A Patient With Scoliosis
While doing a rotation at another physician’s office I had the opportunity to treat an interesting patient. M.M. is a 21-year-old white male who has a long history of scoliosis. His chief complaint was intermittent, debilitating lower back pain. He stated that when the pain begins the medication he takes to reduce the pain and allow him to rest would leave him mentally and physically “incapacitated” for 3 days. He did not like the feeling in his body when this happened and did not like taking time off work, which always accompanied a pain episode. His medical history is significant for placement of Harrington rods in the upper thoracic area bilaterally as a treatment for his scoliosis during adolescence. He takes no regular medications and does take daily vitamin supplements.
When palpating M.M.’s back to access motion, I was struck by the tension of the musculature. The erector spinae and iliocostalis muscles were akin to steel cables. No motion I could induce would get them to soften. At the same moment I thought I was in over my head I realized that M.M.’s body was doing its best to adapt to motion, but that the surgery he had was limiting his adaptive ability. His body could not get to a relaxed state. This predisposed him to muscle sprain/strain episodes. I decided to try trigger point injections into the tight erector spinae muscles to assist in their relaxation.
Being in another physician’s office has its limitations – I was able to find lidocaine and normal saline. Since this is not my normal mixture, I tried a 1:2 injection ratio respectively into the tightest, most-painful-to-palpation areas of the erector spinae bilaterally and into a tight, painful right rhomboid. I was hoping that the volume of fluid would relax the muscles. I instructed M.M. to follow up with me in 3 days.
In 3 days he returned with a smile, stating that he did initially have some discomfort, which had subsided, and that he had not felt this loose in years. He also stated that he had moved some furniture for a friend since the injections and had no pain afterwards. He said this would have normally triggered a painful episode. He pointed out a few new areas of discomfort and requested some injections at these sites to help with the discomfort. I confirmed their trigger point status and injected these points (sacral ligaments and left rhomboid) as well. His return visit yielded even less pain and improved motion.
M.M. has received three trigger point injections thus far. He has had no episodes of pain and with each treatment has noticed further improvement in motion. At the last treatment the erector spinae and iliocostalis muscles were soft and supple, indicating to me that the body’s ability to adapt had significantly improved. M.M. was instructed to follow up as needed after the last treatment since his condition had improved so much. It was wonderful to watch the transformation in his body from the application of Still’s osteopathic principles. They continue to stand the test of time.