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***This post will mark the start of a new segment – Clinical Anecdotes. While research is very important, it takes years and years to generate good research. It is always going to be somewhat behind – I say this meaning that since it takes a long time to generate good and reliable data for literature, by the time something has been validated, many times it is only confirming something that has been going on in the clinic for the past few years. For example, I see “new” research out quite a bit that states exercise is good for your heart health, exercise can help in the diabetic population etc…. But I would argue that this is nothing new. I’m not starting or engaging in an argument about this. This segment is meant to focus on clinical pearls of treatment to help guide your practice. ***
Recently in the clinic I had two athletes come in, both with c/o chest pain, what has helped them took a few visits to figure out but both have now greatly reduced pain levels.
28 year old male with primary c/o chest pain with dips at the gym. Pt presents with thoracogenic scoliosis (R sided convexity). Pin point pain with dips only (bench press was ok) and c/o pain at bottom of dip and pain that lingered – 8/10 at worst. No pain at rest.
18 year old female with c/o thoracic pain that was constant, referred into her neck, and when she retracted her shoulder blades, she had pain in her back as well as her chest that would cause her to cough, pain was 7/10 at worst. Pt’s posture is poor (severe forward head posture with poor stability and control in cervical spine). PMHx of high school rower and track and field sprinter.
The above only describes a limited background. In Case 2, she was cleared by her pediatrician of all other internal medical conditions as well as cleared chest X rays, no co-morbidities identified.
Both had improvement with Graston Technique for soft tissue mobilization. Both had poor posture and, therefore, started on posture correction and neuromuscular re-education for that. Both had complained of pain in a general bilateral chest pain that was also tender to palpation over the anterior shoulder. However, 2 muscles (on top of many others, i.e. pecs had already been addressed through multiple sessions with minimal improvement) were key in their treatment; Serratus Anterior and Latissimus Dorsi. In both cases, when the Lats and SA were released with Graston and soft tissue manual release techniques, both had significant pain reduction: Case 1 had an in session reduction to 1/10 pain with dips 3 sets of 5, and Case 2 had verbal reports of being able to sleep through the night and 4/10 pain with no pain in her neck anymore on her next visit.
With both you can see how they might be experiencing general chest pain on the lateral and anterior sides due to the muscles’ pain referral pattern. I will also note that these were not the only symptoms seen in these patients, only a snapshot.
While their pain and symptom reduction was not due to SA and Lat release alone (both had a few sessions of NMR and postural retraining without the focus on SA and Lats), they have continued to improve and are able to tolerate increased activity with lower pain levels as well as improved their overall mobility.