Spine-centred integrated osteopathic management for multi-site degenerative musculoskeletal pain after conventional and traditional healing failure in a low-resource setting: a concept-driven case report
Ibrahim Npochinto Moumeni
Abstract
Background Multi-site degenerative musculoskeletal pain combining cervical spondylosis, lumbar spine pathology, and bilateral knee osteoarthritis represents a major source of disability in aging populations, particularly when spinal structural anomalies drive compensatory dysfunction across adjacent segments. In sub-Saharan Africa, access to specialized spine-oriented manual therapy remains critically limited. Integrated spine-centred osteopathic approaches for polyarticular degenerative conditions in this context remain undocumented. Case presentation A 56-year-old male farmer from Edéa (Cameroon) presented with chronic multi-site pain evolving over 24 months, including bilateral gonarthrosis (Kellgren–Lawrence grade III left, II–III right), cervical spondylosis with C5–C6/C6–C7 discopathy, bilateral shoulder impingement, and thoracolumbar junction dysfunction consistent with Maigne's syndrome. Lumbar imaging revealed vertebral fusion at L3–L4 and discopathy at L5–S1, providing the biomechanical substrate for adjacent-level compensatory hypermobility. Prior management—two rheumatology consultations, over 70 physiotherapy sessions with reported pain exacerbation, pharmacotherapy, and multiple therapeutic scarifications—had failed, resulting in therapeutic exhaustion with rigid protective gait and functional withdrawal. Following informal referral, the patient undertook a 280 km biweekly therapeutic migration to the Regional Hospital of Bafoussam. Treatment consisted of 12 sessions over 6 weeks integrating the Sorbonne–Maigne segmental approach with family-mediated home rehabilitation adapted from the Cogni-Famille protocol. Outcomes Clinically meaningful improvement was observed after two sessions. At completion, VAS decreased from 8/10 to 2/10, cervical rotation improved from 25° to 55°, knee flexion from 85° to 120° (left) and 95° to 130° (right), walking perimeter from 200 m to 2 km, and the Oswestry Disability Index from 62% to 22%, exceeding the MCID by four-fold. The patient resumed full agricultural activities, with sustained improvement at 12-week follow-up. Conclusion This case supports the effectiveness of spine-centred integrative osteopathic management combined with family-mediated rehabilitation for complex polyarticular degenerative conditions in low-resource settings. The L3–L4 fusion, by overloading adjacent segments, provided the structural rationale for the Sorbonne–Maigne approach and explained prior treatment failures. We introduce four concepts—Therapeutic Exhaustion Syndrome, Therapeutic Migration Trajectory, Multi-Site Convergent Osteopathic Approach, and Osteopathic Dose–Response Threshold—and provide empirical evidence for the previously described unique practitioner syndrome and therapeutic scarcity dynamics.