Osteopathic manipulative treatment for facial numbness and pain after whiplash injury

Participants

• Number: 1
• Description: woman with right face numbness and right cheek pain, 24 hours after a motor vehicle collision. The patient was seated in the front passenger seat: a vehicle traveling at a high speed hit the car she was riding on from behind as it was slowing down, pushing it against a truck in front of it. The airbag did not deploy whereas the seat belt held her back. She did not remember if she had hit her head but she remembered her neck and head having a whiplash movement.
  The facial pain, which occurred after the event, was constant, with intensity of 4 out of 10, and the patient had not done anything to alleviate it as she thought it would resolve on its own. She arrived at the clinic at the pressing request of her friend who was driving at the time of the incident.
  Besides the pain, she presented clear watery drainage from the right ear, discomfort in her right shoulder and right side of the neck (where her seat belt had contact) and vertigo.

The patient did not report any shivers, fever, short breath or chest pain, and believed that the vertigo depended on a seasonal chronic allergy, as it was a symptom that she would experience from time to time.
In this regard, the allergy had caused congestion to the right ear and swelling of the right cheek. She had bone spurs in both shoulders, probably due to her working as a cleaning lady.

On examination, the patient appeared slightly obese, apparently not distressed and with a blood pressure of 167/78 mmHg. Her cranial motor nerves were intact, as well as the sensory nerves, except for the trigeminal nerve that did not respond to light touch. Her sinus cavities were not tender to light touch, whereas her right tympanic membrane opacified. Heart and lungs were normal at the examination. Heart and lungs were normal at the examination.Osteopathic structural evaluation highlighted, at the level of the vertebrae T10-L4, muscle spasms, greater in the left paraspinal muscle than in the right one, a tender point in the left paraspinal muscle at the level of L3, muscle spasms at C2-C5 level and an extended occipitoatlantal joint.
During the treatment a restriction and an asymmetry emerged in the right temporal portion of the cranium.

Interventions and evaluations

• Evaluation of pain at the first visit and at two follow-ups of 4 and 6 months
• 1 session of OMT
• OMT directed to the thoracic rachis, to the suboccipital region and to the cranial region, with the intent to act on the trigeminal nerve
• this was the sequence: myofascial release and inhibition pressure techniques at lumbar and thorax level, while instructing the patient to breathe deeply, followed by countestrain; myofascial release at the cervical level; occipitoatlantal decompression; myofascial release at cervical level; “balancing” of the temporal bones

Results

Despite initially experiencing pain during the techniques of thoracic and lumbar inhibition, following the treatment to the cervical level the numbness resolved, while the “balancing” of the temporal bones promoted the resolution of pain.
At both follow-ups, the patient did not reported any more symptoms.

Discussion

Considering the acute and traumatic character of the painful condition, more gentle techniques have been chosen whereas techniques that could have exacerbated the muscle spasms were avoided (eg, high-velocity low-amplitude). In addition, in case of whiplash, it is recommended to treat first the thoracic and lumbar spine, and only afterwards the cervical spine.

With regard to pain and facial numbness, the trigeminal nerve certainly played an important role, which can generally be affected by many different pathologies, even serious ones, but they were excluded given the patient’s history. In this regard, the evaluation of the skull and temporal bones was carried out because of the chronic allergy that tended to congestion the right ear and that, therefore, could potentially affect the trigeminal.
Similarly, in such cases it is good to evaluate and release any possible restriction on the entire trigeminal nerve pathway.