Top 5 Fridays! 5 Recent Interesting Mirror Box Cases

When I speak about a mirror box in The Eclectic Approach courses, I get asked, "What's a mirror box?" My regular readers will know it's a box.... with a mirror on it. You cut out a hole to place an involved limb inside it, and the uninvolved limb is reflected as the patient gazes into the mirror.

There is a good amount of research on mirror boxes in use with chronic pain/CRPS, thumb "arthritic" pain, phantom limb, as well as CVAs. Since I mainly treat a (neuro)musculoskeletal population and not an only neuro population (as if that's possible), I integrate the use of a mirror box in many different scenarios. Here are 5 recent cases where I've used it to successful outcome.

1) Adult female with mild CP

• she came to me sometime last year saying she was tired of just getting exercise like the UBE - ugh, and pulleys
• she had difficulty opposing left thumb on digit 2, and unable to oppose 3, 4 or 5
• after explaining IASTM and it's role on tone, she agreed to try
• one session of very light IASTM along forearm patterns and she was able to oppose 2 easily, 3 with some difficulty, and 4 was close
• she has been coming every 2-3 weeks for a maintenance session when out of the blue, I decided to try putting her involved left hand in the mirror box
• she was fascinated! She had of course never seen her left hand as her right's reflection
• at first she was unable to make her right hand move outside of synergistic patterns
• after a few minutes of verbal cuing to move her right hand as it does normally, she lost kinesthetic awareness of where her left forearm was in the box
• this is actually pretty easy to do as you get caught up in the illusion
• if I did not tell her her session was over, she could have stayed in the box for hours!
• after getting her own mirror box, she now comes even less for maintenance and feels it is even easier to move her forearm and left hand without synergy

2) Iatrogenic Knee Pain 

• here are links to parts 1 and 2
• she ended up being able to do lunges and squats with more confidence in loading her right knee
• TRX with her trainer was also much more tolerable and she was able to do squats without having to put all her weight in the straps

pic courtesy of orthoanswer.org

3) The Fractured Fibula

• former patient from 6-7 years ago
• after getting his right fibula fractured by a log rolling down a hill, he had surgical repair and was immobilized for 10 weeks
• he came to me directly under private pay
• because he was treated by "Old School E" he was afraid of "that thing" you use to scrape muscles
• solution - use IASTM and JM very lightly on the uninvolved side while the slow responding right foot/ankle was in the mirror box

4) Dancer with Chronic Foot Pain

• this is a case I've been meaning to write up, but it's a long and complex one
• other than her chronic back, right > left leg, shoulder, cervical spine, and dizziness, she also has chronic right foot and great toe pain
• she had previous surgery on the great toe which only limited her motion
• she often came in crying and very stressed out due to her pain
• We read Explain Pain together, she wore a Stop Thought Viruses Bracelet for a while and used the program from the text Mindfulness that I recommend
• these all got her on the right track with some positive thinking
• it was still very painful to weight bear on her right foot
• I placed her right foot in the mirror box and had her weight shift on and off inside it and also plantarflex her ankle while dorsiflexing her great toe (one of her most painful and limited movements)
• in the box, it was nearly pain free
• the biggest breakthrough was when I asked her what she missed the most, and she said tap dancing
• I told her to tap dance in her studio for 20-30 minutes/day
• doing something she loved was a great distraction from pain, plus got her more confident to WB on her right foot and great toe
• other suggestions were to listen to 1 hour of her favorite music a day and just go for a walk, but dancing plus mirror box use at home really improved her function

image courtesy of Dr. Brad Cole

5) Runner with Dorsiflexion Loss

• young marathoner who was immobilized in a boot after a stress fracture
• was a slow responder dorsiflexion who got about 50% of his motion back after 8 visits then plateaued
• I thought, why not try the mirror box and explained it to him, he was down for anything that may help
• upon putting his stiff right foot and ankle in the mirror box and watching his left foot move, the first words out of his mouth were, "Huh.... look at that!" - I find that's a common response
• I then did some light IASTM along his navicular, calcaneus, and around the lateral, anterior, and posterior bony contours of the left tibia, tibial IR mobilizations, and thrust manipulation to distraction
• this is what got him past the 50% we were plateaued at for a few weeks

Do you have any interesting mirror box cases in any form of rehab? Post them below in the comments or in the forum! Of course, gotta plug, you can get a very high quality mirror box that's not made of cardboard, that folds up very easily from mirrorbox-tx.com or from my amazon store! Seems like summer is back in Buffalo, NY - I hope everyone has a wonderful weekend!