SCM Syndrome Case Report American Chiropractic Association Rehab Council. Title. Neuromuscular Dysphagia as a variant of sternocleidomastoid syndrome. A Case Report. Running Header. Dysphagia from SCM Dysfunction. Author. Randall C. Mc. Leod DC, FCCRSc, DACRBPrivate practice, IHCrehab, 5. Range Rd 1. 3, Stony Plain, AB T7. I think the point that Schleip is trying to make with his thought experiment is that if prolonged pressure stretched fascia, we should all end up with droopy. La muscolatura posteriore della coscia comprende il Bicipite Femorale, il Semitendinoso, e il Semimembranoso. Si tratta di muscoli importanti e quasi sempre affetti. From Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol. Upper Half of the Body, Simons DG, Travell JG, Simons LS, Lippencott Williams and Wilkins. MYOFASCIAL TRIGGER POINTS Pathophysiology and Evidence. Informed Diagnosis and Management. Edited by Jan Dommerholt, PT, DPT, MPS, DAAPM President Bethesda. Express Helpline Get answer of your question fast from real experts. Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online. Easily share your publications and get. Myofascial Trigger Points, Fig. This schematic longitudinal view of muscle illustrates key clinical features of a myofascial trigger point. The central trigger. La dizione Trigger Points fu introdotta da Janet Travell 19011997 nel 1952, benche il concetto fosse noto da almeno un secolo in ambienti medici ufficiali. Travell And Simons Trigger Point Charts' title='Travell And Simons Trigger Point Charts' />Myofascial trigger point reference including referred pain and muscle diagrams as well as symptoms caused by triggerpoints. Travell and Simons Trigger Point Flip ChartsBookSoftbound 79. Volumes 1 and 2 of Drs. Travell and Simons Myofascial Pain and Dysfunction The Trigger Point. Z 1. Y4. Keywords. Me. SH Chiropractic, manipulation, dysphagia. Non Me. SH sternocleidomastoid, trigger point. ABSTRACTIntroduction. This patient was a 1. Her condition was highly responsive to chiropractic spinal manipulative therapy coupled with trigger point therapy and proprioceptive neuromuscular facilitation. Case Presentation. This patient presented complaining of a progressive dysphagia of 1. Her condition further resulted in a mounting anxiety regarding her ability to ingest food and provoked a severe weight loss. My examinations revealed mechanical cervical dysfunctions, autonomic and postural functional anomalies as well as mediation of her symptoms through trigger point and articular stimulation. Outcome. This patient responded exceptionally well to chiropractic spinal manipulative therapy coupled with neuromuscular rehabilitative techniques. She showed a very good early response and ultimately complete resolution of her signs and symptoms. Conclusion. Dysphagia can be the primary presenting symptom of a cervical neuromusculoskeletal dysfunction such as sternocleidomastoid syndrome. FULL TEXTIntroduction. Dysphagia difficulty swallowing is a relatively uncommon primary symptom in a chiropractic office. When experienced however, it can be extremely disconcerting for the patient in that the process of ingesting foods and fluids is a biological necessity for sustaining life. As well it can create a concern for the practitioner regarding differential diagnosis. According to the online Merck Manual 1 the majority of cases of dysphagia are the result of some type of severe central nervous system pathology. Of particular interest to the chiropractor would be the possibility that a presentation of dysphagia could be a symptom of an evolving stroke, as outlined in the diagnostic protocol represented by the 5. Ds And 3 Ns table 1. There are a small but intriguing number of papers which refer to a multitude of symptoms, including dysphagia, arising from sternocleidomastoid syndrome That being the result of a functional disturbance of the sternocleidomastoid SCM muscles and its attendant innervations. Missaghi 2 gives an excellent overview of this syndrome as well as a detailed description of the anatomy and usual symptoms associated with SCM syndrome. Dr Donald Murphy DC, DACAN clinical faculty at Brown Medical Univ, in his summary notes the potential for swallowing disorders associated with this syndrome. His position is supported by Dr Burl Pettibon DC, FABCS, FRCCM, Ph. D. Hon in his text on chiropractic rehabilitation 3 and Travell and Simons 4 note the shared neurology of these tissues. Further, Braune et al 5 cites a case where dysphagia was apparently caused by a fasciculation of the SCM muscle. My particular interest in this case was piqued by having seen two prior occasions of dysphagia which responded to chiropractic care. The first was in me. I had spent an entire day renovating