“…A manual medicine approach may combine muscle Gebauer's spray, stretch technique, soft tissue, myofascial, muscle energy, and thrust techniques to address all somatic dysfunctions in the patient with PS [20,23,25,26]. If the patient does not respond adequately to manual treatment, then acupuncture and trigger point injection with lidocaine hydrochloride, steroids, or botulinum toxin type A (BTX-A) may be considered [23,[31][32][33]. If all the pharmacologic and manual medicine treatments fail, the final treatment option is surgical decompression [9,18,20,23,24].…”