By Andrea Battermann

The following case is a complex case, using Traditional Chinese Medicine (TCM) diagnosis and Shiatsu, treatments combined with physiotherapy.

Lorna, 29 years old, was referred by a physiotherapist for Shiatsu therapy. She had received physiotherapy regularly, including manual traction, heat application, spinal mobilisation techniques, acupuncture, and exercises for shoulder and neck, but all were of little benefit. She lives with others and works in an office.

Past medical history

Lorna had had an accident 10 months previously, in which she fell on the stairs of a bus. She tried to prevent the fall with her left arm.

Main symptoms reported by her were:

Severe muscle spasms with muscle tremors and pain on the left side of neck and face, upper back spine and abdomen. A recent deterioration had lead to severe and constant muscle twitching, which mainly affected her neck. The result was an increased muscle tone and pain in her upper body.

Other symptoms were:

Waking up several times a night with pain and muscle spasms. Suffering from dizziness while sitting, standing or walking. Rushes of heat in the whole body.

Since her injury the production of whitish phlegm and flu-like symptoms with an increased frequency of colds and sore throats.

Interestingly her X-ray for shoulder and neck did not show any abnormalities.

Consultant neurologist reported no neurological abnormalities and normal reflex activity. Her condition was characterised by muscle spasms with an overproduction of adrenaline.

Medication used: diazepam, co-dydramol, ibuprofen and propranolol.

Physical assessment

Visually her right shoulder was lower than her left with a decrease in muscle bulk around left shoulder joint, particularly in the deltoid. The muscles in the head and face were constantly twitching, her head was protracted and her walking very rigid.

Range of movement

Neck movements

Lorna could only bend and extend her neck a quarter of its normal movement to the left and although she had no pain she had great difficulty in moving or turning it to the right.

Shoulder movements

Shoulder movements were limited and painful when moved both by Lorna and myself. She said that from middle of the deltoid muscle down into left arm was numb with an intermittent burning pain at base of her skull. She also had a hot burning sensation around neck and left scapula (shoulder blade).

It was painful around her left shoulder when pressed and there was an increase in muscle tone in the deltoid muscle, The middle to lower part of the neck was painful when lying down with a general increased in muscle tone. She had severe muscle spasm on the left side of the neck and in the shoulder and upper back.

Pain

The pain eased after the application of heat on, when lying down for an hour or with painkillers. Mornings were always better than later in the day. The pain was worse following a busy day or any shoulder movement. The pain felt deep-seated, all of which made her feel very tired.

Other relevant symptoms

Appetite: Following the accident it became erratic at times, especially when the pain was greater.

Stools: irritable bowel syndrome with constipation, normal stools and diarrhoea alternating.

Urination: Increased frequency, large amounts, pale colour.

Digestion: Occasionally vomited.

Taste: Craved sweet food at time of menstruation, otherwise preferred salty taste.

Thirst: Prefers to drink a lot of warm drinks.

Climate: Preferred warm and hot temperatures.

Perspiration: Since the accident, suffered from day and night sweats (drenching sweat on torso at night).

Eyes: Sensitive to bright light, stares when in pain, sometimes dry eyes, dark patches under eyes, watery in the wind and easily tired.

Ears: Tinnitis in both ears, worse in left ear when tired.

Voice: Tired and weak.

Spleen: Bruises easily.

Nails: White flecks.

Hair: Sometimes lank, lifeless, soft and thin when in pain (since accident), loose head hair (pre-existent).

Headaches: Occasional above eyes, particularly right side.

Circulation: Cold hands and feet (pre-existent), more on left side of body and hands since accident.

Menstruation: Pre-menstrual pain and cramps, dark clots in menstrual blood; since accident, more painful with breast distension, cramps and lower back pain.

Aims of treatment

Physical

  • To reduce muscle spasm and tremor with Shiatsu techniques.
  • To relieve pain.
  • To increase mobility in the neck, upper back and left shoulder.
  • To re-educate: self-mobilisation techniques, postural advice, ergonomics and pain management.

