massage and bodywork professionals
a community of practitioners
Adductors? Frozen hip? Not sure what?? Help please.
I have a client with an issue I need some input on. I work for a chiropractor and we are both scratching our heads about a patient of his. I have been working with chiros for the past 7 years and this is my first stumper, The client is a female forty something 5'6 about 150 lbs. She is a smoker but she leads a somewhat active life. Her right leg is the issue. As far as she knows she has never had an injury but she does feel the restriction in her thigh and groin area. When trying to do any PNF to her hip flexors or IT Band area, the Dr and I can not get her leg to cross in the front, over to her left side. He adductor are as tight as can be. I do deep work on her adductors, abductors, hip flexors, along with stripping and then range of motion. We will go from her leg being at a 90 degree to having full range of motion so I can externally rotate her knee and tuck her R foot up near her femoral artery on her L leg (butterfly position). Afterwards she is great. But then we jump to two days later. After two days she is back to where we started. We have her stretching like crazy and her son even does PNF with her everyday, especially butterfly stretches with her adductors. The Dr. and I considered frozen hip syndrome, but the things he and I are doing would work for that and she should sustain for longer than 2 days. Has anyone ever experienced this or heard of it? Any ideas on what to do to alleviate the issue, or what the issue is? What are we missing??? By the way before I get to her leg at the start of the massage I am performing deep tissue on b/l erector spinae, ql's gluts, piriformis, TFL IT band, and I am doing TPT where needed. Any insight is welcomed and appreciated.
Views: 7581
Replies to This Discussion
-
Permalink Reply by Stephen Jeffrey on
-
Hi Robyn
this could be more a mental emotional traumer residing in the soft tissues, untill resolved, the holding pattern may continue to return.
I would use Myofascial release prior to working the muscles in the way you describe above as unwinding (john barnes style) should help and Reiki.
When everything in my toolbox is used and results are poor I always refere on.....maybe crainial osteopathy.
We can help fix lots of people but there will always be some that don't respond and I totally understand your fustration :)
Best wishes steve
-
-
I take it the chiro has checked for a Acetabular labrum tear ? they can be a nightmare to sort out ?
-
Permalink Reply by Angela Palmier on
-
Hi Robyn,
I've got some thoughts, but I'm hesitant to post just this minute. In the interim, I've contacted a dear friend who will hopefully give you some guidance here....stay tuned and if he can step away from his video production for a minute or two, I'm sure he'll respond soon ;) Oh wait, the video's are done! If he's tied up right now, go to Whitney Lowe's website www.omeri.com If memory serves me correctly, he has some research and protocols posted there.....
-
Permalink Reply by Monica Reno, LMT, NCTMB on
-
Monica Reno, LMT, NCTMB said:Robyn, keep in mind if the adductors are "as tight as can be" they may be concentrically contracted. In which case they are short and have lost their ability to contract fully, performing their intented action. If this is the case stay away from the deep work in the bellies, in favor of strokes at the musculotendinous junction that will stimulate length in the fibers. However, if the adductors are weak, eccentrically contracted, they may feel tight, but are actually TAUT. Here start with MFR to deep lateral rotators, especially piriformis and obturator internus and gluteals. The DLR if tight will not allow for the adduction you seek. Some easy first clues to look at would be the clients foot when at rest lying on the talk supine....does their foot rotate externally? DLR. Your best assessment will always come with muscle testing.
-
Permalink Reply by Ann-Marie Keller on
-
Has your client had an injuries or surgeries ie back, abdominal? You may want to look into myofascial release. She may have some fascia that is bound up causing restrictions. I use myofascial release techniques on some of my patients; when massage therapy and stretching only supplies limited relief. I have been practicing myofascial release for 3 years. Website: www.myofascialrelease.com
-
Permalink Reply by Robyn Cox, NCTM on
-
She has had no traumas, physical or mental. I have also performed pin and stretch movements which are myofascial techniques. They help her for a couple days but then it all goes back.
Ann-Marie Keller said:Has your client had an injuries or surgeries ie back, abdominal? You may want to look into myofascial release. She may have some fascia that is bound up causing restrictions. I use myofascial release techniques on some of my patients; when massage therapy and stretching only supplies limited relief. I have been practicing myofascial release for 3 years. Website: www.myofascialrelease.com
-
-
I haven't been holding them long enough, about a minute. I will try holding them longer to see if that works. I have taken a lot of continuing ed that has touched on MFR but I am thinking I need to take some classes on it to have a better understanding of how it all works and the different techniques. Thanks.
Rick Britton said:How long are you holding the MFR stretches for? You need to be holding each stretch for at least 3 minutes and sometimes up to 5 minutes. If you are holding stretches for only 60-90 secs then you are only releasing the contractile element. You need to be feeling for the 'collagenous barrier' and holding that on stretch, following the 3D nature of the fascia as it releases. By holding the collagenous barrier on stretch you allow the piezo-electric effect to cause re-hydration of the fascia, which then allows it to move. If you do these techniques correctly then you should get a more permanent release.
Hope this helps
Robyn Cox, NCTM said:She has had no traumas, physical or mental. I have also performed pin and stretch movements which are myofascial techniques. They help her for a couple days but then it all goes back.
