Shiatsu
By Andrea Battermann
The following case is a complex case, using Traditional
Chinese Medicine (TCM) diagnosis and Shiatsu, treatments
combined with physiotherapy.
Lorna, 29 years old, was referred by a physiotherapist
for Shiatsu therapy. She had received physiotherapy regularly,
including manual traction, heat application, spinal mobilisation
techniques, acupuncture, and exercises for shoulder and
neck, but all were of little benefit. She lives with others
and works in an office.
Past medical history
Lorna had had an accident 10 months previously, in which
she fell on the stairs of a bus. She tried to prevent the
fall with her left arm.
Main symptoms reported by her were:
Severe muscle spasms with muscle tremors and pain on the
left side of neck and face, upper back spine and abdomen.
A recent deterioration had lead to severe and constant muscle
twitching, which mainly affected her neck. The result was
an increased muscle tone and pain in her upper body.
Other symptoms were:
Waking up several times a night with pain and muscle spasms.
Suffering from dizziness while sitting, standing or walking.
Rushes of heat in the whole body.
Since her injury the production of whitish phlegm and flu-like
symptoms with an increased frequency of colds and sore throats.
Interestingly her X-ray for shoulder and neck did not show
any abnormalities.
Consultant neurologist reported no neurological abnormalities
and normal reflex activity. Her condition was characterised
by muscle spasms with an overproduction of adrenaline.
Medication used: diazepam, co-dydramol, ibuprofen and propranolol.
Physical assessment
Visually her right shoulder was lower than her left with
a decrease in muscle bulk around left shoulder joint, particularly
in the deltoid. The muscles in the head and face were constantly
twitching, her head was protracted and her walking very
rigid.
Range of movement
Neck movements
Lorna could only bend and extend her neck a quarter of its
normal movement to the left and although she had no pain
she had great difficulty in moving or turning it to the
right.
Shoulder movements
Shoulder movements were limited and painful when moved both
by Lorna and myself. She said that from middle of the deltoid
muscle down into left arm was numb with an intermittent
burning pain at base of her skull. She also had a hot burning
sensation around neck and left scapula (shoulder blade).
It was painful around her left shoulder when pressed and
there was an increase in muscle tone in the deltoid muscle,
The middle to lower part of the neck was painful when lying
down with a general increased in muscle tone. She had severe
muscle spasm on the left side of the neck and in the shoulder
and upper back.
Pain
The pain eased after the application of heat on, when lying
down for an hour or with painkillers. Mornings were always
better than later in the day. The pain was worse following
a busy day or any shoulder movement. The pain felt deep-seated,
all of which made her feel very tired.
Other relevant symptoms
Appetite: Following the accident it became erratic at times,
especially when the pain was greater.
Stools: irritable bowel syndrome with constipation, normal
stools and diarrhoea alternating.
Urination: Increased frequency, large amounts, pale colour.
Digestion: Occasionally vomited.
Taste: Craved sweet food at time of menstruation, otherwise
preferred salty taste.
Thirst: Prefers to drink a lot of warm drinks.
Climate: Preferred warm and hot temperatures.
Perspiration: Since the accident, suffered from day and
night sweats (drenching sweat on torso at night).
Eyes: Sensitive to bright light, stares when in pain, sometimes
dry eyes, dark patches under eyes, watery in the wind and
easily tired.
Ears: Tinnitis in both ears, worse in left ear when tired.
Voice: Tired and weak.
Spleen: Bruises easily.
Nails: White flecks.
Hair: Sometimes lank, lifeless, soft and thin when in pain
(since accident), loose head hair (pre-existent).
Headaches: Occasional above eyes, particularly right side.
Circulation: Cold hands and feet (pre-existent), more on
left side of body and hands since accident.
Menstruation: Pre-menstrual pain and cramps, dark clots
in menstrual blood; since accident, more painful with breast
distension, cramps and lower back pain.
Aims of treatment
Physical
- To reduce muscle spasm and tremor with Shiatsu techniques.
- To relieve pain.
- To increase mobility in the neck, upper back and left
shoulder.
- To re-educate: self-mobilisation techniques, postural
advice, ergonomics and pain management.
