Decreasing adhesions and avoiding further surgery in a pediatric patient involved in a severe pedestrian versus motor vehicle accident

Abstract

In this case study, we report the use of manual physical therapy in a pediatric patient experiencing complications from a life-threatening motor vehicle accident that necessitated 19 surgeries over the course of 12 months. Post-surgical adhesions decreased the patient's quality of life. He developed multiple medical conditions including recurrent partial bowel obstructions and an ascending testicle. In an effort to avoid further surgery for bowel obstruction and the ascending testicle, the patient was effectively treated with a manual physical therapy regimen focused on decreasing adhesions. The therapy allowed return to an improved quality of life, significant decrease in subjective reports of pain and dysfunction, and apparent decreases in adhesive processes without further surgery, which are important goals for all patients, but especially for pediatric patients.

Keywords: musculoskeletal manipulations; pediatrics; physical therapy techniques; tissue adhesions.

Figure 1.

Ultrasound comparison of the scrotum demonstrating improvement in scar formation between the first and second round of treatment. A-B: transverse images of the scrotum. (A) Ultrasound before second round of treatment showing a thickened scrotal wall with complex echogenicity. (B) Ultrasound after the second round of treatment showing improvement in the scrotal wall and echogenicity. C-D: Transverse ultrasound images of the left testicle. (C) Image from before second round of treatment showing testicle located in the inguinal canal, surrounded by scar tissue with complex echonicity. (D) Image from after the second round of treatment showing the testicle located farther down in the inguinal canal with less scar tissue demonstrating complex echonicity surrounding the testicle. E-F: Longitudinal ultrasound images of the left testicle. The surrounding tissue of the testicle after treatment (E) is decreased in complexity as compared to before the second round of treatment (F).