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Rhabdo Resuscitation and Recovery Using Osteopathic Manipulative Treatment

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 8. doi: Subito , type of study: case report

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p5.xml)

Keywords:

case report [710]
male [784]
McArdle disease [1]
OMT [3752]
osteopathic manipulative treatment [3772]
pediatrics [535]
rhabdomyolysis [1]

Abstract:

Introduction/Background: McArdle Disease (also referred to as glycogen storage disease V) is an autosomal recessive disorder characterized by a deficiency of skeletal muscle рhοѕрhοrуlase. It often presents with episodes of ехеrсiѕe intolerance, and in some cases, rhabdomyolysis requiring hospitalization. Current practice guidelines emphasize supportive care, with a paucity of literature regarding management with osteopathic manipulative treatment (OMT). Case: A 16 year-old male with a history of McArdle Disease and thrombophlebitis was admitted for rhabdomyolysis secondary to medication-induced hyperemesis. He was evaluated for OMT on hospital day 3. Despite down-trending creatinine and creatinine kinase levels, he remained hospitalized due to unremitting abdominal and flank pain. Trials of lidocaine patches, heat pads, ice packs, acetaminophen, muscle relaxants, opioids, and anxiolytics failed to control his pain. Osteopathic physical examination revealed an asymmetric cranial rhythmic impulse (CRI), significant abdominal lymphatic congestion, and right-sided hypertonicity and myofascial restriction spanning the thoracolumbar, pelvic, and sacral regions. Somatic dysfunctions were treated with cranial, soft tissue, myofascial release, and balanced ligamentous tension. Results: Across two instances of inpatient OMT, a healthy CRI was re-established and the lymphatic congestion and myofascial tension resolved. The patient experienced a significant decrease in pain level and was discharged home. Discussion: This case demonstrates a unique application for OMT in a patient with rhabdomyolysis secondary to McArdle Disease. Applying osteopathic principles to the pathophysiology–namely the myolysis and visceral insults–elucidates possible mechanisms of treatment benefit. Lymphatic congestion and myofascial tension secondary to muscle breakdown would expectedly impede recovery, as would viscerosomatic facilitation from kidney injury. OMT to address these somatic dysfunctions would, therefore, reduce impediments to recovery. Further studies on applications of OMT in related cases of muscle necrosis or damage are warranted.


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