Massage Therapy Student requests help.

[Pernkopf]

Dear Diane,

I am a new massage therapy student and I am starting to treat in practical clinical in May (3rd term). We have learned Swedish techniques 1st term and basic MFR techniques 2nd term. We will learn TrP's 3rd term. I am glad I found this sight. I can see that the science I have been seeking and craving is out here to be found and employed in efficacious treatments [DNM].

I will endeavor to contribute so I can download your manual.

My request for help is in regards to my friend. She was in a car accident.

August 2006
MVA - broadside at 40 MpH (small car, passenger seat intruded drivers compartment).
Hx:Contusion on left cheek. Abdominal pain. MRI of abdomen nothing ordered for head. One day post trauma, headache, nausea and lethargy. Readmitted to ER for symptoms of concussion.

Returned to work following MVA. She had trouble with concentration and memory. Noticed that she had lost sense of smell and could not discern food that was spicy. I am unsure of exact time line for this... post trauma she had her first Migraine with crinkled cellophane wrap aura, vision loss in right eye and severe head pain. She also began having ice-pick headaches (right side of her head, Parietal bone in the cutaneous area of C2). She was given a FULL+++ neuro work up and diagnosed with ABI and subsequently attended rehab 6mo's post trauma. She continues to have fatigue and short term memory problems but has shown improvement. The ice-pick head aches have turned into a constant burning sensation or feeling of her hair being pulled on the right side of her head above her ear. She was prescribed Gabapentin 3mo's ago but could not tolerate the side effects. Currently trying Lyrica. She is losing hope that she will ever be pain free.

I recognize that the treatment modality you are teaching may be the help my friend needs. Would you recommend the occipital nerve treatment from your Head and Neck.pdf?
Is there a possibility that the pain is deriving from spill over from the trigeminothalmic tract and the posterior column of the spinal cord (occiput proprioception) where they are are very close? I have Neuroanatomy Through Clinical Cases Blumenfeld, H. and got that idea from there. Loss of pain (spicy) sensation in the mouth. CNV damage.

I hope you can see that I am not your average massage student. I read the TrP's article with a smile on my face. I bought the Travell & Simmons book for 200.00 I think I'm going to sell them to a class mate!

Thank you for your time in this matter. And to anyone else who my have some ideas to share.

Karen.

[Diane]

Hi Karen,
I will endeavor to contribute so I can download your manual. If you just PM me with your email address, I'll be happy to send it to you directly.
August 2006
MVA - broadside at 40 MpH (small car, passenger seat intruded drivers compartment).So, impact was on passenger side? Was friend driving or a passenger?
Hx:Contusion on left cheek. Abdominal pain. MRI of abdomen nothing ordered for head. One day post trauma, headache, nausea and lethargy. Readmitted to ER for symptoms of concussion. Was there any loss of consciousness?

Returned to work following MVA. She had trouble with concentration and memory. Noticed that she had lost sense of smell and could not discern food that was spicy. I am unsure of exact time line for this... post trauma she had her first Migraine with crinkled cellophane wrap aura, vision loss in right eye and severe head pain. She also began having ice-pick headaches (right side of her head, Parietal bone in the cutaneous area of C2). She was given a FULL+++ neuro work up and diagnosed with ABI What is ABI? ...and subsequently attended rehab 6mo's post trauma. She continues to have fatigue and short term memory problems but has shown improvement. The ice-pick head aches have turned into a constant burning sensation or feeling of her hair being pulled on the right side of her head above her ear. She was prescribed Gabapentin 3mo's ago but could not tolerate the side effects. Currently trying Lyrica. She is losing hope that she will ever be pain free.

I recognize that the treatment modality you are teaching may be the help my friend needs. Would you recommend the occipital nerve treatment from your Head and Neck.pdf? Yes, she may benefit a lot by having someone treat her scalp nerves by stretching her skin.
Is there a possibility that the pain is deriving from spill over from the trigeminothalmic tract and the posterior column of the spinal cord (occiput proprioception) where they are are very close? I think trigeminal "pain" would be restricted to face. The cutaneous occipital nerves can disseminate as far forward as the forehead. The processing from any cutaneous receptive fields of the occipital nerves would be DRG, not trigeminal. Be sure to treat the neck too. The superficial cervical plexus is plugged right into the skin over the front of the neck, which is continuous with the skin of the face (trigeminal).
I hope you can see that I am not your average massage student. Yeah - I kinda noticed. :)

[Pernkopf]

Hi Diane,

Thank you for the prompt reply. My friend was the driver and the impact was on the passenger side. If it had been the driver-side she would be dead. Pretty sobering thought for an accident of 60 Kph.

She did not lose consciousness at the time of the accident.

She has had two CT's and an MRI for her head since the first Abdominal MRI. There mustn't be anything unusual in them because she hasn't told me of any lesions etc.

ABI = Acquired Brain Injury.

Thank you for the suggestions on the cervical region and the trigeminal nerve insight.

One weird thing is, the muscles of left side of her body (head to toe) is noticeably under toned, slow to react, weaker, higher pain tolerance. An example is if her upper traps & rhomboids are loaded bilaterally with TrP's, she doesn't report pain on the left, but pain is 5-6/10 on the right. The right side of her body is normal to hypertoned, with low pain tolerance. I should get a reflex hammer and check it out. I've made myself curious now. I wish I could see her neuro evaluation.

If you have another course this year I'd be interested.

Karen

[Pernkopf]

Thank you again Diane for the help.

This is like getting invited to grand rounds. A true privilege. I'll sit quietly and learn from this place.

Karen

[Diane]

Thank you again Diane for the help. You are more than welcome. One weird thing is, the muscles of left side of her body (head to toe) is noticeably under toned, slow to react, weaker, higher pain tolerance. An example is if her upper traps & rhomboids are loaded bilaterally with TrP's, she doesn't report pain on the left, but pain is 5-6/10 on the right. The right side of her body is normal to hypertoned, with low pain tolerance.It's pretty common for one side to be tight and the other side painful. This is no reflection on the body, which is just trying to comply with orders coming at it from the brain, and is more a reflection I think of a brain whose output isn't very synchronized bilaterally, or is fighting with spinal cord reflexes and can't win. I usually treat the "tight" stuff first if I can.. treating the tight stuff can help the "pain" to downregulate I've (anecdotally) found.

[Luke Rickards]

It's pretty common for one side to be tight and the other side painful.Diane, I've never actually discussed your observation with anyone other than patients but I have found that to be pretty common as well.

[Diane]

Diane, I've never actually discussed the your observation with anyone other than patients but I have found that to be pretty common as well.
Luke, do you have a theory for this? apart from a simplistic "silent culprit/ noisy victim" explanation I mean...
I was wondering about that crossed extension reflex getting too hyperactive perhaps, then possibly the brain can't figure out how to downregulate pain and hyperactivity at the same time and the spinal cord reflex won't/can't shut off because pain is still blaring away from the interoceptors embedded in the neural tunnels - just a big neurological mess that can self-perpetuate indefinitely, unless actively disengaged somehow, e.g. exteroceptive input.