Season Started Successfully after GT Intervention In This Issue

Fall 2010
In This Issue
Achilles, Plantar Pain
By Terri Angelo, MA, ATC,
Summa Health System,
Akron, OH
Page 1
Treating Meralgia
Paresthetica During
Pregnancy: GT is
Low-Risk Care Option
By Carla Cupido, DC,
Vancouver, B.C
Page 1
By GT Clinical Advisor
Jackie Shakar, DPT,
Page 4
Season Started Successfully after GT Intervention
By Terri Angelo, MA, ATC, Summa Health System, Akron, OH
On Aug. 18, 2008,
just a couple of weeks
before the start of the
NFL season, a
45-year-old NFL
to us with a diagnosis
of right Achilles
tendinosis with
director to check his orthotics and to
start the Graston Technique® as part
of his treatment.
Continued on page 2
Treatment of Bilateral Pitting
Edema of the Ankles
Secondary to Obesity and
By Karson Mui, DC, Mui
Chiropractic and Wellness
Center, West Newton, MA
Page 5
By Carla Cupido, DC, Vancouver, B.C
Marketing Efforts Yield
Results for Rehab Center
By Amy L Grabowski, DC,
NOVA Pain & Rehab Center,
Arlington, VA
Page 6
2010/2011 M2–Advanced
Training Dates
and Locations
Page 7
Instrument, Stroke
Videos and Marketing
Materials Added to
Preferred Provider Section
Page 7
Three years before
this bout of right
Achilles pain/tendinosis, this patient had
a diagnosis of bilateral
achilles tendinitis and
right plantar fasciitis.
At that time, the
patient presented with tight gastroc/
soleus and had pain with running on his
treadmill, which is what he used to get
into shape for the upcoming season.
Treating Meralgia Paresthetica During Pregnancy:
GT is Low-Risk Care Option
A 37-year-old woman presented with
right-sided anterior and lateral thigh
pain, paresthesia and tightness. The
patient was six months pregnant at
the time of her initial appointment.
Concerns related to her pregnancy
were previously ruled out by the
patient’s medical physician.
Symptoms commenced insidiously
two months into the patient’s pregnancy
and were most aggravated with rightsided sleeping, prolonged airplane
travel and standing for long durations.
The patient’s occupation required
her to stand continuously for multiple
hours while delivering presentations;
therefore her condition was persistently
aggravated. Mild relief was noted with
movement and sitting.
The patient participated regularly in
kickboxing before her pregnancy
and has since committed to other less
aggressive forms of exercise.
Upon observation, primarily because
of the patient’s pregnancy, her lumbar
lordosis was exaggerated, increasing
her anterior pelvic tilt. Range of motion
testing produced a sensation of pulling
through the right thigh with lumbar
extension, as well as right- and left-sided
lumbar Kemp’s tests. Orthopedic testing
only revealed a positive right-sided
Ely’s test. All testing for nerve root and
discogenic diagnoses were negative.
were intact.
Continued on page 3
Page 3
Treating Meralgia Paresthetica During Pregnancy
Continued from page 1
Anterior and lateral thigh tenderness was noted
upon palpation, as was iliotibial band and quadriceps hypertonicity. Discomfort was observed upon
palpation of the right femoral triangle.
Meralgia paresthetica, also known as BernhardtRoth syndrome or lateral femoral cutaneous nerve
(LFCN) entrapment.
LFCN Review
The LFCN originates from the lumbar plexus from
nerve roots L2-4 (depending of course on your
anatomy source). The nerve travels the lateral
border of the psoas, navigating under the lateral
aspect of the inguinal ligament. The most common
entrapment site is 1cm medial to the anterior
superior iliac spine.1
The patient’s plan of management included two
included Active Release Technique (ART),®
myofascial release with a VibraCussor® and
Graston Technique® to the right iliotibial band,
vastus lateralis, rectus femoris and sartorius.
ART® was also performed on the patient’s right
iliopsoas, obturator externus and pectinius.
Ascites and obesity can also cause mechanical
stretch resulting in MP. Extrapelvis causes include
trauma around the ASIS from belts, tight clothing
and the seat belt in an MVA. Mechanical factors
include prolonged sitting or standing and leg-length
discrepancy resulting in a pelvic tilt. MP can also
present as a polyneuropathy or as an isolated
neuropathy with diabetes.
This patient was a prime candidate for MP,
considering she was pregnant and she spent large
amounts of time both standing during long presentations and sitting on an airplane for work.
From the GT clinician’s perspective Graston
Technique® offers a low-risk conservative care
option for the treatment of MP. Low-risk
treatments that can also prove to be diagnostic
may in fact prevent the necessity of more invasive
and time-consuming diagnostic testing. Avoiding
drug prescriptions and of course surgery are two
more enticing reasons to attempt success with
GT treatments.
1. Carai A, Fenu G, Sechi E, Crotti FM, Montella A. Anatomical variability
Clin Anat. Apr 2009;22(3):365-70.
Clinical Outcome
After the initial treatment, the patient’s perceived
tightness improved by 15% and the frequency of
discomfort was decreased by 10-15%; however,
when the pain was experienced, it was approximately 5% more intense. After this report, over the
course of treatment, the patient consistently noted
decreased pain, numbness and frequency of
symptoms. On the 10th appointment, despite still
delivering long work presentations, the patient
reported the pain so infrequent that she was
unable to correlate it to anything anymore and the
numbness had almost completely dissipated.
When promoting Graston Technique®
on your clinic/practice website,
don’t forget to take advantage of providing
a link to
Meralgia paresthetica (MP) can be caused by
intrapelvic, extrapelvic and mechanical factors.
Intrapelvic origins include pregnancy, abdominal
Talk to your webmaster to ensure when
visitors exit the GT site, they automatically
come back to your website!
and in some cases abdominal aortic aneurysm.