Mental
- To re-educate: relaxation techniques for stress management,
establish a positive body image.
Energetically
- To remove obstruction of Qi (energy) flow in traumatised
area and thus relieve pain.
- To promote free flow of Qi circulation throughout the
whole body to restore energy and vitality.
Emotional
- To reduce anxiety and calm the mind.
Diagnosis and interpretation of symptoms from the
TCM point of view prior to the accident
One of the cornerstones of oriental medicine is the concept
of Qi (chi). This is the basic life force and is said to
flow within channels (or meridians) around the body and
to provide the ability of the internal organs to function.
There are a number of problems that can happen to this energy,
if it stagnates or blocks up within the channels people
can experience pain and stiffness. The more stagnated or
blocked up it is the more pain they will have. If they fail
to have enough energy internally or this energy stagnates
then the internal organs fail to perform their function.
The internal energy and the external energy are also related
to each other. Blockages or deficiencies at one layer or
another can effect each other.
If one looks at this case from an oriental medical perspective
one can see that this person has blocked energy within the
channels and there is some deficiency/ stagnation problems
within the internal organs.
Prior to the accident Lorna had signs of both deficiency
and stagnation of her internal energy
Deficiency manifests in the following symptoms: Tinnitus
in both ears, worse when tired, loose head hair, increased
frequency and large amount of urination, preference for
warm drinks and salty food. Poor digestion, occasional nausea
and vomiting at times, diarrhoea.
Stagnation manifests in the following symptoms: Occasional
lateral headaches, vertigo, and painful periods with dark
blood clots and cramps. Psychologically, it manifests in
stubbornness and suppression of feelings.
Diagnosis and interpretation of symptoms following
the accident
Various physical symptoms were aggravated after
the accident. Lack of sleep led to an exacerbation of Qi
(energy) deficiencies, manifesting as dark rings under her
eyes and a weak voice.
The Qi had been stagnated before the accident. The shock
of the accident and her pain increased muscle tension in
her body. In general, pain causes constraint and stagnation
in Qi flow, which aggravated Lorna's original Qi stagnation.
Lorna reported that her menstrual problems had become worse
which is a sign of increased stagnation. Psychologically,
she pushes herself beyond her physical capacity to maintain
her full-time job. She overworks despite feeling tired and
in pain. The increased Qi stagnation attacks the digestion,
further depleting it and aggravating pre-existing gastrointestinal
symptoms. The accident injured the channels located to the
back and side of the head, neck and shoulder area. Lorna's
pain was relieved by rest, with her head positioned towards
her affected side indicating a deficiency problem within
these channels.
The three channels/ meridians (Large Intestine, Triple
Heater and Small Intestine) flow to the head. The physical
trauma to these meridians had caused obstruction in the
Qi flow to the head and face. Lorna developed a deficient
Qi flow in her head, especially in the left side of her
face. It is said the 'Qi moves the Blood' impeded Qi flow
means impeded Blood supply to the sinews and muscles, which
then as a result start to twitch.
The treatments
First session
According to the characteristics of the symptoms and location
of the injury, the following channels/meridians are involved:
Liver (LIV), Large Intestine (LI) and Kidney (KD), Triple
Heater (TH), Conception (CV) and Governing Vessel (GV).
Lorna was lying with her body twitched continuously. Treatment
commenced on the chest with an even holding touch tonifying
(strengthening) her Kidney meridian on either side beside
the sternum and dispersing the accumulation of Qi energy
with the other hand on the chest. Two points were then held
at the same time on one of the channels (the Governing Vessel)
to establish the Qi energy flow. Then one hand was moved
on the chest, finding points of deepest penetration on the
Kidney channel /meridian. The other hand was holding points
on the Kidney and Bladder meridian in the upper back at
the same time.
Lorna's muscle spasms and tone, as well as the twitching
intensity visibly decreased.
The author then held and contacted the Liver meridian on
the chest while applying a more dynamic and active Shiatsu
technique with the other hand to disperse the Qi stagnation
in that area. Eventually, a better Qi flow was established,
resulting in more muscle relaxation and spinal mobility.
Second session
Lorna reported less muscle spasm and twitching after her
treatment and she felt more relaxed. In this session, work
was given on head, neck, shoulder girdle and along the spine
on the Kidney and Large Intestine meridians.
