After years of leading an athletic life balanced with a nursing career and now a young family, Meaghan Keeven can’t imagine not being physically active every day.
For years, Keeven, Washington University nurse practitioner in the Barnes-Jewish Hospital emergency department and an area outreach clinic, has been passionate about participating in figure fitness competitions, CrossFit training and competitions, daily physical activity and now raising her young son with her husband.
“I first started noticing an imbalance on my left side when I was lifting weights,” says Keeven about the initial pain she felt more than a year ago. “I started having difficulty with overhead movement, my strength and mobility were not good and I had tingling in my fourth and fifth digits on my left side.”
Keeven, who worked out up until the day she delivered her son, hoped that taking it easy for a few months would make a difference, but the problem remained. She was understandably concerned that the pain and difficulty she was experiencing would limit the physical activity she loves.
“Working out is my passion, and being able to work out every day is who I am. If you take that away, you take away a part of me,” Keeven says. “Being able to get back to what I love was so important, not just for me, but for my family. We’re an active family and being physical is a huge part of my daily activity.”
Keeven sought care from Washington University orthopedic surgeon Chi-Tsai Tang, MD, at the Washington University and Barnes-Jewish Orthopedic Center in Chesterfield, who also sees patients at Barnes-Jewish Hospital and Barnes-Jewish West County Hospital.
Dr. Tang confirmed her initial complaints of left shoulder pain and a weakness with overhead activities, as well as sensations of fullness and bulging of veins in her left arm with weightlifting. She was diagnosed with vascular thoracic outlet syndrome (TOS), as well as a small labral tear in the shoulder through an MRI.
“She is not the first person I have seen with vascular thoracic outlet syndrome, but her presentation was probably the most striking, as there were obvious and immediate skin and venous changes with the Roos test (a physical exam maneuver looking for TOS where arms are elevated overhead and the patient repeatedly opens and closes their hands),” he says. “I thought physical therapy would be helpful because in thoracic outlet syndrome there is often a large soft tissue component causing the problem.”
Keeven was referred to the Sports Therapy and Rehabilitation Center (STAR) at their Chesterfield location. They also have a location at Barnes-Jewish West County Hospital and will open a South County location in 2016.
She began her initial therapy with Joan Merkt, STAR physical therapist. “We worked on stabilizing her scapula (shoulder blade) stabilizers, her muscle imbalances and were able to get her to a certain level, but she was still feeling pain,” Merkt says. “She was very compliant and did everything she was advised, but we still needed to release the fascial tightness she was experiencing.”
Keeven was then referred to Amy Smoot, medical massage therapist at STAR. Both Merkt and Smoot worked simultaneously with Keeven for a short period and then medical massage became her primary treatment.
“I was able to work with Meaghan using a myofascial release treatment,” Smoot says. “Myofascial release is a hands-on technique used to release restricted fascia. The fascial system is a head-to-toe, three-dimensional webbing. It is often overlooked and goes untreated,” she explains.
She adds that fascia can become restricted due to injury, inflammation, poor posture and/or surgery. If left untreated, fascia can become painful and can cause restriction. It can also cause broader pain and restriction throughout the rest of the body. “Meaghan is an athlete and for her to be able to be active again was very important,” Smoot says. “Her shoulder range of motion has improved markedly, and she’s able to work out
Keeven says working with Merkt on her muscle imbalance and mobility was beneficial, but the additional medical massage therapy with Smoot made the final difference for her.
Dr. Tang agrees with the benefits of medical massage therapy. “It is one of the most useful services in the treatment of pain, because myofascial pain is so common yet extremely under-recognized,” Dr. Tang says. He adds that it can be difficult to diagnose because no imaging test can show an abnormality, and difficult to treat because a lot of things can contribute to pain.
Now that Keeven has her pain under control thanks to the one-on-one therapy she received through STAR, she is back to her daily activity and working out. “Since I’ve gone to Amy, I’m 90 percent better. I don’t feel at all like I did and I have no pain,” she says.
Keeven still has the small labral tear in her shoulder, which often does not need surgery, and at this time, she is just being cautious with her activities.
The therapists at the Sports Therapy and Rehabilitation Centers (STAR) at Barnes-Jewish West County Hospital and the Washington University and Barnes-Jewish Orthopedic Center in Chesterfield provide a multitude of therapy treatments for patients of all ages.
Whether you are a weekend warrior suffering from pain, an athlete looking to improve performance or an older adult recovering from a total joint replacement working on strength and mobility, the licensed physical therapists and licensed massage therapists can provide an individualized plan to help you get back to the activity level that meets your needs.
With more than 30 outpatient and inpatient therapists and staff between both locations, STAR offers treatments for conditions including arthritis, endurance athlete-related injuries, fatigue related to cancer and medical treatments, joint, neck and low back pain, pelvic floor dysfunction, and pre- and post-surgery conditions.
“Our therapists offer one-on-one care and provide undivided attention to our patients,” says Matthew Green, MPT, manager of rehabilitation services. “By focusing just on the patient, it can often translate to fewer visits and better outcomes.”
STAR not only provides physical therapy but also medical massage therapy to complement physical therapy by focusing on a specific area of need, Green says. “We are building our medical massage therapy program, which is pretty unique to our area,” he says. “STAR is taking massage therapy from the pampering, luxury focus on the whole body to a focus on the problem, specifically in treating patients with myofascial pain.”
As the need for therapy continues to grow and expand in such areas as oncology rehabilitation and women’s health, STAR plans to open a third location in South County in 2016.
“Our therapists treat patients from a wide number of zip codes,” Green says. “Having two clinics with a third in our future provides patients with more options closer to home.”
Related article: Myofascial release, massage therapy help patient suffering from chronic pain.