, it's not difficult to imagine something ordinary pushing us below our threshold.

I seem to remember discussing this here or on another site, but has anyone experienced a response from light manual therapy in which the patient shakes all over as if freezing, but states that they are not cold or uncomfortable? It's happened to me twice now, the most recent was yesterday while working on a coworker with pain in the area of the 1st rib. I can't remember what my hands were doing when it occurred the last time, but I remember the patient. At the time, I guessed it was a sympathetic nervous system response. This time, some whole body gentle rocking (patient supine, with me pushing her gently from shoulder girdle and pelvis like a baby in a cradle) calmed her down, but it took at least a minute or more, followed by seated Simple Contact. She was not in any obvious distress when she was shaking and had quite a lot to express ideomotorically. Is there a chance that I stimulated a sympathetic ganglion in the anterior neck somehow?? Other thoughts?

Sarah

[nari]

I suspect both approaches might be the key; and if the lady has or has not got PMR, does it matter?

Self-limiting conditions are always suspect as to the origin of the issues. Especially as she does not respond to prednisone. Auto-immune deficiencies and pain are so neatly tied in together; is it, could it be, an exaggerated response to a latent sensitivity.

I met a patient with very similar effects; she was an experienced hiker and during one long stretch, she felt extremely hot. Within moments she could barely walk with global pain. Two years later, she was mobile, but very slowly with severe pain in both ankles and feet. Her diagnosis was FM, along with peripheral neuritis. She responded better to ideomotion than anyone else, and during the movements, was aware of being totally painfree; this was utterly delectable to her.


Nari

[Diane]

So, this patient came back in today looking good, walking normally, not limping. She's been back to the hospital for routine followup, and three specialists concurred that she does indeed have polymyalgia. They adjusted her prednisone, and she got the magical relief from it. Turns out she has temporal ateritis as well, they decided. Besides pred, she's on a bunch of other stuff that helps her blood sugar stay stable.

Her movement is much much better; she said she's been doing the corrective movement every day, and enjoying life a lot more. I helped some old stuff in the knees mop itself up, and treated a few gnarly bits in the upper arms. She won't need any more at this point, but wanted to make sure I was ok with seeing her if she needed "a touchup" (her phase). Of course, I'm fine with that.

You're right Nari, it doesn't matter that she does or does not have a dx. What matters is that she feels at home in her own body.

Sarah, people move all the time, and sometimes quite visibly. Sometimes they realize it, sometimes not. Sometimes they groan. Then they wonder, where did that groan come from? They barely realize it came out of their own body. I doubt your handling disturbed anything specific, like a ganglion. Your weren't doing anything high velocity, unless I read your post wrong.

[Diane]

I went in and changed the title of the thread from "treating polymyalgia with ideomotor movement" to "treating somebody with polymyalgia with ideomotor movement". It occurred to me that the first title was medical model and the second is more appropriate, more "therapy" model. It's hard to make one's brain stay out of the medical rut, especially when every PT under the sun, pretty much, rushes headlong to be considered more medical even if it means becoming less therapeutic. This shows up in things like imagining we treat conditions instead of the people who have been diagnosed with them. The first title was my bad.