Treatment plans/techniques for specific conditions?

Replies to This Discussion

Permalink Reply by Gordon J. Wallis on February 14, 2012 at 12:26am

Yes.

Kay Warren said:

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....

• ▶ Reply

Permalink Reply by Jimswife on February 14, 2012 at 8:09am

Thank you Kay.  I am glad you mentioned that because I was thinking PNF would be good in this situation.  Just not sure how to go about it.  If you could give me more info about how to use the abs I'd appreciate it.  I will try side-lying next time too. 

Another therapist worked on him and made a little progress.  Described his HT muscles as feeling like a bodybuilder even though he is not.  Just from the constant heavily guarding. Trigger points felt in the fascia.  Jump response just light pressure on areas. 
 
Kay Warren said:

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....

• ▶ Reply

Permalink Reply by Gordon J. Wallis on February 14, 2012 at 2:15pm

There is a relationship between the cervical and lumbar spine.

elizabeth mount said:

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?

Attachments:

• LOVETT BROTHER RELATIONSHIP.jpg, 18 KB

• ▶ Reply

Permalink Reply by Jimswife on February 14, 2012 at 4:06pm

I don't know how I missed your reply Elizabeth.  The myo approach you mention about small melts on the muscles related to the problem is similiar to the approach I went with the second time I worked on him.  I was trying to so hard to make something happen, (trying to force my way in) and when I realized I was doing that I decided to just try and help him relax.  Thinking I know how tense I get all the way up to my shoulders when my back is hurting, he probably is feeling the same.  So I decided to just do some light work to reduce some tension and free up the fascia a bit.  And I did feel him relax.  Even though the pain was still there he said it felt good. 

 

 elizabeth mount said:

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?

• ▶ Reply

Permalink Reply by Kay Warren on February 14, 2012 at 10:09pm

I had to wait a bit to post this, I wanted to have time to be reasonably thorough.

 ok, more info on reciprocal inhibition. It's not the same as PNF, I'm not saying PNF is bad or inappropriate, it's just not what I use.

The logic behind Reciprocal Inhibition is that muscle groups work in opposing pairs. We'll use the calf as an example. If you get a cramp in Gastrocnemius/Soleus, merely attempting to stretch it doesn't help much, you need to give it a powerful signal to let go.  The best way to do that is to engage it's opposite, (the extensors) against strong resistance. When the effort to engage the opposite muscle, (the extensors) hits approx 25% of the level of force currently being expended by the cramping in the gastroc/soleus, there is a neuro-chemical signal which goes from the extensors, to the brain, and then back down to gastroc/soleus to "let go". So, in practical terms, you have them stand up. Put your weight against the top of the foot, and tell them to pick up your hand with everything they have, and hold that level of effort for 5 second.  Repeat 2 more times. The cramp should be gone.  If not, repeat. 

So, how do we translate this to the back?  Barring fresh surgical pins, rods or plates, or some other serious issue I don't know about, have the client lie on their back with their knees up and their feet flat on the table. Sit almost on their feet, wrap your arms around their knees, and have them pull their knees to their chest while you hold on, trying to not let any movement happen. They need to roll the pelvis too. You may want to have them do a couple of dry runs before you start with the resistance. Hold for 5 seconds, then let them release. Repeat 2x. this should start the loosening process for QL & the lower portions of Erector Spinae.  For illiocostalis, hold one leg, have them pull it upward toward the opposite shoulder, this engages the internal and external obliques.  This won't fix everything, but it will start the process. From there, let them roll to their side, do fascial stretch & release along the transversus abdominus, and the obliques by cross-handed pressure from the bottom of the ribcage to the top of the illiac crest.  This is about a 2 minute hold. then see if you can drop the upper leg down to the table, as if you were doing an Ober Test. If so, good.  Have them match their knees up again and attempt to glide between the layers of back muscles in a lateral to medial direction. You don't need to dig in hard at all. Don't worry about the trigger points just yet. Have them pay attention to their breathing.Then work from ES down through QL. flip to the other side and repeat.Go slow, your hand will sink in if you let it. if you try to push, you will get nowhere.  Remember the cornstarch exercise in school? it's like that.  Another issue with chronic low back pain in QL is that there may be a rib out of place that is creating pain and trigger points.  Adhesions will soon follow.  Release QL  and get them to a DC who is truly competent with ribs, they're tricky.