Mental
  • To re-educate: relaxation techniques for stress management, establish a positive body image.

Energetically
  • To remove obstruction of Qi (energy) flow in traumatised area and thus relieve pain.
  • To promote free flow of Qi circulation throughout the whole body to restore energy and vitality.

Emotional
  • To reduce anxiety and calm the mind.

Diagnosis and interpretation of symptoms from the TCM point of view prior to the accident

One of the cornerstones of oriental medicine is the concept of Qi (chi). This is the basic life force and is said to flow within channels (or meridians) around the body and to provide the ability of the internal organs to function. There are a number of problems that can happen to this energy, if it stagnates or blocks up within the channels people can experience pain and stiffness. The more stagnated or blocked up it is the more pain they will have. If they fail to have enough energy internally or this energy stagnates then the internal organs fail to perform their function. The internal energy and the external energy are also related to each other. Blockages or deficiencies at one layer or another can effect each other.

If one looks at this case from an oriental medical perspective one can see that this person has blocked energy within the channels and there is some deficiency/ stagnation problems within the internal organs.

Prior to the accident Lorna had signs of both deficiency and stagnation of her internal energy

Deficiency manifests in the following symptoms: Tinnitus in both ears, worse when tired, loose head hair, increased frequency and large amount of urination, preference for warm drinks and salty food. Poor digestion, occasional nausea and vomiting at times, diarrhoea.

Stagnation manifests in the following symptoms: Occasional lateral headaches, vertigo, and painful periods with dark blood clots and cramps. Psychologically, it manifests in stubbornness and suppression of feelings.

Diagnosis and interpretation of symptoms following the accident

Various physical symptoms were aggravated after the accident. Lack of sleep led to an exacerbation of Qi (energy) deficiencies, manifesting as dark rings under her eyes and a weak voice.

The Qi had been stagnated before the accident. The shock of the accident and her pain increased muscle tension in her body. In general, pain causes constraint and stagnation in Qi flow, which aggravated Lorna’s original Qi stagnation. Lorna reported that her menstrual problems had become worse which is a sign of increased stagnation. Psychologically, she pushes herself beyond her physical capacity to maintain her full-time job. She overworks despite feeling tired and in pain. The increased Qi stagnation attacks the digestion, further depleting it and aggravating pre-existing gastrointestinal symptoms. The accident injured the channels located to the back and side of the head, neck and shoulder area. Lorna’s pain was relieved by rest, with her head positioned towards her affected side indicating a deficiency problem within these channels.

The three channels/ meridians (Large Intestine, Triple Heater and Small Intestine) flow to the head. The physical trauma to these meridians had caused obstruction in the Qi flow to the head and face. Lorna developed a deficient Qi flow in her head, especially in the left side of her face. It is said the ‘Qi moves the Blood’ impeded Qi flow means impeded Blood supply to the sinews and muscles, which then as a result start to twitch.

The treatments

First session

According to the characteristics of the symptoms and location of the injury, the following channels/meridians are involved: Liver (LIV), Large Intestine (LI) and Kidney (KD), Triple Heater (TH), Conception (CV) and Governing Vessel (GV). Lorna was lying with her body twitched continuously. Treatment commenced on the chest with an even holding touch tonifying (strengthening) her Kidney meridian on either side beside the sternum and dispersing the accumulation of Qi energy with the other hand on the chest. Two points were then held at the same time on one of the channels (the Governing Vessel) to establish the Qi energy flow. Then one hand was moved on the chest, finding points of deepest penetration on the Kidney channel /meridian. The other hand was holding points on the Kidney and Bladder meridian in the upper back at the same time.

Lorna’s muscle spasms and tone, as well as the twitching intensity visibly decreased. The author then held and contacted the Liver meridian on the chest while applying a more dynamic and active Shiatsu technique with the other hand to disperse the Qi stagnation in that area. Eventually, a better Qi flow was established, resulting in more muscle relaxation and spinal mobility.

Second session

Lorna reported less muscle spasm and twitching after her treatment and she felt more relaxed. In this session, work was given on head, neck, shoulder girdle and along the spine on the Kidney and Large Intestine meridians.

