A state ranked swimmer, age 16, was sent 360 NMT by her orthopedic surgeon for evaluation and treatment. She had no pain but had been diagnosed with ‘multi-directional instability,’ mostly in the left shoulder. She had tried many different PT approaches, acupuncture, stretch therapy, trigger point dry needling, and cortisone injections. Her race times were slowing down despite practicing up to 3 hours, 6 times/week.
Evaluation, clinical reasoning & treatment strategizing
This patient nicknamed her case as one of ‘muscle alienation.’ She described tiredness, brain-fog, muscle knots, muscle weakness, shortness of breath, and digestive ups-and-downs. Our treatment strategy was to identify and deactivate latent trigger points that might be interfering with optimal muscle activation patterns and creating a sense of instability. We also wanted to increase proprioceptive awareness and strength. We asked about her nutrition. The patient responded that she had been eating spaghetti every day. Wheat is known to be an inflammatory food item (see Rehabilitation of the Spine by Craig Liebenson, 2007, p. 730). It was suggested that this excessive grain intake might be contributing to the perpetuation of her condition.
Latent trigger points were deactivated in all muscles of the shoulder and neck, specifically the trapezius, scalenes and levator scapula. She was taught self-massage activities to complement the PT work. Later work focused on the muscles of the legs. She also stopped her “spaghetti habit”.
Outcomes and follow-up
Due to enigmatic instability and multi-factorial facets of this case, we referred this young patient to a physician that specialized in functional medicine. Her blood tested very high for candida antibodies. A prior course of antibiotics 18-months before, combined with prolonged daily chlorine exposure may have led to this long-standing candida infection. Candida can contribute to muscle pain and fatigue. Her doctor recommended the ‘Paleo’ diet and probiotics. This helped reduce some muscular symptoms, although the instability still remains puzzling. She continues receive treatment at 360 NMT while exploring other solutions.