a ceiling with my head and neck in extension. Late in the afternoon I suddenly found I had great difficulty swallowing, my throat simply would not work. A prompt visit to my chiropractor relieved the problem however I can clearly recall the sense of near panic that I felt when I realized that I was unable to swallow. The second incidence was in an adolescent female who was suffering from a diffuse juvenile myositis and hospitalized for the same. Her mother advised me she was having difficulty swallowing and her physicians were proposing surgery in an attempt to alleviate her symptoms. A trial of spinal manipulative therapy SMT resulted in her also responding very rapidly and subsequently demonstrating a complete resolution. With these cases in mind, when I was presented with a third case, I felt it should be documented somewhat more carefully for further consideration or study. Case Presentation. In this case a 1. For the first 9. 5 months her condition progressed slowly Sept to mid June. Approximately mid June her symptoms began to progress much more rapidly resulting in such difficulty swallowing that she suffered a weight loss of 2. This was not only a red flag denoting the advancing severity of her condition, but also resulted in a substantial amount of anxiety on the part of the patient due to her inability to ingest food or drink normally. The patient had been examined by her physicians including a referral for endoscopic evaluation, all of which were unremarkable. Closer inquiry revealed that she was able to recall that she had experienced 3 memorable traumas the previous summer, including an injury from rough play with her siblings, a trampoline injury and a boattubing injury. In general, it is my experience that when a patient remembers an injury 1. My evaluation revealed Mechanical dysfunction of the cervical spine. Rt lat bend 3. 3deg, Lt lat Bend 5. Flexion 5. 8deg norm 6. Extension 7. 0deg, norm 8. Rt Rot 7. 0deg, Lt Rot 8. CROM chartsSpecific site fixation was noted at C5 on Rt. Bending motion palpation. She had notable weakness of the deep cervical neck flexors poor resistance to forced extension. Her symptoms were aggravated by. Lateral pressure on C5. C5 6 facet pressure on the right. Full Cervical extension. Trigger point pressure at Rt. Medial sub occipital area, Rt SCMs and Rt Levator scapulae musc. Her symptoms were diminished by. Cervical flexion. Trigger points at Lt. SCMs and Lt. Levator scapulae. An ad hoc Borg6 type of severity scale was created where 0 meant no difficulty or normal swallowing and 1. She reported a difficulty of 8. Her thermography showed a strong unilateral bias as well a severe asymmetries in her cervical spine. Bollywood Music For Windows 8 here. A postural s. EMG study showed only mild to moderated increases, predominately in the lower thoracic spine and a moderate spike at C1. I arrived at a working diagnosis of dysphagia of somato visceral origin as a result of referred symptoms from post traumatic subluxation of the mid cervical spine, co morbid with symptom referral from the cervical musculature, ie. Management and Outcomes. Due to the severity of her symptoms and the relatively short chronicity of her condition, I advised an intensive but declining treatment schedule beginning at 5. X the first week, 3. X the second week, 2. X the third week followed by 1. X weekly support until she was satisfactorily resolved. This would parallel a program I would use for acute pain levels of 8 or more. Her treatment would involve chiropractic spinal manipulative therapy SMT, proprioceptive neuromuscular facilitative PNF techniques predominately post isometric relaxationstretching and active home care as required. More specifically she was treated with SMT at C6 right posterior, C5 left posterior occasionally C7 inferior or extended with mild 5 6 rib on the left and some lumbar adjustments at L2 and L3 which were not likely directly related. Her PNF care consisted of post isometric relaxation contract relax stretch at both heads of the SCMs, sub occipital musculature and the pectoralis muscles roughly the same PNF care as would be used for an upper crossed syndrome of Janda. Her home care was predominately for strengthening the deep cervical neck flexors and involved neck retractions against resistance supine with mid cervical pressure into a cervical roll under C5 as well as seated neck retractions with no resistance. Her progress was excellent. By the end of her first week of care she still demonstrated some apprehension regarding food but her difficulty in swallowing was down to a 2 of 1. Most soft foods had been re introduced. By the end of the second week hard foods were being introduced and her swallowing difficulty was down to a 1.