Spinal manipulation after multiple fusions in an adult with scoliosis: a case report

Manual Therapy and Exercise for the Management of Chronic Neck Pain With Multiple Neurovascular Comorbidities: A Case Report

This case describes the clinical decision-making behind the conservative clinical management of an individual presenting with chronic neck pain with myriad neuromuscular comorbidities. The focus of this case report is to support the safe utilization of manual therapy and describe the tolerable prescription of strength and endurance exercise in a patient with numerous complications to improve self-efficacy. A 22-year-old female college student presented with a chief complaint of chronic, non-specific neck pain with comorbid Chiari malformation, migraines, upper cervical spinal fusion, Ehlers-Danlos syndrome (EDS), and postural orthostatic tachycardia syndrome (POTS) to an outpatient physical therapy clinic for evaluation and treatment. Following four sessions of physical therapy treatment, no clinically significant improvement in the individual's symptoms and daily function was achieved. Despite the lack of measurable change, the patient reported the program's value on her ability to self-manage her complex condition. The patient responded well to manual therapy, specifically thrust manipulations. In addition, both endurance and strengthening exercises were well tolerated and provided a measure of self-management that may not have been achieved before physical therapy management. This case report highlights the need for exercise and pain-modulating interventions in highly complex individuals to reduce medical intervention by advancing the patient's self-efficacy. There is a need for further research about the utility of standardized outcome measures, joint manipulations, and the addition of cervico-ocular exercises for those who present with neck pain and pertinent neuromuscular comorbidities.

Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review

BACKGROUND AND PURPOSE

Pain and disability may persist following lumbar spine surgery and patients may subsequently seek providers trained in manipulative and manual therapy (MMT). This systematic review investigates the effectiveness of MMT after lumbar surgery through identifying, summarizing, assessing quality, and grading the strength of available evidence. Secondarily, we synthesized the impact on medication utilization, and reports on adverse events.

METHODS

Databases and grey literature were searched from inception through August 2020. Article extraction consisted of principal findings, pain and function/disability, medication consumption, and adverse events.

RESULTS

Literature search yielded 2025 articles,117 full-text articles were screened and 51 citations met inclusion criteria.

CONCLUSION

There is moderate evidence to recommend neural mobilization and myofascial release after lumbar fusion, but inconclusive evidence to recommend for or against most manual therapies after most surgical interventions. The literature is primarily limited to low-level studies. More high-quality studies are needed to make recommendations.