Ann-Marie Keller said:Has your client had an injuries or surgeries ie back, abdominal? You may want to look into myofascial release. She may have some fascia that is bound up causing restrictions. I use myofascial release techniques on some of my patients; when massage therapy and stretching only supplies limited relief. I have been practicing myofascial release for 3 years. Website: www.myofascialrelease.com
-
-
I highly agree. That is the myofascial work I am talking about.
Rick Britton said:for a start try some gross cross hand stretches (there are some nice demos on Youtube and massagenerd if you need some tips). Feel for the restrictions, cross your hands either side of the restriction, keep soft hands and sink through the layers gently whilst applying gentle stretch. When feel the tissue come to a stop then you have reached the barrier. At this point relax yourself and get your client to relax, maintain the stretch throughout (if you release the stretch the collagen fibres you are trying to unwind will re-coil), and follow the restriction applying gentle pressure.
These are fantastically effective techniques and if you really want to get some good training then I can't recommend the John F. Barnes training highly enough
-
-
Hi Robyn,
I'm not a massage therapist, I'm a patient who has similar and even worse symptoms than your patient. I was researching "frozen hip" and that's how I came across your discussion. You can google frozen hip and find medical articles by Chard and Jenner. The onset is gradual and eventually results in limited rotation and flexion, with usually no injury or trauma. Also common in middle aged women. Treatment for frozen hip is manipulation under anesthesia with PT.
I'm going on 2 years of suffering from this, I've had 4 MRIs, 3 x-rays, fluoroscopy, and arthrospoic surgery. All came back normal except for a labral tear (which happens if you dont treat the frozen hip early on). I finally found an ortho who knows what he's doing. I went to chiros and massage therapists, even acupuncturists.
I strongly urge you to tell your patient to see an orthopedist and ask about frozen hip. Its uncommon but it happens.
-
Permalink Reply by Peter Lelean on
-
Nice one Robyn. Have you checked out R SIJ movement? Evaluate in standing, left thumb on L2 process, R thumb on PSIS. Client raises R knee to xiphoid. If Sij doesn't articulate, use a vibrator on it while client repeats lift slowly 10 times. And . . check symphysis alignment supine. Let's know how you go. Cheers P
-
-
Thankyou Monica for taking the time to join and give us this info. I would think most therapists are aware of the difficulties in treating frozen shoulder (frozen hip, maybe not so) and it would appear your condition is proveing difficult, your contribution highlights referal to an ortho as being a good choice. Please let us know how you get on :)
Monica Zamora said:Hi Robyn,
I'm not a massage therapist, I'm a patient who has similar and even worse symptoms than your patient. I was researching "frozen hip" and that's how I came across your discussion. You can google frozen hip and find medical articles by Chard and Jenner. The onset is gradual and eventually results in limited rotation and flexion, with usually no injury or trauma. Also common in middle aged women. Treatment for frozen hip is manipulation under anesthesia with PT.
I'm going on 2 years of suffering from this, I've had 4 MRIs, 3 x-rays, fluoroscopy, and arthrospoic surgery. All came back normal except for a labral tear (which happens if you dont treat the frozen hip early on). I finally found an ortho who knows what he's doing. I went to chiros and massage therapists, even acupuncturists.
I strongly urge you to tell your patient to see an orthopedist and ask about frozen hip. Its uncommon but it happens.
-
-
Since I am in a medical setting, ethically that is what we did. We know we can not help everyone, as much as we would like to think we can. We are realistic and we referred her out to an orthopedic. But I will tell you she had already been to an orthopedic before coming to us and it didn't help. I have a medical background with my massage training because I went to a chiropractic college to get my education. I know full well what frozen hip is, along with the symptoms and the fact that it is believed to be an idiopathic disorder and sometimes a symptom of a secondary joint issue. I also know some various techniques to treat it. But with massage therapy there are many different techniques and knowledge, and not any massage therapist knows them all. That is the purpose of the board, to reach out to other professional that have experience with certain disorders and pain referrals. I exhausted my bag of tricks that is why I have come here and asked my fellow colleagues to help if they could. When you go to quality Dr.'s and Massage Therapist's, we know we have limits and our first priority is the patients' well being. The motto that every massage therapist and Dr. should have is when in doubt refer out. That is our way of thinking and I am sorry you were seeing professionals that did not feel this way. I am sorry it has taken you so long to find someone that has the knowledge of what your symptoms are and can treat them. Thank you for your comment, it is always nice to get the insight of a patient.
Monica Zamora said:Hi Robyn,
I'm not a massage therapist, I'm a patient who has similar and even worse symptoms than your patient. I was researching "frozen hip" and that's how I came across your discussion. You can google frozen hip and find medical articles by Chard and Jenner. The onset is gradual and eventually results in limited rotation and flexion, with usually no injury or trauma. Also common in middle aged women. Treatment for frozen hip is manipulation under anesthesia with PT.
I'm going on 2 years of suffering from this, I've had 4 MRIs, 3 x-rays, fluoroscopy, and arthrospoic surgery. All came back normal except for a labral tear (which happens if you dont treat the frozen hip early on). I finally found an ortho who knows what he's doing. I went to chiros and massage therapists, even acupuncturists.
I strongly urge you to tell your patient to see an orthopedist and ask about frozen hip. Its uncommon but it happens.
© 2024 Created by ABMP.
Powered by
