Disclosures: Derek S. Dixon, DO, MA: No financial relationships or conflicts of interest

Case Diagnosis: Upper Crossed Syndrome in setting of Cerebral Palsy

Case Description: A 54-year-old female with cerebral palsy with mixed athetoid greater than spastic tetraparesis who was initially referred to the neurorehabilitation clinic for consideration of Botox for her upper back pain. The pain had been present for nearly eight years at the time of presentation. Pain pattern was found to fit with an upper crossed syndrome as a likely compensatory pattern to her scissoring gait. It was decided to pursue osteopathic manipulative medicine (OMM), given the mechanism of pathophysiology was not related to spasticity as previously thought.

Setting: Outpatient Neurorehabilitation Clinic

Assessment/Results: The patient completed a total of three sessions of OMM with complete resolution in her pain by the start of the third treatment session.

Discussion: Given the patient’s athetosis she was treated with balanced ligamentous tension (BLT) and facilitated positional release (FPR). These particular techniques allowed for compensation while continuing to treat during her writhing movements.

Conclusion: This case shows one example of the use of OMM in a patient with a complex movement disorder. The treating physician needed to be selective in choosing techniques that allowed for compensation due to the patient’s writhing movements.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/osteopathic-manipulative-medicine-for-chronic-pain-in-the-setting-of-cerebral-palsy/