Was it the HVLAT? A Reflective Case Discussion

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There is quite the debate these days about how manual therapy works and particularly what types are best or get different/better results or is it all just placebo. Here is a case,  n=1.

I’m evaluating a patient with upper back pain, medial to the scapular border and lateral to the spine, around T5-ish.  We all know where this spot is, right? The complaints are approximately 8 months in duration, 5/10 pain secondary to increased breast tissue (20 lbs) during pregnancy and post-partum time periods, per the patient.

Your hyper-vigilant SWAT Team. A Metaphor

We all have a nervous system who is our boss and our buddy.  One of it’s jobs, as an organ and part of the whole, is to protect us and alert us to danger.  This is biologically advantageous, no doubt. We want some level of protection so we don’t ignore tissue and other damage.  One way of protecting us is to limit movement in a predicted pain-causing manner, or to cause movement away from danger.

If you have too much vigilance, however, movements are stifled and restricted and life gets a little scary. The body environment becomes a little hostel while in this overly vigilant state.  To illustrate this, let me paint an image for you…