Bayliss Amy J, Klene Frank J, Gundeck Evelina L, Loghmani Mary T
Department of Physical Therapy, Indiana University, Indianapolis, IN, USA.
J Man Manip Ther. 2011 Aug;19(3):127-34. doi: 10.1179/2042618611Y.0000000006.
Musculoskeletal pain is commonly reported by pre- and postnatal women, with the most common complaint being low back pain. However, lower leg pain is also frequently reported by women particularly in the third trimester. The purpose of the case study is to illustrate how instrument-assisted soft tissue mobilization (ISTM) can be used to treat a patient with a 2-year history of chronic calf pain. The subject was a 35-year-old female who developed calf pain during the last trimester of her pregnancy following severe lower leg edema. The calf pain was present for the 2 years following delivery and was described as a dull ache, typically aggravated by direct pressure on the calf, prolonged standing, and stairs. An X-ray, magnetic resonance imaging (MRI) with contrast, and ultrasound Doppler study prior to referral ruled out tumors, vascular, lymphatic, or skeletal bone abnormalities. However, her MRI did show a dense superficial venous tissue asymmetry in the same location of her symptoms. Impairments were minimal; the only asymmetrical objective findings were calf length, strength, and soft tissue restrictions detected on palpation. After nine treatments incorporating an ISTM approach, soft tissue mobility, pain, calf strength, and lower extremity functional scale score all improved and her symptoms were abolished.
肌肉骨骼疼痛在产前和产后女性中很常见，最常见的主诉是腰痛。然而，小腿疼痛在女性中也经常出现，尤其是在孕晚期。本案例研究的目的是说明如何使用器械辅助软组织松动术（ISTM）来治疗一位有2年慢性小腿疼痛病史的患者。该患者为一名35岁女性，在妊娠晚期出现严重小腿水肿后出现小腿疼痛。产后2年一直存在小腿疼痛，表现为隐痛，通常在小腿受到直接压迫、长时间站立和上下楼梯时加重。转诊前的X光、增强磁共振成像（MRI）和超声多普勒检查排除了肿瘤、血管、淋巴或骨骼异常。然而，她的MRI确实显示在症状相同位置有密集的浅表静脉组织不对称。功能障碍很轻微；唯一不对称的客观发现是触诊时发现的小腿长度、力量和软组织受限。采用ISTM方法进行九次治疗后，软组织活动度、疼痛、小腿力量和下肢功能量表评分均有所改善，症状消失。
