Case Study: Peter, Aged 73 – Resolution of Severe Migraine and Blurred Vision

Chris Boynes, Chartered Sports and Spinal Physiotherapist

Patient Presentation: Peter, aged 73, presented to the clinic suffering from severe migraine and blurred vision. His medical history included suffering from headaches/migraines in his 20s, which had been managed with drugs. He also noted a history of longstanding neck and shoulder stiffness and felt that beta blockers had potentially increased his migraines.

Problem List: The clinical problem list included headaches/migraines, suggesting involvement of the GB channel with pain localised around the GB14 and GB20 areas in the neck. Other issues included reduced range of motion (ROM) in both shoulder joints and general joint and connective tissue tightness.

Treatment Approach Emphasising Deep Oscillation (DOT):

Peter’s treatment incorporated a combination of techniques, including Traditional Chinese Medicine (TCM), Intramuscular Stimulation (IMS), and manual therapy (such as SNAGs, mobilisations, and adjustments). Initial manual therapy using a Mulligan's headache SNAG at C0/C1 and rotation at C1/2 yielded only a small positive change.

Deep Oscillation Therapy (DOT) Integration:

DOT was a critical component of Peter's protocol, utilised for pain and tissue 'softening'.

• Application: DOT was administered at frequencies of 200 Hz and 60 Hz for sessions lasting 20 to 40 minutes.

• Mechanism of Action: Deep Oscillation works by creating a deep, resonant vibration within the tissue layers, which has a gentle yet powerful effect. DOT permeates connective tissue layers to a depth of 8 cm.

• Targeted Frequencies: The high frequency of 200 Hz used in Peter's treatment is associated with significantly reducing pain and helping to break down trapped cellular metabolic waste. The medium frequency of 60 Hz helps relax tissue layers and boosts microcirculation in the interstitial spaces of the connective tissue.

• Patient Sensation: DOT is applied through vinyl-gloved hands or applicators and involves no heat or electrical stimulation. Peter reported feeling warmth during the DOT treatment, which is actually the friction of the gloves on the skin, as DOT does not generate heat.

Outcome Focusing on DOT's Contribution:

While the combined TCM and IMS treatment was credited with eliminating his headaches and significantly decreasing his neck and shoulder tension, Peter provided specific, positive feedback about the DOT:

• Immediate Improvement: DOT left Peter with an easier-moving neck, aided by warmth applied after treatment.

• Patient Feedback: According to Peter, the whole of his neck and shoulders felt much improved after the DOT treatment. He reported experiencing more mobility and stated that the tissue felt very relaxed. This aligns with the known clinical effects of DOT, which include pain relief, muscle/tissue relaxation, and increased range of motion (ROM).

• Long-Term Results: Within five sessions over six weeks, Peter achieved no further headaches/migraines and experienced less joint stiffness.

Recurrence and Second Success:

Five months later, Peter returned with intermittent headaches and cloudy eyes. The subsequent treatment again included TCM, IMS, and DOT. Following this session, Peter felt the DOT had eased the tissue and joint stiffness. He returned one week later with clear eyes and no headaches.

The contribution of Deep Oscillation Therapy appears to be its ability to soften and relax deep connective tissue without pressure, enabling other modalities, like IMS and TCM, to achieve better and faster results, ultimately contributing to the complete resolution of his severe migraines and related stiffness.

Chris Boynes

BEd(Hons) PE MCSP MACPSEM MAACP HCPC Reg, Lic Acu