Chronic pain syndromes involving musculoskeletal and neurological features remain a
significant therapeutic challenge. These conditions often lead to long-term disability, diminished
quality of life, and high healthcare utilization, yet optimal treatment strategies remain poorly
defined. The purpose of this report is to demonstrate how a multidimensional approach can
provide improvement in a patient with otherwise refractory post-surgical pain. Years following a
jet ski accident, a 50-year-old female with a history of thoracic spinal fusion, transverse process
fractures, and rib trauma presented to the clinic with debilitating headaches, persistent neck and
thoracic spine pain, and neuromuscular dysfunction. Despite multiple interventions, the patient’s
symptoms persisted, significantly impairing her daily activities. Examination revealed an
innominate shear, thoracolumbar rotational dysfunction, occipital and suboccipital tenderness,
scapular winging, and impaired neuromuscular coordination in the iliopsoas and serratus
anterior. Imaging revealed no new structural abnormalities, despite severe and escalating
symptoms. Treatment included ozone and prolotherapy injections to cervical and thoracic
myofascial trigger points, osteopathic manipulative treatment (OMT), and therapeutic exercises
targeting myofascial lines and functional movement trains. Over the treatment course, the
patient reported improvement in migraine frequency and intensity, reduced muscle spasms,
improved posture, and partial restoration of function. Although back pain persisted, the patient
has transitioned from severe daily impairment to manageable soreness with improved resilience
to physical exertion, sustained symptom control, and greater independence. This case
demonstrates that combining regenerative injections, OMT, and functional exercise offers a
novel approach to chronic pain, reinforcing the importance of addressing overlapping structural,
neurologic, and functional domains together.
