Michelle Vlahakis—C.SMA of the Month (Dec 2021)
Michelle Vlahakis, M.S., Dipl. Ac. (NCCAOM), L.Ac, C.SMA
Michelle Vlahakis completed the SMAC program in July 2021, and is now a practicing sports acupuncturist in San Diego, California.
“A sports acupuncture colleague on the east coast referred me a challenging patient who had recently moved to San Diego. The patient is an active, 26-year-old, athletic male (basketball, golf, running, weightlifting) and was initially treated by my colleague for acute & severe radicular pain into his left leg. Treatments provided significant relief, however,pandemic lockdowns prevented continuation of care and his symptoms regressed over the next several months. About 10 months after his initial injury,he was diagnosed with an L4/L5 herniation and was treated surgically (microdiscectomy). He reported a full recovery with post-op physical therapy and diligence with home strength and mobility program.
His initial office visit with me was approximately 10 months after his surgery and 2 weeks after an acute onset of right-sided LBP (8/10 pain scale) that began after playing basketball. Two months prior to this new acute injury, he drove from the east coast to San Diego to start his new job as a naval dentist. He works long hours while standing or sitting for prolonged periods of time and is on-call (24/7) every couple of weeks.
Upon observation, the patient walked with stiff and guarded movement reporting that his pain severely interfered with daily activities (7-9/10), including sleeping, standing, walking, dressing and contributed to increased stress (10/10) and negatively affected his mood (10/10). Patient reports taking 600-800mg of Ibuprofen without relief. The patient pointed to the L1-L3 vertebrae but with further questioning and palpation, the L4 vertebra, especially near the right facet joint seemed to be the source of the issue. Further palpation of the injured area, the right lumbar yaoyan region, sacroiliac and upper gluteal region were tender to palpation. He described these areas as dull/achy with intermittent sharp/stabbing pains, along with generalized weakness and tightness. He did not report any paresthesia, therefore radicular pain did not seem to be the issue at this time. However, I performed the straight leg raise to rule out disc herniationas a rule of thumb,and it was negative. Interestingly, during the initial assessment, the patient mimicked the stork standing test himself without any prompting. When asked what aggravates the pain, he went into lumbar extension with trunk rotation and then pointed to his lumbar vertebrae. When asked what alleviates the pain, he bent over and reached for his toes (in trunk flexion) and said that stretching provides temporary relief. Although he did not stand on one leg, i.e., the stork standing test, his movement (approximating the lumbar vertebrae) gave me enough information to feel confident with a working diagnosis of L4 facet joint impingement with secondary muscle spasm. I could have performed Yeoman’s test for further confirmation but did not feel it necessary as there were enough signs and symptoms to proceed with postural assessment and treatment.
Despite severity of local symptoms, the patient appears calm, collected, and optimistic about treatments due to prior experience with acupuncture for initial injury in early 2020. Medical history includes asthma, vision problems, dry skin & eczema. Sleep quality is poor, wakes often, and doesn’t feel rested upon waking.
Postural observations
- (R) posterior pelvic tilt
- (L) anterior pelvic tilt
- (R) ilium elevated
- (L) pelvic rotation
- (L) shoulder elevated
- (L) + Gillet’s
- FWD lean
- Asymmetrical hip shift
MMT
- (R) Psoas MMT weaker than (L)
- (R) glute min MMT weaker than (L)
Points
Michelle’s treatment strategies are rooted in styles she learned while at Tri-State College of Acupuncture, primarily Mark Seem’s Acupuncture & Physical Medicine (APM), Kiiko Matsumoto’s Japanese acupuncture (KM), TCM, and Trigger Point Therapy by Travell & Simons. She combines these diagnostic filters with assessment and treatment strategies learned in the SMA program.
- Pelvic blocks (L) ASIS, (R) GT were placed first.
- (R) GB 41, (R) TH 5
- (L) BL 62, (L) SI 3
- (B) KD 3 thread to KD 4,
- (L) BL 58
- (R) LV 8, (B) GB 34
- (R) glute min MP
- (B) glute med MP
- (B) piriformis MP
- (L) glute max MP, (R) latissimus dorsi MP
- (R) internal oblique @ GB 26 / daimai
- (L) SIJ needling
- (B) HTJJ L1-L3
- (R) L4 facet
- (R) QL – deep Yao Yan
- (B) biceps femoris long head MP
- (L) FCU MP
- (L) levator @ dijia
- (B) GB 21
Myofascial release performed on low back, glutes and posterior thigh and calves.
The patient was already performing many physical therapy exercises. I added the Figure 4 cross-over exercise for his elevated ilium.
Upon his second visit 5 days later, the patient reported that he felt fatigue and weakness the day after treatment, but all other symptoms felt substantially better, with improvement each passing day.Treatments continued for a total of 5 visits over the course of 4 weeks. Each treatment, the patient presented with a new issue in addition to his original injury, e.g., jaw pain, neck pain, wrist pain. Each treatment I evaluated, assessed, and modified the treatment to address his current complaints in addition to his underlying postural imbalances and zang-fu organ disharmony, i.e., LIV/KID Yin deficiency. After the 4thvisit the patient was substantially better, with improvements in both postural assessment and pain levels and was able to return to all his usual activities, including running and basketball.
The SMA training and certification helped me feel more confident with assessing & differentiating injuries and provides the tools to address the underlying root cause(s), while seamlessly integrating TCM with anatomical structure and function. The cadaver training and dissections were instrumental in developing my understanding of anatomy & physiology and has enabled me to fine tune my needle technique to obtain better patient outcomes. I’m am incredibly grateful for the guidance and mentoring of Matt Call is on, Brian Lau, Lili Gould & Ian Armstrong throughout my SMA journey, as well as all of the other talented instructors and TAs. This program has afforded me the opportunity to connect with so many talented acupuncturists from around the globe and I’m so happy to be a part of this group.
To connect with Michelle Vlahakis, visit her C.SMA Directory Listing.
