Quick Case: Epic Fail Acute Thoracic Pain | Modern Manual Therapy Blog

Quick Case: Epic Fail Acute Thoracic Pain

I've been meaning to post this Quick Case summary for a while as it's always a valuable learning experience when you absolutely cannot help someone with their pain.


Pt is a pediatric dentist, late 30s, woke up one day with insidious onset of left thoracic pain. This was 3-4 days prior to seeking PT. History of intermittent cervical pain that normally improves with PT and massage. The day before seeing him in his house, he had a very aggressive massage to the thoracic area and woke up in 9/10 constant thoracic pain.


Next I went to check for the UQ Clinical Practice Patterns

Cervical motions were FP in all planes
Shoulder LRF on right was FP actively, FN passively, on left.....

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After reaching to above 60 degrees shoulder elevation with some shoulder ER, he screamed and almost fell off the table. He ended up on the floor in a quadruped position in a significant amount of pain. His hand had barely gotten to his head level. So much for the Clinical Practice Patterns.

I couldn't even get him off the ground for 15 minutes

He started breathing rapidly and with very short breaths. I couldn't even help him off the ground without a lot of swearing for at least 15 minutes. He is a close friend of mine and normally very level headed, I've never seen him even so much as raise his voice at his kids. His daughter came into the room and he screamed for her to "GET OUT!"

Needless to say, after getting him to slow down his breathing, I helped him on the table, and offered to kinesiotape him. He was severely bruised from the massage the day before. He admitted to having the MT push very hard because at the time, it felt good. Could this be what made his nervous system so vigilant about any movement or input from that area? The bruising itself was not tender to touch.

The taping helped him move around somewhat but at this point he could barely move his neck, trunk or arms. He was in a mostly flexed posture. His wife (a PA) asked if any medication would help; in my experience sometimes you need to chemically take the edge off so rest becomes possible. One of their friends is a PCP, so I suggested his wife call her. She asked her to prescribe some muscle relaxants in whatever dose she thinks is appropriate. 

My only advice was to get some rest and take off of work the next day and to move as his tolerance allowed, but not to push it. I also stated if his pain was this severe, and unremitting after 2 more days, he may want to see an ortho. Fortunately it was not, and he recovered with time and movement.
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What's the point of this? A while back, someone once complained stated that he would rather see a write up of a failed case. Four years ago, I thought, "I'm blocking this guy...."

Now... it's a valuable lesson for myself and for my readers. No matter how much fancy assessment, pain science education, and magic hands treatment you learn, you will epic fail to relieve someone's pain - even a close friend who you know very well. We all win some and lose some and can stand to get knocked off of our high horse every once in a while.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...


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