ABDOMINAL PAIN
Presenting symptoms
A 44 year-old woman was referred to 360 NMT by her Physiatrist for chronic low back and abdominal pain that had begun soon after a motor vehicle accident many years before. A complex surgical history compounded her symptoms. She had undergone two micro-discectomies, a L4-L5 spinal fusion, a complete colonectomy (removal of the colon) and surgeries to remove scar tissue and ovarian cysts. She described many visits to the ER for acute pain management.
Evaluation, clinical reasoning & treatment strategizing
Active and latent trigger points were palpated and found throughout the abdominal and lower back muscles. We performed a thorough postural assessment that revealed a hyper-lordotic lumbar spine, an asymmetrical pelvis and hypermobility. Clinical reasoning indicated trigger point therapy for pain relief. John Jarrell MD published a research paper in 2004 noting a 90% correlation between abdominal wall trigger points and underlying visceral disease. This viscera-somatic connection with trigger points can therefore signify underlying organ pathology. It can also be the source of abdominal pain.
Treatment
Trigger points were deactivated in the erector spinae, quadratus lumborum, multifidi, and serratus posterior superior. These back muscles can refer pain to the abdominal cavity. Treatment was given also to the iliopsoas, obliques and rectus abdominus muscles. Gentle visceral mobilization was performed to address adhesions between the three abdominal muscle layers. Cross fiber friction using capsaicin cream was performed on the scar tissue in the lower back.
Results and Follow-up
In this case, trigger points were indeed indicating underlying visceral pathology. NMT results were not long-lasting until the patient finally had a hysterectomy. After surgery, pain relief from trigger point treatment became more permanent. She is now stable and stays pain free with a combination of NMT, trigger point injections, medication, acupuncture and core stabilization strengthening.
