2016 – Disabling Shoulder Pain Treated by Contralateral Isometrics with Ipsilateral Ortho-Bionomy, Massage and Visualization: A Case Report

Posted:Friday, February 10, 2017

Rosi Goldsmith, BA, LMT, DAFNS

Introduction: Shoulder pain is the third most common musculoskeletal condition, with high social-economic costs. Contralateral inhibition (CI) has been used to treat a limb affected by stroke and to prevent unilateral overuse sports injuries, but is not well researched for pain treatment. This is the first such case report on CI for disabling shoulder pain.

Case Presentation: The patient was a married, 45 year old, right-handed male, with a 3-year history of right shoulder pain following a traumatic injury. The slightest touch or use of his right arm exacerbated the pain for days and interfered with all aspects of his daily life. Previous treatment included surgery, psychotherapy, pain management training, physical therapy, and chiropractic. He took analgesics, and wore an advanced transcutaneous electrical nerve stimulation (TENS) unit for approximately 2 hours daily.

Methods: The practitioner identified the most painful tissues in the affected right arm, then applied isometric and very slow isotonic contractions to homologous left arm muscles. The patient’s wife was recruited to assist with daily home exercises. The practitioner applied cross-fiber friction, myofascial release and proprioceptive exercises to the right arm when direct touch became tolerable. The patient recorded VAS pain scales at each session and kept a weekly frequency/duration log of TENS unit use. The practitioner charted verbal narratives on other changes the patient experienced.

Results: Following 12 clinical sessions in 24 weeks, the patient had a 50% VAS reduction in between-session pain, and TENS unit usage dropped from 13-14 hours per week to none. The patient reported improvements in sleep and confidence, as well as resumption of normal home and family activities. He also reported that he was able to return to work for the first time in three years.

Conclusion: Physical therapy research has documented CI with “neurological crossover” effects, but it is not well researched. A prospective study could choose more appropriate rating scales, and determine when CI treatment might be most effective. This case suggests massage therapy may be beneficial for some cases of severe unilateral pain, but additional larger scale studies are needed.