Treatment plans/techniques for specific conditions?

Replies to This Discussion

Permalink Reply by Roeh Dale Gill on February 10, 2012 at 9:25pm

Have you tried Myo? I have found that Myo does wanders for problems like the ones you described that and acupressure is awsome as well. Though both are pretty time consuming and take a few times to really help. They really do seem to really make a difference.

 

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Permalink Reply by Jimswife on February 11, 2012 at 1:48pm

I did do a little bit Myo work on him. (I only have 30 minutes with him and did suggest a 60 minute massage next time and he thinks he wants to try that too) anyway, I went that route because it was so darn stiff.  Like afraid of me hurting him more than he already was.  It did help him to relax some.  He also had an appointment with a different therapist midweek.  He said she did bilateral QL release on.  And that he about jumped off the table but it did help him for a little bit.  But it said that he felt worse the next day.  So I wanted to try a different approach.  Myo keeps coming to mind, so that must be the route to go and just move on from there.  And I have also suggested to him that he should be evaluated by the physical therapist.  But he's not too thrilled about going that route because he has done PT a few times in the past with no relief.  You can tell he's just so frustrated and hurts like crazy. 

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Permalink Reply by Therese Schwartz on February 11, 2012 at 2:32pm

Do you know how to do a CranioSacral sacrum release?  It's a place I start everyone with SI or lower back issues.  It would be difficult to describe here but I will do my best with it later if that would help!  If anyone you work with knows how to do it, maybe they can teach you.  It's easier if it's a hands-on situation!  It's very gentle, and still effective.

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Permalink Reply by Jimswife on February 11, 2012 at 3:01pm

No I do not.  I would love to hear about it.  When I have time I will look it up on you tube.  Maybe there is a video that will help.  (I am a visual learner)

Therese Schwartz said:

Do you know how to do a CranioSacral sacrum release?  It's a place I start everyone with SI or lower back issues.  It would be difficult to describe here but I will do my best with it later if that would help!  If anyone you work with knows how to do it, maybe they can teach you.  It's easier if it's a hands-on situation!  It's very gentle, and still effective.

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Permalink Reply by elizabeth mount on February 11, 2012 at 3:47pm

the suboccibitals are the top of the one of the back lines in antomy trains and the article described working there could help with low back pain.  this lead me to think it might help to work on areas related to the issue to open up room for the trouble areas to move to.  mid upper errectors, hamstrings quads, IT Band.   (make sense at all?)  another myo approach is to do small melts on all the muscles related to a problem instead of melting one muscle as much as possible.  if you make the major muscles involved in low back pain each 10% better insted of makeing only QL and Glutes medius 50% better that might be more comfortable durring and after.   I sometimes have a mental block against using sidelying but it is the best for the myo low back routine.  everytime i give in and do it i am soo much happier with the results.   You could try abs and psoas for something different,  They need to be done eventually.  He could be more or less gaurded there.  I might assume he would be more guarded but it might be worth seeing if that is an easier area to work on.  what are everyone's thoughts?

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Permalink Reply by Therese Schwartz on February 11, 2012 at 8:09pm

Jimswife, I did a quick search on Youtube and didn't find anything about a sacral release.  It would be difficult to see anyway, because one hand is under the client.  I will do my best to describe this.  The most important thing is to be slow and careful and gentle - no more than 5 grams of pressure.  If you take a nickel and put it on your hand/arm, that's 5 grams.  The idea of that is to keep the techniques from damaging anyone.  Practice on someone/a fellow therapist so they can give you good feedback.  Have your client wear sweat pants or something like that.  OK so here goes my attempt:

Client is supine, for the sake of the description I'll have you stand on the left side of the table.  Have the client bend their left leg up and put their foot on the table.  Then they roll their hips toward you so you can slip your right hand under them and onto the sacrum.  Then have them roll flat onto your hand and put their leg back down.  Now take your left hand and slip it under them and gently place your fingertips onto the lower spine - gently!!  All you are doing here is stabilizing the spine so that when you traction the sacrum the spine won't come with it.  Now use 5 grams to traction the sacrum off the bottom of the spine, and wait.

When you feel like you've gotten a good release (or even just some!), move on to the next stage which is: slip your left hand out and place your elbow on their right ASIS.  Reach across and place your fingertips on their left ASIS.  Using 5 grams, squeeze the two ASIS's toward each other.  If the client is larger, they can do one side and have them match your pressure.  The idea is that the back wings of the pelvis/ilia open up and the sacrum can drop into your hand.

It helps if your table is really padded because it can be hard on your underneath hand.  I find it most comfortable for me to be in a lunge position with the table as tall as it would be for Swedish massage.  This usually takes 10-15 minutes, sometimes less.

I agree with Elizabeth - a global approach can be really useful.  And also those psoas muscles are very likely an issue and need to be worked on.  Also he might benefit from heated bamboo massage.  That really helps my clients that are in his situation.

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Permalink Reply by Jimswife on February 12, 2012 at 6:28am

Sounds interesting.  I think I may try this on a friend for practice.  I agree about psoas.  I did talk to him about this.   But not sure if he will trust me and relax enough to let me sink in.  I have him focus on his breathing to calm himself when I work on his back.  He gets frustrated with himself because it's hard for him to let go.  I really feel bad for him because he is just so uncomfortable.  And It would be wonderful if I can provide some relief.  Even just to relieve some of the tension he has going all the way up his back.   Ya know?    