Third session

Lorna reported that the muscle twitching had disappeared. There was increased pain in her left shoulder and neck. The author worked locally on Large Intestine and Small Intestine meridians to improve the Qi flow throughout the left shoulder.

Summary of sessions

In further treatments the author worked more intensively on Lorna’s neck, trying to establish the Qi flow between head and torso while working on dispersing local Large Intestine and Liver Qi stagnation and tonifying the
energy.

The energetic connection between head and torso, especially the thoracic spine, was always blocked and stagnated. Treatments were often finished by working down the Bladder or Kidney, Liver or Large Intestine meridians into the legs and feet to encourage the Qi flow down-wards from the upper body into the lower half. Several months later the patient suffered a severe flare-up when bending forward repetitively when filing in the office. The severe muscle spasm and twitching recurred which was successfully treated with two further Shiatsu sessions

Throughout the course of treatment, Lorna was taught relaxation techniques, postural exercises and ergonomics, stretches for her neck, shoulder and thoracic spine. Additionally, advice was given on pain relief by using Do-In (self-Shiatsu). Initially, the treatment consisted of 3 one-hour sessions every fortnight and later this was reduced to 1 monthly session.

Outcome of treatments was as follows:

  • The pain in Lorna’s neck, shoulder and upper back eased immediately after the sessions.
  • The neck mobility has increased by 50% in range of movement immediately after treatment.
  • The numbness in Lorna’s left arm, shoulder and neck area has disappeared
  • Lorna was able significantly to reduce her pain medication.
  • The range of movement in the neck is normal in extending, bending, rotating and bending to the left side. The rotation and bending to the right has improved by 50%.
  • The range of movement in Lorna’s shoulder has generally improved, but there is still limited movement in bending and the ability to turn it outwards is still limited due to increased muscle tone.
  • The deltoid (shoulder) muscle is slightly wasted and the muscle power in her left arm remains reduced.
  • Lorna’s vitality and general health have improved.

Lorna practises a daily exercise programme and she avoids activities that might aggravate her condition.

Feedback from Lorna, after treatment, was as follows:

  • The whole body was treated and not just the local area of pain and injury.
  • Long-lasting benefits reduced the number of appointments.
  • Additional to several positive treatment outcomes, Lorna experienced Shiatsu as very relaxing.
  • She felt that the most important factor was the length of the appointments, which allowed enough time for feedback and physical work – this reduced the number of appointments in that the benefit (out-come) lasted longer.
  • Lorna commented that Shiatsu might prevent injury from turning into a chronic pain.
  • She is able to pace her physical activities better by allowing for frequent rest times in between.
  • Shiatsu should be available on the NHS and is a competitive cost effective treatment.

About the Author

Andrea Battermann MCSP SRP MRSS(T) Chartered Physiotherapist

Andrea Battermann first qualified with a Diploma in Social Work in Germany in 1985, working in alternative education and rehabilitation with physical and mental disabilities. She further qualified as a chartered physiotherapist in Germany In 1992, Andrea worked for 6 years within various specialities within the NHS including neurological rehabilitation, chronic pain management, rehabilitation of amputees and out-patient work. In 1994, Andrea qualified as a Shiatsu practitioner with the European Shiatsu Institute and is a registered practitioner and teacher with the Shiatsu Society in U.K. She is the principal of the Shiatsu College in Edinburgh which she founded in 1997.

Andrea has built up a successful private practice incorporating physiotherapy, shiatsu, acupuncture and counselling. She treats mainly musculoskeletal problems, chronic pain and psychosomatic conditions. In 1995, Andrea began a professional training in Process Orientated Psychology (POP), a Jungian based and body orientated psychotherapeutic approach. She is particularly involved with the application of POP for Shiatsu, TCM, and bodyenergetics. Andrea is a recognised lecturer for Acupuncture Association of Chartered Physiotherapists in U.K. She is a co-author of the book Complementary Therapies for Physical Therapists. Her main interest is to link oriental and western medicine with psychology to create a more holistic model of healthcare.

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