Physical Therapy Management of Complex Regional Pain Syndrome I in a 14-Year-Old Patient Using Strain Counterstrain: A Case Report

Abstract

This report describes the examination, intervention, and outcomes for a patient with Complex Regional Pain Syndrome I (CRPS I) treated with Strain Counterstrain (SCS). The patient was diagnosed with CRPS I following a Grade II ankle sprain. Treatment consisted of SCS once per week for six months with one additional session each week in Months 4 through 6 for strengthening, endurance, and gait training. A re-examination was performed monthly. A clinically signifi cant decrease of 2 points in overall pain as measured with a numeric pain rating scale (NPRS) occurred as of Month 2; a 2-point decrease in tenderness on 10 of 13 SCS tender points also measured with an NPRS was documented as early as Month 1. Throughout the treatment period, an increase in function was noted by way of patient report and objective tests and measures. Gait improved with regard to cadence, use of an assistive device, and weight-bearing status. Single limb stance on the involved leg increased from 0 (s) to 40 (s) over the course of treatment and ankle active range of motion as measured with a goniometer and muscle strength as measured with manual muscle tests both returned to normal values. CRPS I remains a poorly understood and diffi cult-to-treat chronic syndrome. By way of its proposed effects on the neuromuscular system and facilitated segments, SCS may be an additional effective treatment tool in the management of some patients diagnosed with CRPS I.

Effects of Strain/Counter Strain on Cervical Pain & Disability: A Case Report

“…Similar to my case report, Wynne et al [5] reported the immediate effect was more substantial than the lasting effect, which was significant [5]. Additional studies are suggested to assess the temporal aspect of symptom relief from S-CS [3,5,7]. In a case report on S-CS for a 14-year old with Complex Regional Pain Syndrome, Collins [7] reported pain reduction for up to three days post-intervention and an overall improvement over the six months of treatment for the patient in their case [7].…”

“…Additional studies are suggested to assess the temporal aspect of symptom relief from S-CS [3,5,7]. In a case report on S-CS for a 14-year old with Complex Regional Pain Syndrome, Collins [7] reported pain reduction for up to three days post-intervention and an overall improvement over the six months of treatment for the patient in their case [7]. Future studies may investigate the duration of symptom reduction after S-CS to determine an optimal plan of care for patients with pain.…”

“…Determining the efficacy of S-CS as an effective intervention or adjunct to modalities, mobilization, or therapeutic exercise has been challenging due to the lack of interventionspecific S-CS research. Prior research has demonstrated that S-CS decreases pain [4][5][6][7][8], improves strength [4], increases mobility [7], improves function [7], and decreases disability [3,6]; however, studies have documented such gains for patients with cervical muscle weakness. This case report describes not only the result of S-CS for neck pain and weakness; it includes outcome measures of neck disability and strength changes in a patient with cervical pain and weakness.…”

Effects of Strain/Counter strain on Cervical Pain & Disability: A Case Report

“…Prior research on the efficacy of S-CS in affecting positive changes in pain and strength in the foot [4,5], hip [2], low back [6], and for neurological conditions such as complex regional pain syndrome [3] have been reported. See Table 1 for a summary of the research.…”

“…Determining the efficacy of S-CS as an effective primary intervention or adjunct to modalities, mobilization, or therapeutic exercise has been problem-some for practitioners due to the lack of interventionspecific S-CS research. Prior research has demonstrated that S-CS decreases pain [1][2][3][4][5], improves strength [2], increases mobility, improves function, and decreases disability [3,6]; however, none of the studies have described the application of S-CS for musculoskeletal-related cervical pain [1][2][3][4][5][6].…”