need some help.

[StressSolutions]

I have a couple female clients, each mid 40's. Each with complaint of low back pain, right hip pain, right anterior thigh pain.

One has herniated disk, and pain into the groin area. Going on 5+ years of pain

The other has lots of pain when turning over, twisting. Psoas, piriformis work seems to help. In pain now for about 2 months. Started belly dancing about 2 months ago.

I know...don't formulate a plan ahead of the treatment, quiet and listen to the body, remove self from outcome, etc.

been reading studying some stuff, sure appreciate some

[Breathe]

How is pelvic tilt? Any7 muscle weakness (such as glutes?) Any ROM reduction? Is it better or worse with mild activity?

TPs in adductor magnus can refer to groin, and are often present with pelvic instability. Pain with trunk rotation is pretty non-specific. Is it contra- or ipsilateral? in sides or close to spine? (or dead center?) QL, facet joint irritation, nerve root compression, hypertonic psoas, s/i joint problems, all could produce some or all symptoms.

[StressSolutions]

Uh.......


huh?


Wow, Stacey. Pretty much the only testing I know is when they are supine, knees bent, I hold knees together, they try to open. and then the opposite, knees apart, squeeze together.

The client without the disk thing does seem pretty weak. May be an upslip on the left, with the left leg a tiny bit shorter.

Trunk rotation pain...right side may very well be QL attachment, since it seems painful above piriformis.

Both are nurses, one at Mayo, the other at the county hospital.
thanks

[maestra]

Mick, have you tried the side-lying MFR stretch for QL?

[StressSolutions]

No, had kinda forgotten about QL, the "hip hiker". Should have been first on my mind...with the belly dancing, they spend half their time with the hip hiked.

Is that stretch done with a pillow under the ribcage to act as a fulcrum?

Thanks!

[pueppi]

Just going to throw one thing out here:

The other has lots of pain when turning over, twisting. Psoas, piriformis work seems to help. In pain now for about 2 months. Started belly dancing about 2 months ago.

Might want to see what she's doing in bellydancing.

Might want to stop dancing for a bit until it gets under control.

The 2 months may or may not coincide, but it does jump out at me as a probability.

I'd also want to look at the hamstring attachments.

[StressSolutions]

Hey, I was hoping to hear from you...

Yup, she's held off on the dancing for now. (we thought of that...) They didn't have class last week, she plans to skip this week (tonight) and she's on vacation next week.

Wow, how quickly I've forgotten names and locations. Good thing I've still got these books... I need this review.

The adductors are tight, but don't seem to hurt. Looks like it could be rectus femoris or vastus lateralis, along with the hip stuff.

Thanks, keep the ideas coming. Or better yet, if you can be here by 130, I'd be glad to accept some assistance!

[maestra]

No, had kinda forgotten about QL, the "hip hiker". Should have been first on my mind...with the belly dancing, they spend half their time with the hip hiked.

Is that stretch done with a pillow under the ribcage to act as a fulcrum?

Thanks!

Yes, pillow under ribcage, sidelying, client lays almost diagonal on table... as you are going to advise her to drop her top leg off the edge of the table and to move her top arm up over her head to create a long lean line...
Then do MFR work in the QL area...
Does that help you picture it?

[StressSolutions]

Yes, thanks. Marion had sent me some MFR stretches pdf style, and after digging those out I've printed a copy for her to reference, we'll do that for sure.
thanks!

[Breathe]

*mutters*

... gotta learn more MFR... :?

Sounds like a nice stretch.

[Blisss]

*mutters*... gotta learn more MFR... :? Sounds like a nice stretch.

This stretch is used in other modalities, too. (I learned it from James Waslaski). There's a good photo & description on this website, Breathe, if you're interested:
http://www.stretchman.com/quadratus_lumborium.html

[Breathe]

Great site Blisss! Thanks!

[palpable]

*mutters*

... gotta learn more MFR... :?

Sounds like a nice stretch.

It is a great stretch, and is good "homework". Clients can easily do it themselves- I do it for myself all the time.

Stand with feet about hip distance.
To stretch the R QL:

Inhale and Raise R arm straight over head
Place L hand on L hip (mostly just for balance)
Exhale and Sidebend to the L, but do NOT let R foot leave the floor.

I also will flex slightly foward to deepen the QL stretch. Very slight flexion, though, so as not to re-engage the QL.

[WaltFritz]

Hi Mick,

Nice to see you on this board. For everyone else, I'm new here, so be nice!

Mick, you stated the standard disclaimer about actually needing to see/touch these patients before one can assess needs from an MFR standpoint. That being said, there are certainly things that pop to mind. As someone above said, check the pelvis for balance, both in an ant/post plane as well as unilateral deviations/leg length discrepancy. Spring test or "knee to chest test" the sacroiliacs to see if one/both are jammed. Treat the offending quadriceps (and the other side as well), cross handed releases and hang around here for a while. Continue with the psoas. Chances are there is quite an anterior pelvic tilt. Think triad for a forward pelvis: psoas, quads, and posterior releases to the lumbar lordosis right up into the lower ribcage. Pelvic floor work via a supine lumbosacral decompression. This should give you some ideas.

[StressSolutions]

Soooooo you may all be wondering how things are. She came in for her appt on Wed feeling quite good, really good actually. We spent an hour working all over, full body massage, lots of swedish, tiny bit MFR.

I don't think I could NOT traction a neck now. Anyway, she was to come in on Friday if she wasnot feeling great, since her plans were to hop a plane to Mexico Friday evening. Hope she made it aboard and south, cause it is sure snowy now!

thanks for the help.

[WaltFritz]

Just a comment on the link posted above (stretchman). Reading through his website and the accompanying stretches, I think it is important to differentiate true MFR with what is posted on this link. What he is doing appears to be a contract-relax type of stretching, which certainly has value. This is quite different from myofascial release. The contract-relax stretch is a neuro based modality and, if performed in the way it is described on the stretchman website, involves tapping into only the elastic portion of the connective tissue and muscle. Short duration stretching of the elastic part of the fascia tend to produce only short term results. True myofascial release extends past the elastic barrier into the collagenous barrier, where you wait for the change in state of the collagen to produce lasting length changes. While the positions shown on this site can be effective positions for MFR, the described technique is not MFR.