Therese Schwartz said:

Jimswife, I did a quick search on Youtube and didn't find anything about a sacral release.  It would be difficult to see anyway, because one hand is under the client.  I will do my best to describe this.  The most important thing is to be slow and careful and gentle - no more than 5 grams of pressure.  If you take a nickel and put it on your hand/arm, that's 5 grams.  The idea of that is to keep the techniques from damaging anyone.  Practice on someone/a fellow therapist so they can give you good feedback.  Have your client wear sweat pants or something like that.  OK so here goes my attempt:

Client is supine, for the sake of the description I'll have you stand on the left side of the table.  Have the client bend their left leg up and put their foot on the table.  Then they roll their hips toward you so you can slip your right hand under them and onto the sacrum.  Then have them roll flat onto your hand and put their leg back down.  Now take your left hand and slip it under them and gently place your fingertips onto the lower spine - gently!!  All you are doing here is stabilizing the spine so that when you traction the sacrum the spine won't come with it.  Now use 5 grams to traction the sacrum off the bottom of the spine, and wait.

When you feel like you've gotten a good release (or even just some!), move on to the next stage which is: slip your left hand out and place your elbow on their right ASIS.  Reach across and place your fingertips on their left ASIS.  Using 5 grams, squeeze the two ASIS's toward each other.  If the client is larger, they can do one side and have them match your pressure.  The idea is that the back wings of the pelvis/ilia open up and the sacrum can drop into your hand.

It helps if your table is really padded because it can be hard on your underneath hand.  I find it most comfortable for me to be in a lunge position with the table as tall as it would be for Swedish massage.  This usually takes 10-15 minutes, sometimes less.

I agree with Elizabeth - a global approach can be really useful.  And also those psoas muscles are very likely an issue and need to be worked on.  Also he might benefit from heated bamboo massage.  That really helps my clients that are in his situation.

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Permalink Reply by Walt Fritz, PT on February 12, 2012 at 6:45am

While your description of your client's pain and symptoms are quite good, what is missing, for me, is being able to assess him personally. Without this, suggestions are just that. But, I use a gentle anterior lumbar approach to this type of condition with good success.

http://www.youtube.com/watch?v=YiAGPZYWBsA

Sacral releases/traction and/or lumbosacral decompression are often another very good choice. I will often move into one of them after I spend some time with the above technique.

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Permalink Reply by Daniel Cohen on February 12, 2012 at 9:36am

Beautiful video Walt. I use similar technique but different. I like the abdominal touch and lift using it in many ways. Gentle oscillation of the back is usually where I start, sensing lines of tension like a spider's web. Dialogue is also helpful and involves the patient in their healing. It is really about sensing with touch.

Many different modalities will be effective. Most important is the Therapists ability, experience, and rapport.

Walt Fritz, PT said:

While your description of your client's pain and symptoms are quite good, what is missing, for me, is being able to assess him personally. Without this, suggestions are just that. But, I use a gentle anterior lumbar approach to this type of condition with good success.

http://www.youtube.com/watch?v=YiAGPZYWBsA

Sacral releases/traction and/or lumbosacral decompression are often another very good choice. I will often move into one of them after I spend some time with the above technique.

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Permalink Reply by Jimswife on February 12, 2012 at 10:27am

Thank you Walt.  Beautiful video.  Got me thinking that's for sure.  Along with all the other reponses I have gotten.  Thank you everyone for your input.  I've been going through my books from school and refreshing my memory.  

Many different modalities will be effective. Most important is the Therapists ability, experience, and rapport.  

 

I agree.  Every body is different.  And the same technique will not work on every body.  I do feel that I have established a good rapport with this client.  I suppose that is why he has made additional appointments with me even though we have made little progress.  I am lacking in experience.  I have only been practicing for a few months now.  So this has definitely been a challenge and a great learning opportunity as well.  But after this next session (which I believe is next week) if I am unable to make a change I am going to suggest he see a different theraist.   

I have a couple more questions: 

-  I am wondering about trying cryo therapy.  Thinking that maybe it could help release some of the trigger points he has going on. (QL, ES)  Maybe he would have less of a jump off the table kind of reaction? 

-  I am also wondering where I should start.  Should I begin with him supine or prone? 

 

Thank you for your input everybody.  I do appreciate your help.  I am learning so much here! 

 

 

 

 
Walt Fritz, PT said:

While your description of your client's pain and symptoms are quite good, what is missing, for me, is being able to assess him personally. Without this, suggestions are just that. But, I use a gentle anterior lumbar approach to this type of condition with good success.

http://www.youtube.com/watch?v=YiAGPZYWBsA

Sacral releases/traction and/or lumbosacral decompression are often another very good choice. I will often move into one of them after I spend some time with the above technique.

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Permalink Reply by Gordon J. Wallis on February 12, 2012 at 11:37am

Its impossible to really give an accurate suggestion as to how to help your client without personally working with him.. However, the basic concept I usually follow is simple......... I look for sore spots.. Determine what muscle has the sore spot.. Work that muscle and strengthen its antagonists.  As far as pressure..Its always, sore is good, hurt is bad..

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Permalink Reply by Kay Warren on February 13, 2012 at 10:16pm

reciprocal inhibition. use the abdominals to send a message to the back muscles to let go.... an besides you should be working on him sidelying.  if you need more info, let me know....

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