COTW Update! CTS Take 2 | Modern Manual Therapy Blog

COTW Update! CTS Take 2

There were some interesting developments along the "Great Neurophysiologic Effect" Case from last week.

Part 1 of the case is here.

On Treatment 5: She stated her thumb was better after the new digits 1-3 neurodynamic tensioner emphasis. However, this was completely reversed by working a 16 hour shift in her booth. I added some IASTM to the upper thoracic, and mid thoracic spines along with some mobilization to that area. It turns out after review of HEP, she was not performing cervical retraction, only the neurodynamic exercises and the postural correction. After practicing these, she said her thumb felt a bit better.

Treatment 6: On previous visits, she stated her "mid-back" was hurting but she and I both attributed it to trying to be more upright. However, after another 16 hour shift, both her thumb and her left lower spine had pain plus radiating Sx into her left lateral thigh. Sidegliding in standing was slightly blocked to the left, but shift correction in standing with overpressure did not help. Prone lying in "roadkill" or modified hips offset centralized her left LE pain. Overpressure repetitions into further sidegliding while she was propped on elbows abolished the LE and lumbar pain. She got up feeling much better in the lower quarter, however her thumb was still bothering her. At this point, I asked how she hands customers change and takes their cash/tickets. She said she shifted her weight to the left and reached out the window. However, to compensate for the repeated WS to the left, she slightly SB her trunk and head to the right, creating both cervical and lumbar derangements! She was performing this hundreds of times a day in her sometimes double shifts.

After walking and seeing that her lumbar spine was stable and reduced. I had her perform cervical retraction with SB overpressure to the left, she actually went further than I did when I demonstrated a few reps on her! Her severe and constant thumb pain completely abolished and remained better. She came in with severe Sx and left with none! For HEP, she was instructed on SGIS overpressures to the left and cervical retraction with SB to the left, both performed 2-3 times every 15 minutes.

While the first few treatments completely resolved her right UE complaints and all of her pain except her left thumb, there was a bit more to this island which ended up being a bit of an iceberg. I am confident that on her next visit, she will be feeling much better as long as she is compliant with her HEP.


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