A very active 60 year-old female suffered severe trauma to her left pelvis and right knee after being hit by a car. This trauma to the buttock resulted in severe muscle contusion, intra-muscular bleeding, a bruised sciatic nerve, and severe pain. She also sustained injuries to multiple areas of her right leg. She had been in physical therapy 2x/week for five months prior to coming to Myopain Solutions. She took pain medication (including narcotics) as needed. She described a loss of body awareness and trouble finding a comfortable sleeping position. She also reported that she could not sit or stand for long periods of time at her job. Questions remained if her pain was muscle or nerve sourced.
Evaluation, clinical reasoning and treatment strategizing
Standing postural evaluation revealed a pelvic obliquity. She stood with her weight shifted to the left to offset weakness in her gluteal muscles. She walked with the aid of a cane and used a widely spread stance to enable better balance. Palpation using an algometer revealed many muscles to have a very low pain-pressure threshold. Multiple sites were able to mimic her symptoms around her left pelvis. She had signs of allodynia and hyperalgesia.
Because of the sensitivity around her left hip, initial treatment needed to desensitize the soft-tissues. Mechanoreceptor strategies for desensitization included hydrotherapy treatment, vibration, cutaneous stimulation, plus gentle rocking and jostling. Once she was able to tolerate more pressure, NMT treatment included myofascial trigger point therapy to treat all functionally related muscles of her left hip.
Outcome and follow-up
After one month of treatment, she was able to eliminate all pain medication. She received NMT weekly for one year. As her walking pattern normalized, she used her cane infrequently. This case demonstrates how regular NMT treatment can assist with severe muscle damage due to trauma.