Disclosures: Nicholas R. Wawrzyniak, MS: Nothing to disclose

Case Description: A 49-year-old female with history of asymptomatic L4-L5 disc herniation presented to the osteopathic manipulative treatment (OMT) clinic for follow-up of chronic low back pain (LBP). Pain was described as a constant dull achiness, 5/10 severity. The patient was seen several times with minimal response to NSAIDs, corticosteroid injections, and manipulations targeted at lumbar spine and local myofascial tissues. Upon further investigation the patient noted her pain was worse while wearing flat shoes or barefoot, alleviated with high heels. Thus, applying the models of myofascial meridians and regional interdependence, the relief of pain with plantarflexion suggests the pain may be caused or exacerbated by a range of motion restriction in the calves. The patient was found to have severely hypertonic left triceps surae as well as a dorsiflexion restriction of negative 10° as measured by goniometer.

Setting: Outpatient osteopathic manipulative medicine clinic.

Patient: 49-year-old female with chronic low back pain.

Assessment/Results: After treatment, our patient’s left ankle dorsiflexion was significantly improved by 20°, and she reported reduction of symptoms including no pain while standing barefoot.

Discussion: Myofascial meridians are a biomechanical concept in which consecutive muscles and the associated webs of fascia in the body “create lines of pulls which transmit strain and movement through the body.” The concept of regional interdependence (RI) states that “seemingly unrelated impairments in remote anatomical regions may contribute to the patient’s primary complaint.”

Conclusion: These results provide evidence for the practical utility of understanding the myofascial meridians in the context of OMT and other physiotherapy modalities as well as a framework for providing holistic care of musculoskeletal injuries.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/regional-interdependence-of-myofascial-meridians-in-chronic-low-back-pain-a-case-report/