<個案分享> 腰背痛症 — 骨髂 / 肌肉 / 神經線 / 筋膜 ，用軟功好，還是出硬功？ / Case sharing - Low back pain
- Helen Ho
- 2019年4月1日
- 讀畢需時 4 分鐘
作為一個物理治療師，雖然我多以 #髗骶骨治療 （CST / craniosacral therapy) 及 #保雲療法 (Bowen therapy) 這些相對輕柔的手法為我的患者做治療，但當有需要時，我也會出手用一點硬功，作骨骼調整。
近日遇到兩個腰背痛患者，便需要我出手給力👐。一個是急性腰痛，早上起床突然腰痛，活動一段時間好像好些，但轉移位置又突然一下劇傷，不太穩定。過了兩三天，他來做治療，如無改善應該會依醫生建議去照磁力共振MRI。檢查後發現腰椎有兩三節旋轉移位刺激了神經，幫他調整椎骨後再做筋膜釋放。剛治療完時，他第一個感覺亦不是感到有所改變，而是感到腰肌緊硬，很不舒服。我説，因為身體習慣了腰脽錯位的狀況，當放回較正位時，周圍的身體組織未適應，所以會感到怪怪。當晚他回家睡了一覺，第二天已大有改善。過幾天來覆診，腰痛已好很多，轉移位置沒有太大不適。再之後一次的覆診，他已能活動自如，腰痛問題已解決。
另一個患者，最初因失眠及肩頸不適來做髗骶骨治療 CST。她的身體是軟綿綿的，柔韌性很高，但身體肌肉力量不足，所以也開始跟我做瑜伽。最近一次治療，她跟我說左邊身總是繃緊的，而左腰不適很影響活動，雖然她不是那些劇傷情況，但總覺得下腰不舒服，用唔到力。而她站立時，盤骨也總是歪了一邊，不是側向左就是側向右，難以維持正中位置。我說不如今次改變一下方式，先幫你檢查脊骨。檢查後當然發現她的頸胸腰椎都有一些位置有錯位情況，而左邊的背肌也明顯緊張。我先由頸椎開始處理，只是處理有問題的一節頸椎骨，已幫助她整個上背放鬆下來；當處理完腰椎問題後，她下背肌肉也放鬆下來。站立時，她明顯覺得下腰不再被拉向一方，能自然站直，盤骨也不再歪向一邊。當然這個效果能維持多久，問題純粹是肌肉骨髂影響，還是有其他內臟問題影響，又是另一回事我需要去跟進。
還記得閲讀 Dr. Uplegder (craniosacral therapy 創始人)的書時，他會分享不少自己的個案。他本身是 osteopath，他也曾提過，當他做症時，發現患者有明顯的骨骼問題，他都會先用整骨手法處理，再去做 CST。近來我的治療習慣也傾向按照患者的狀況混合不同手法。此終，每種手法都有不同的長處，而每個患者的身體都有不同需要及反應。對我來說，靈活變通運用不同手法是需要的及一直學習溶合中。
<Case sharing - Back Pain> - bony structure, muscle, nerves, fascia... which technique should I use to treat the problem?
Nowadays, although I love to use Craniosacral therapy (CST) and Bowen Therapy as my main treatment modalities, which is relatively soft in nature , I still would use some hard skill, like manipulation to realign the bony structure if needed.
There's 2 back pain cases I treated recently that used manipulation skills rather than CST to deal with their problems, and it works well.
The first case was an acute back pain client. He suddenly suffered from low back pain while getting up the bed one day. Changing position like turning or getting up bed were the most painful activities, he felt better along the day if just sat and worked in front of computer. He consulted me a few days after the onset, he would go for MRI check up if no improvement noted after my treatment. After checkup, I found that his lower lumbar spines are mal-aligned which seemed to cause nerve irritation. I fixed his problem with spinal manipulation and fascia release. His immediate response was not pain relief, but somehow the whole back got tightened up. I told him it's like his body got used to the mal-aligned position, once I put it back, it couldn't adapt to the new position immediately. The soft tissues around the problem site needed some time to adapt. When he came back the next follow up, he told me his back condition got much better the day after the treatment. And he became totally pain free in lower back when he came back in the 2nd follow up.
For another client, at first she came to consult me because of insomnia and shoulder neck pain. She had a flexible body but lack of muscle strength. She also joined my yoga therapy class for improving her body function. In her last treatment, she told me that her left side of body was always tightening up, and she felt really discomfort in her left lower back and lack of strength in this region. When she stood, her pelvis always shifted to one side and unable to hold herself in neutral and central position. She felt that CST could help her back discomfort to certain extent, but the problem came back after a few days. So I let her lying on her tummy and checked her back this time. It showed that some of her spines were rotated and mal-aligned, and left back muscles were also tense. I started with her neck, fixing her most prominent mal-aligned cervical spine, her upper back muscles already relaxed. After fixing her lumbar spine, her mid & lower back also relaxed. When she stood, she could feel a great difference, she could stand straight easily with no pelvis tilting. She claimed that now she didn't feel something pulling her pelvis aside. Such good results after the manipulation, however I still have to check and see whether the effect lasts in next session.
When I read the books written by Dr. Uplegder (Founder of Craniosacral therapy), there's a lot of case sharing in his book. He was an osteopath, so if he found there's bony restrictions in his cases, he would immediately treat it with osteopathic manual techniques before his usual CST practice. For me, I also find myself embracing different techniques in my practice now. Each technique has its own strength. And each client's body is different and the need & response is different. Incorporating different techniques according to the client's needs is important and always a good learning for me as a therapist.
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