Throughout most of my 29 years of practicing clinical cardiology, I was never really satisfied with treatments I employed in the treatment of musculoskeletal chest pain. This was especially true with the recognition of nonsteroidal anti-inflammatory drug complications. Now, at the end of primary clinical practice, I believe I have found a satisfactory treatment.
My life journey has led me to my “retirement job” as an associate professor of medicine, teaching cardiology and internal medicine at the Marian University College of Osteopathic Medicine in Indianapolis. I made the transition somewhat gradually, and was thus learning about osteopathy while I was still practicing cardiology. I felt that if I was going to be teaching at an osteopathic medical school, I should take some classes in osteopathic manipulative medicine (OMM) to better understand what the students were learning.
One day while I was still involved in practice, a sweet 85-year-old female patient of mine, with extensive cardiovascular disease, was brought into my office by her concerned daughter. This patient had severe left-sided back, chest, and arm pain for the previous 3 weeks. She had been to our Emergency Department when this started, and had extensive testing ruling out an acute vascular or life-threatening event. She was later seen by her internist, who had prescribed a nonsteroidal anti-inflammatory drug, with no relief of pain. Her daughter was concerned about her mother’s suffering and the possibility of an atypical presentation of some sort of vascular abnormality.
I remember reviewing the extensive noninvasive testing this woman had undergone and finding no clear answers. Of course, her history gave away a big clue, as she had had continuous pain for 3 weeks, which suggested a musculoskeletal etiology. On examination, I found that she was exquisitely tender around and under her left scapula, and the tissue texture was abnormally dense. I looked to her and her daughter and asked if I could try something out of the ordinary. We all started laughing a bit when I told them I would be very gentle, and wouldn’t kill her. They said OK.
I felt uncertain on how to proceed, but I remembered from class that utilizing a very gentle amount of force applied to a muscle in spasm could relieve that spasm if correctly aligned, that is, closely perpendicular to the long axis of the muscle spasm. I positioned her scapula and shoulder so I could place one finger on the culprit rhomboid muscle directly over and nearly perpendicular to the area of spasm. This area was clearly tense and tender. Then I applied a little force with my finger and waited. After about 90 seconds, the muscle softened and her pain was 80% gone. Honestly, I was as surprised and pleased as they were with the positive result.
At that point, I recognized I had found a reasonable solution to the problem of musculoskeletal chest pain treatment after all those years.
I am sharing this story to introduce my fellow allopathic (MD) colleagues to the field of OMM. I suspect many physicians are, as I previously was, unaware how effectively somatic dysfunction such as musculoskeletal chest pain can be treated with OMM. There are a multitude of gentle, non high-velocity low-amplitude techniques available in OMM. This includes techniques such as muscle energy, strain counterstrain, myofascial release, soft tissue, and balanced ligamentous tension. The technique I employed for this specific chest discomfort is called myofascial release.1
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-Daniel M. Gelfman, MD
This article originally appeared in the June 2017 issue of The American Journal of Medicine.
