RESUMEN
BACKGROUND AND PURPOSE: The nervous system plays a significant role in groin/hip flexor pain which is a common complaint in the active population. Patient examinations that lack consideration of the nervous system's involvement may result in chronic pain and dysfunctional breathing patterns due to continuously excited (also known as "up-related") primal reflexes. Primal Reflex Release Technique™ (PRRT™) is a novel treatment paradigm that was designed to calm primal reflexes from their excitatory state. The purpose of this case series was to describe the effects of down-regulating primal reflexes using PRRT™ on pain, function, and breathing pattern dysfunction in subjects who presented with groin and hip flexor pain and exhibited hyperesthesia to TriggerRegions™ in areas of respiration. CASE DESCRIPTIONS: Six subjects with acute groin and/or hip flexor pain were examined using a battery of tests including muscle integrity strength and range-of-motion (ROM) measurements, special orthopedic tests, breathing functionality and PRRT™ rib palpation assessments. If subjects were determined to be potential PRRT™ responders through PRRT™ rib palpation assessments, the technique was performed according to PRRT™ guidelines. Outcome measures including the Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS), the Global Rating of Change (GRoC) Scale, and the Disability in the Physically Active (DPA) Scale were collected to determine the effects of the treatment. OUTCOMES: All subjects demonstrated full resolution of pain as reported on the Numeric Pain Rating Scale, and the change was statistically (p = 0.001) and clinically significant. All subjects returned to optimal function as reported on the Patient Specific Functional Scale, and the change was both clinically (minimal detectable change) and statistically significant (p = 0.001). All subjects returned to normal breathing function as observed through the seated assessment of lateral expansion test. The number of treatments (mean = 1.83 ± 1.16) and time to the resolution of symptoms was minimal (mean = 2.833 ± 2.56 days). DISCUSSION: By assessing and treating abnormal breathing patterns, postulated to be a result of a sustained excitatory nervous system, subjects returned to full activity, without pain, in less than three days. After a two-week follow-up, subjects remained functionally pain free. Considering the state of the nervous system in the presentation of musculoskeletal pain and not focusing all treatment on local muscle structures may be beneficial. A multifaceted assessment approach is needed to determine other pain factors. LEVEL OF EVIDENCE: Level 4.
RESUMEN
OBJECTIVE: The purpose of this case study was to report the effects of the MyoKinesthetic (MYK) system on pain, functional ability, and psychosocial well-being of a 20-year-old female collegiate softball athlete diagnosed with chronic bilateral knee pain associated with osteoarthritis. CLINICAL FEATURES: The patient presented with bilateral chronic knee pain lasting more than 2 years. A clinical examination and radiographic imaging revealed chondromalacia and the beginning stages of osteoarthritis of the knee. No other comorbidities were noted. INTERVENTION AND OUTCOME: The patient received 4 treatments with the MYK system over 2 weeks. Treatments 1 through 3 were directed at the S1 nerve root; the fourth treatment was directed at the L4 nerve root. Outcome measures included the Numeric Pain Scale, the Patient-Specific Functional Scale, and the Disability in the Physically Active Scale. Pain, function, and quality of life were measured collectively using the Knee Injury and Osteoarthritis Outcome Score. The patient experienced clinical improvements (minimal clinical important differences, minimal detectable changes) for all outcome measures, with the exception of the quality-of-life subscale within the Knee Injury and Osteoarthritis Outcome Score. CONCLUSIONS: The patient in this case study reported a decrease in pain and an increase in function during the course of 4 treatments, which were administered over 14 days and in accordance to the MYK guidelines. Traditional treatment guidelines typically recommend 8 weeks for positive effects to manifest. Manual therapy techniques, such the MYK system, may be a viable treatment option for patients with osteoarthritis of the knee.