This quick, concise technique can be used to optimize the skin's biomechanical-structural relationship. Patients undergoing excisions, especially Mohs micrographic surgery of multiple layers, are often contorted in unnatural positions for extensive periods of time, likely leading to somatic dysfunctions. A brief application of muscle energy to the regions involved following the procedure would likely be appreciated by and beneficial to these patients. It is also particularly applicable for dysesthesia syndromes, characterized as an unpleasant and/or abnormal sense of touch, which have been linked to nerve impingements. The sensation of pruritus is transmitted to the central nervous system through unmyelinated C-fibers and thinly myelinated Aδ nerve fibers.
13 Numerous neuropathic conditions are known to cause dysesthesia and pruritus, such as notalgia paresthetica, classically presenting as macular amyloidosis on the medial scapula. Although the exact pathophysiology is unclear, a recent study showed that 61% of patients with the condition had underlying vertebral pathology.
14 One proposed mechanism is that the spinal nerves of vertebrae T2 to T6 emerge from the multifidus muscle at right angles, leaving them susceptible to chronic injury.
15 Other dysesthesia syndromes by region include burning mouth syndrome involving the oral mucosa, trigeminal trophic syndrome involving the nasal ala, cheiralgia paresthetica involving the hand, brachioradial pruritus involving the dorsolateral forearm, meralgia paresthetica involving the anterolateral thigh, pudendal neuralgia and pruritus ani/scroti/vulva involving the perineal area, and postherpetic neuralgia, typically unilateral and involving 1 to 3 unilateral dermatomes.
16 These cutaneous conditions may all benefit from muscle energy directed at the appropriate cord levels of the spine that correspond to the involved dermatome; however, further research is needed to investigate this.
17 Other techniques such as soft tissue, myofascial release, and rib raising may also be adjunctive to muscle energy, as demonstrated in a case report of a patient with sustained improvement in her notalgia paresthetica following a single 20-minute treatment session with these techniques.
18 Burning mouth syndrome in particular may be treated with a direct technique known as sphenopalatine ganglion release. The sphenopalatine ganglion's parasympathetic innervation derives from the facial nerve and contains sensory fibers from the trigeminal nerve.
19 Stimulation of the ganglion may reduce xerostomia and pain by normalizing the activity of the parasympathetic nervous system and sensory components of the trigeminal nerve. To perform this technique, the 5th finger is used to manually massage and stimulate the sphenopalatine ganglion in the superior, posterior, lateral aspect of the patient's pharynx.