You will definitely need to address the hamstrings. The question is, how quickly? Do you it this session, or the next?  Ask them if they're having trouble reaching around to wipe their butt.  If so, do it now. Their hamstrings are so tight, even in a sitting position that their pelvis is rolled too far under for them to be able to reach their own butt effectively.  If they're only having a little trouble some days, do it next session.  All 3 hamstrings attach to the ischial tuberosity, and if they're too tight, (and they usually are) the will pull the pelvis down, creating a posterior rotation, with the hip joint as the axis, and it will create problems with the SI joint. QL then overworks to try to pull the ilia back into position using brute force, which doesn't work. Once the adhesions in the hamstrings have been released, and the tissue remodeled (another long post) you use AIS (active isolated stretching) for hamstring maintenance.

• ▶ Reply

Permalink Reply by Kay Warren on February 14, 2012 at 10:14pm

I forgot to ask, in what direction is L5-S1 herniated? Psoas is going to be an issue, but you'll have to soften QL & ES before you can go there. has he had an MRI? Do you have the report?  if not, get it, then have a DC read it. Mostof the non-DCs who read MRIs consistently understate and miss important things.

• ▶ Reply

Permalink Reply by Jimswife on February 15, 2012 at 5:54pm

Thank you Kay!  Very helpful information!  And I am excited about giving it a try.  Going to practice on a family member first so I am comfortable with the technique.  

Not sure about the direction of the herniation.  He has had an MRI.  And he did have a surgery.  I can not recall what it was at the moment.  I planned to look at his file tomorrow.  

Kay Warren said:

I forgot to ask, in what direction is L5-S1 herniated? Psoas is going to be an issue, but you'll have to soften QL & ES before you can go there. has he had an MRI? Do you have the report?  if not, get it, then have a DC read it. Mostof the non-DCs who read MRIs consistently understate and miss important things.

• ▶ Reply

Permalink Reply by Roeh Dale Gill on February 16, 2012 at 12:01pm

Remember to tell him that going to a PT as well as you will help him more. Just tell him when he goes to both it will probably make a big difference. I am not afraid to tell people I am part of a team and my team consists of docs, chiro, PT, Emotional and so forth so they understand that one doesn't exist with out the other. I have friends who are DOM, DCM, pastors of all faiths and so forth that I refer them to to treat them as a whole person! Since I know these people I can give an honest review and let them know I trust them and they trust me enough to send clients as well.

 

• ▶ Reply

Permalink Reply by Jimswife on February 16, 2012 at 4:24pm

I have talked to him a few times about seeing the PT in our office.  The other therapist has also.  He is hesitant because of past experiences w/ physical therapy.  It was a frustrating situation for him.  The first place he went to was really focused on exercises he needed to do.  Which was fine and all.  He did them.  Said that he did his "homework" too.  But didn't get any relief.  Went to another place and that therapist did a little more manual work than the previous place felt like there was a little improvement until they started to have him do all these exercises. Then he felt worse.  He felt like it was a waste of time and alot of money.  I can't say that I blame him.  You are going to get help and some relief from this constant pain and you spend all this time and money but are getting no where as far as pain relief. 

 

• ▶ Reply

Permalink Reply by Roeh Dale Gill on February 16, 2012 at 4:30pm

Well he needs some one to go at his pace. Maybe if you give him a few stretches that are very easy at first he could work his way up.

• ▶ Reply

▶ Reply to Discussion

• ‹ Previous
• 1
• 2
• Next ›
• Page