Core Stability and Manual Therapy for 41-year-old Male with Chronic

Pain and a History of Two Blast Injuries: A Case Report

Kenneth K. Schirer
Advisor: Linda M. Hall
Doctoral Program in Physical Therapy, Central Michigan University
Background and Purpose Outcomes
West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Scores
• Blast injuries, concussions, and Post Traumatic Stress Disorder (PTSD) can contribute to chronic pain
• Outpatient multidisciplinary approaches have been shown to be effective with managing chronic pain WHYMPI Category Initial Discharge
• The purpose of this case report was to apply the concepts of manual therapy and core stability Interference 2.66 2.89
Support 5.00 4.33
exercises to a client with a history of two blast injuries to improve his pain and functional Pain severity 3.33 3.00
independence Life-control 6.00 5.50
Affective distress 2.00 2.00
Negative responses 0.75 0.50
Solicitous Responses 1.67 Invalid
Case Description Distracting responses 2.75 1.75
Household chores 5.00 5.20
Outdoor work 5.40 5.20
• A 41-year-old Caucasian male was admitted to an After the Impact Program (ATI) after receiving two Activities away from home 2.75 2.00
blast injuries within a two-month timespan Social activities 2.50 2.50
• Main chronic pain complaint locations were: General activities 4.33 3.89
• Thoracic spine *All categories are out of 6 points. Higher point values are better for support, life-control, household chores, outdoor work, activities away from home,
• Right hip social activities, and general activities. Lower point values are better for interference, pain severity, affective distress, negative response, solicitous
responses, and distracting responses.
• Right knee
• Right ankle High Level Mobility Assessment Tool (HiMAT) Scores
• Bilateral temporal region of skull
• Client had increased pain with: HiMAT Category Initial Discharge
Walk 3 NT
• Ambulating Walk backward 4 NT
• Running Walk on toes 3 NT
• Swimming Walk over obstacle 3 NT
Run 4 NT
• Lifting objects Skip 1 NT
• Prior to admission, he was independent with his activities of daily living and did not utilize an assistive Hop forward (affected) 4 NT
device to ambulate Bound (affected) 4 NT
Bound (less-affected) 4 NT
• Outcome measures used: Upstairs dependent 4 NT
• High-Level Mobility Assessment Tool (HiMAT) Upstairs dependent 4 NT
• West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Down stairs dependent 0 NT
Down stairs independent 0 NT
Total HiMAT score 38 -

*NT = not tested; walking, walking backward, walking on toes, walking over an obstacle, running, skipping, hopping forward, bounding, upstairs
Interventions independent, and down stairs independent are out of 4 points. Upstairs dependent and down stairs dependent are out of 5 points. Total HiMAT score is
out of 54 points.

• This client was treated for a period of 90 days in the ATI program
• Physical therapy treatment included:
• Therapeutic exercise to strengthen his upper and lower extremities
• Core stabilization exercises
• Functional activities, such as ambulating to assist with his core activation with dynamic
activity
• Manual therapy was used to assist with the client’s thoracic kyphosis and and to correct a
right posterior rotated innominate
Discussion
• Applying the concepts of manual therapy, core stabilization, therapeutic exercise, and a home
exercise program demonstrated slight improvement in functional aspects related to pain
• Future research should focus on applying these concepts to a larger population and in different
treatment settings