Case Study #1: “Martin”
History: Martin is a 47-year-old who presented on April 4, 2016 with 10/10 low back pain and tingling in both legs. He was doubled over, only able to support his upper body with use of his arms. He also reported occasional numbness in his legs, but the low back pain and weakness was his greatest concern. Martin is a top executive for a major corporation and was traveling for business. He had been this way for four days and had been to the hospital a few days prior.
Martin is a single father of two. He has a history as a professional tennis player and in the recent past played on a flag football team. Martin is a chronic low-back pain patient. His usual pain level is 4-5/10. He takes pain medication regularly: Oxycodone (10 mg) three times a day, Androgel and Celebrex. Martin’s pain management medical doctor referred him to Arizona Pain and Posture for assessment and treatment.
A lumbar spine radiology report on March 8, 2012 revealed superior and inferior end-plate compression deformities, mostly L1, L2, L3, and to a lesser extent L4. Bone mineralization was normal. An MRI report of the lumbar spine without contrast was performed on March 24, 2012. Relative findings include neural foramen on the left is mildly narrow due to a bulging disc.
Examination: Patient walked with severe forward antalgia supporting upper body on thighs. Active range of motion in seated position revealed motion from 20 degrees flexion to 85 degrees flexion. Coming up from 85 degrees he used his hands to crawl up his thighs. He was unable to sit up past 20 degrees flexion even with the use of his hands. He could not stay at 20 degrees and had to flex back down to 30 degrees to get relief of severe pain. Soft tissue palpation revealed severe tight and tender muscles of bilateral lower back, upper buttocks and antero-lateral hip flexor muscle groups. Due to severe pain and loss of motion, we were unable to perform any other orthopedic examinations. Joint palpation revealed moderate tenderness, aberrant motion flexion, and fixation of L5 and S1.
Treatment was initiated with the patient lying supine with knees bent. Manual release was applied to right side, then left side anterior pelvic nerve group and myofascial structures. Patient was then placed in side-lying, right side up first, then left side, to perform continued release of posterior-lateral myofascial structures and nerve root decompression. Finally he was asked to sit up. Immediately he was able to reach a neutral seated position. At this point, motion mobilization to the lumbar and sacral aberrant motion segments were performed. The patient was asked to walk. He was pleasantly surprised to find himself able to stand up without use of his arms. After walking down the hall and returning, he reported 6/10 pain.
The patient was treated again with the same treatment two days later. On that day he initially reported maintaining the same level of 6/10 pain. He presented with 50% less spasm and tenderness in hips and low back. He was able to sit and stand up in a neutral position without use of his arms. After performing the same treatment as two days earlier he was able to move into 5 degree extension and reported 4/10 pain.
Follow up: Patient has been unable to get back in for treatment due to his extremely busy schedule and business travel. In his most recent communication on April 25 he stated that he has had no more severe attacks and has been maintaining his minimal pain levels of 4-5/10.
Conclusion: Despite significant history of medical findings and presentation of severe acute pain of a chronic condition, the Bonacci Method helped improve his posture, allowing him to experience immediate pain relief and improved range of motion and strength. He was able to return to work and family responsibilities without return of severe pains for three weeks. He has had lasting results with only two sessions. He is expected to return for follow-up treatment and would likely benefit from co-management with prolotherapy.
Case Study #2: “Rocky”
History: Rocky is a 54-year-old golf instructor. On April 13, 2014, while working on increasing his golf swing velocity, he suffered an injury to his right low back. Since then he has experienced constant 2/10 pain in the right sacroiliac joint and occasional numbness in his right quadricep. He reported that twisting or sitting makes his pain worse and lying down makes it better. He reported that when walking or standing his back hurts and feels stuck.
Rocky presented with an MRI report of the lumbar spine taken on January 16, 2015. The impression of the lumbar spine report revealed overall mild multilevel degenerative changes except for L4, L5 which were more severe. Also noted was grade-one anterolisthesis at L4, L5 with possible bilateral pars defect, resulting in moderate to severe narrowing of bilateral foramina with abutment and possible compression of the bilateral L4 nerve root.
The patient reported having multiple chiropractic visits and multiple physical therapy visits during the previous two- year period. He stated the treatments helped, however, he did not find lasting results. He had been unable to return to the gym to strengthen or stretch the area due to pain. He also reported not returning to golf due to pain. He was about to schedule an appointment for prolotherapy, but thought he would make one last attempt at an alignment therapy first.
Relevant examination findings include 20% limited lumbar range of motion on flexion and extension, with extension motion reproducing pain into the right quadricep.
Treatment: The patient was treated with the Bonacci Method, releasing nerve structures and myofascial structures in the surrounding pelvic and hip area, as well as joint mobilization work to the lumbar and sacral spine. After alignment of the nerves, soft tissue and joint in the immediate and surrounding area, the patient was asked to take a walk and return to a seated position. Immediately on his walk back to the table, the patient reported that his lower back pain was gone for the first time in two years. His range of motion was full and without pain.
Follow up: The patient was treated for six consecutive visits from March 21, 2016 to April 11, 2016 with the same treatment protocol over a three-week period, two visits per week, to ensure alignment. His pain in the low back did not
Conclusion: Alignment of nerves, soft tissue and joint allowed for improved posture. The improved posture and aligned body parts resulted in 100% pain relief and restoration of motion. He has maintain these results for two weeks without continued treatment.
In his last communication he reports returning to the gym, returning to work, and increasing his home exercises for strength and flexibility. His recommended follow-up treatment is one time per 4 to 6 weeks for alignment to prevent return of the problem.