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Case Study
Hello, I am a massage therapy student in Ontario and am trying to piece together a plan for my case study. My client has pain when touched very lightly on her superior sacrum. She says it is always there. But on the first day of her menstrual cycle she feels it go into her gluteal area and down her leg to her knee. She was told she had sciatica...but I'm not sure that is what it sounds like. Any ideas? Of what it is...and possible treatments I could try with her? Thank you!
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Replies to This Discussion
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Permalink Reply by Gordon J. Wallis on
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With all these case studies, there is no cookie cutter prescription. And it's really impossible to tell somebody what to do or how to treat someone remotely like this. And if I do suggest anything that I think maybe helpful, someone else might suggest the opposite. And that just leads to confusion. When I work on someone I have a system of assessment, then make judgments on how best to treat from there. You have to start with a certain set of parameters , a system of assessment and then treatment. There must be a lot of ways to asses. I have my own way, that is different then what I see others doing in books and videos. But you need that set of assessment procedures in order to measure any improvement in the client/patient condition. And any assessment of progress or non progress should be some kind of objective measurement. Increased range of motion, or less pain within whatever range of motion. I'm a trigger point guy. I can keep track of the number of trigger points each session and tell if what I'm doing is at least getting ride of trigger points. Also, before each session I like to ask the client ( I like to use a 1 to 100 scale ) what their pain level is before and after the session. 1 being no pain and 100 being the worst pain. Say the client comes in and initially says her pain level is a 40. She is not feeling good. But after the session she tells you it's a 20. So that's a good improvement. You have cut her pain in half. So your treatment is on the right track. Next time she comes in you again ask her to rate her pain before and after the session. With frequent enough treatments along those lines she could achieve long term or more permanent relief. If say after six sessions she always starts the session with a 40 or higher. You perhaps should re-evaluate your approach. Anyway what I said might not help you with how to treat. Maybe someone else can help you with that?
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Permalink Reply by Therese Schwartz on
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I agree with Gordon that it's impossible to tell someone how to treat someone remotely. However, if this were my client, I would start by checking out her piriformis, gluteus medius (including side lying to get the part on the side of the hip), quadratus lumborum, quads, hamstrings and TFL's. Oh, and psoas muscles too! Also check suboccipitals because the sacrum and the occiput will mimic each other - dysfunction in one will create dysfunction in the other. Anything you can do to gently mobilize the muscles/fascia will be helpful if she has tension in any of those areas. In all treatments, it's important to use only as much pressure as it takes to get the job done. No need to overdo it for you or her either one!
As for what it is, it could be SI joint dysfuntion or piriformis syndrome, both of which get diagnosed as sciatica. It could also be coming from her lumbar spine. And this is the challenge of suggestions without touching the client! Her pelvis could be stuck on one side, which causes problems.
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After I said all I said. It's probably trigger points. Usually is. Here is an interesting site that you might find helpful.
Www.triggerpoints.net
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Permalink Reply by Jaclyn Pilkington on
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Thank you for your responses. I just reread my question and I should have said 'any recommendations for techniques to look into'. It's true that you can't tell me how to treat this client without meeting them. Sorry for not wording my question a little more efficiently. Thank you though for both of your insights and help. Still being in school, I feel like there are endless techniques/approaches to try with every client that sometimes I get overwhelmed about where to even start. :) The last thing I want to do is aggravate this clients symptoms more, or hurt her, so I appreciate your feedback.
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There really are an endless number of techniques and approaches! Each therapist has to find what resonates with them, and that can take some experimentation. I still feel overwhelmed at times about where to start with clients, especially the complex cases! :-) (I've been doing massage, CranioSacral Therapy, and MFR for over 8 years) The best thing I can tell you is to listen to the client's body - the tissues will tell you where to start. That can come to you intuitively, or you can asess tissue movement in different ways - wiggle the client gently and see what is stuck is always a good way to start, and gentle wiggles feel good to people.
As far as actual techniques, I failed to answer your question properly! In the case of this client I would start with work from this school: http://www.advanced-trainings.com/
One of the hip technique sequences can be viewed here: https://www.youtube.com/watch?v=cM38tl7lgGY
I have used Til Lucau's work for 6 years with excellent benefits for clients. He has more videos on YouTube; they are worth checking out! I have a bunch of his DVD's; he also has webinars available.
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Thank you for all the help - I will try to 'trust my gut' or rather my hands, and do my best. WIth so many ways to go it definitely can seem overwhelming when first starting.
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All you can do is do your best! If your clients know that you are doing the best you can, they will appreciate everything you do for them. Just don't give it everything you have physically - I have done that routinely for 8 years and it will take its toll on you, guaranteed. Even though I find myself working too hard physically at times (ironically, mostly when I'm tired because I don't have the mental capacity to think enough), I know it really isn't smart or effective. I say all the time that if a therapist always does "deep tissue" and forces the muscles to let go, it's because they aren't creative enough to find a better way. Get in deep if you need to, but do it intelligently and thoughtfully.
Ultimately it all comes down to this: find a stuck spot and get it to move again. That's what all this is about! All of the complication is because people like things to be complicated. Keep it simple! :-)
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