Third session
Lorna reported that the muscle twitching had disappeared.
There was increased pain in her left shoulder and neck.
The author worked locally on Large Intestine and Small Intestine
meridians to improve the Qi flow throughout the left shoulder.
Summary of sessions
In further treatments the author worked more intensively
on Lorna's neck, trying to establish the Qi flow between
head and torso while working on dispersing local Large Intestine
and Liver Qi stagnation and tonifying the
energy.
The energetic connection between head and torso, especially
the thoracic spine, was always blocked and stagnated. Treatments
were often finished by working down the Bladder or Kidney,
Liver or Large Intestine meridians into the legs and feet
to encourage the Qi flow down-wards from the upper body
into the lower half.
Several months later the patient suffered a severe flare-up
when bending forward repetitively when filing in the office.
The severe muscle spasm and twitching recurred which was
successfully treated with two further Shiatsu sessions
Throughout the course of treatment, Lorna was taught relaxation
techniques, postural exercises and ergonomics, stretches
for her neck, shoulder and thoracic spine. Additionally,
advice was given on pain relief by using Do-In (self-Shiatsu).
Initially, the treatment consisted of 3 one-hour sessions
every fortnight and later this was reduced to 1 monthly
session.
Outcome of treatments was as follows:
- The pain in Lorna's neck, shoulder and upper back eased
immediately after the sessions.
- The neck mobility has increased by 50% in range of
movement immediately after treatment.
- The numbness in Lorna's left arm, shoulder and neck
area has disappeared
- Lorna was able significantly to reduce her pain medication.
- The range of movement in the neck is normal in extending,
bending, rotating and bending to the left side. The rotation
and bending to the right has improved by 50%.
- The range of movement in Lorna's shoulder has generally
improved, but there is still limited movement in bending
and the ability to turn it outwards is still limited due
to increased muscle tone.
- The deltoid (shoulder) muscle is slightly wasted and
the muscle power in her left arm remains reduced.
- Lorna's vitality and general health have improved.
Lorna practises a daily exercise programme and she avoids
activities that might aggravate her condition.
Feedback from Lorna, after treatment, was as follows:
- The whole body was treated and not just the local area
of pain and injury.
- Long-lasting benefits reduced the number of appointments.
- Additional to several positive treatment outcomes, Lorna
experienced Shiatsu as very relaxing.
- She felt that the most important factor was the length
of the appointments, which allowed enough time for feedback
and physical work - this reduced the number of appointments
in that the benefit (out-come) lasted longer.
- Lorna commented that Shiatsu might prevent injury from
turning into a chronic pain.
- She is able to pace her physical activities better by
allowing for frequent rest times in between.
- Shiatsu should be available on the NHS and is a competitive
cost effective treatment.
About the Author
Andrea Battermann MCSP SRP MRSS(T) Chartered Physiotherapist
Andrea Battermann first qualified with a Diploma in Social
Work in Germany in 1985, working in alternative education
and rehabilitation with physical and mental disabilities.
She further qualified as a chartered physiotherapist in
Germany In 1992, Andrea worked for 6 years within various
specialities within the NHS including neurological rehabilitation,
chronic pain management, rehabilitation of amputees and
out-patient work. In 1994, Andrea qualified as a Shiatsu
practitioner with the European Shiatsu Institute and is
a registered practitioner and teacher with the Shiatsu Society
in U.K. She is the principal of the Shiatsu College in Edinburgh
which she founded in 1997.
Andrea has built up a successful private practice incorporating
physiotherapy, shiatsu, acupuncture and counselling. She
treats mainly musculoskeletal problems, chronic pain and
psychosomatic conditions. In 1995, Andrea began a professional
training in Process Orientated Psychology (POP), a Jungian
based and body orientated psychotherapeutic approach. She
is particularly involved with the application of POP for
Shiatsu, TCM, and bodyenergetics. Andrea is a recognised
lecturer for Acupuncture Association of Chartered Physiotherapists
in U.K. She is a co-author of the book Complementary Therapies
for Physical Therapists. Her main interest is to link oriental
and western medicine with psychology to create a more holistic
model of healthcare.
