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Hi All:

I have been using heat packs in the past to help loosen up tight muscles before I go in. I know a tiny bit of myofascial work, but that's about it. Right now I have two clients that even with heat, the muscles (erectors and longissimus) take forever to yield. One has so little change, I'm thinking of not even using them (the packs)  in the future.

Maybe I'm being unrealistic in my expectations, but I'm not satisfied with the results thus far. Anyone have any suggestions that I can use that so I can avoid plowing my clients into oblivion in a fruitless effort?

Thanks in advance!

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I can't relate to what you are asking? Do those clients have a specific complaint?

I use heat packs, because the clients enjoy the feel, and heat does make the tissue more pliable.  But no amount of heat is gonna replace the need to go into the hypertonic tissue and massage the stiffness away.  Much easier if you buckle down and develop whatever skills you have in MFR and NMT trigger point release.  Lots of places online you can use to educate yourself--youtube videos, for instance, are free.

Note that latent trigger points may not be painful even when directly pressed, but can still cause an entire muscle to be rock hard and very sore. For instance, the upper traps become the storehouse of stress.  The best way to melt the traps, even if you don't have a clue what a TP feels like, is to find the most dense area (either at the junction of neck and shoulder or at the other end, close to the acromioclavicular joint).  Find it, and pinch it hard enough that the client notices, and hold it till the tissue begins to melt.  Might take a minute or so.  Obviously, you'll accomplish this faster and less painfully if you develop the ability to find a trigger point and get it to release.\\

Heat alone ain't gonna relax hypertonia in erectors.  It's a pretty safe bet if they are that tight, they are tight for a reason: trigger points in the paraspinals themselves or in supporting muscles that can act on them. When the trigger points are taken out, the tissue will melt quicker than a snow cone in Death Valley heat.

Don't fight the muscle pushing down on the belly of it. Push from the side of the muscle.

If they come in with a pain complaint, I want to deal with that as quickly as possible.  And morre often then not, trigger points are involved if not the cause.  Ive massaged tons of people that have very hard muscle and others that have soft flabby muscles, and sitll others that have healthy supple muscle tissue.   If they have no pain complaint.  I don't try to do anything except give them a really good massage.

if their psoas is hypertonic, when they lie facedown, it is being stretched, and will pull forward on the lumbar spine, forcing the erectors and longissimus to tighten protectively.  Put them side-lying and you will have much more success.  Also, make sure their hamstrings are not adaptively shortened.  Short hamstrings pull downward on the ischial tuberosities, changing the position of the illia relative to the sacrum which changes how the SI functions, creating more work for the stabilization muscles of the lower back.

This should get you started.

Kay Warren

Uhm, What was the clients reason for getting a massage in the first place?  

So if the psoas is tight and contracted, the lumbar erectors become tight and contracted?  If thats the case wouldnt the person be in a lot of pain and not be able to move?  My way of thinking, and I could be wrong, because I never think along these lines during a massage.  But I would think that if the psoas is contracted, then the lumbar erectors would have to be over stretched. Tight because of being over stretched. And to solve that problem the contracted psoas would have to be relaxed.  And I would think that the clinet would be feeling pain somewhere.

Kay Warren said:

if their psoas is hypertonic, when they lie facedown, it is being stretched, and will pull forward on the lumbar spine, forcing the erectors and longissimus to tighten protectively.  Put them side-lying and you will have much more success.  Also, make sure their hamstrings are not adaptively shortened.  Short hamstrings pull downward on the ischial tuberosities, changing the position of the illia relative to the sacrum which changes how the SI functions, creating more work for the stabilization muscles of the lower back.

This should get you started.

Kay Warren

This is a good point because you don't know what is creating the initial paraspinal tighness in the first place! Also if the muscles are not responding as you wish, then another area(s) may be controlling.  The only way you will know is developing your assessment skills. If the client is in pain and you are just digging around you may or may not find the solution.  The psoas is a good place to start to compare and palpate, but I encourage you to look further, could be the quads too, or the calf muscles- it will be worth a few minutes time to check. 

Why would prone position place the psoas of anterior hip into stretch? the anterior hip is supported by the table, so how can it be pulling the lumbar spine forward?  I'm assuming the table is positioned flat, for normal prone massage, and neither thigh has been allowed to hang off the table.

Kay Warren said:

if their psoas is hypertonic, when they lie facedown, it is being stretched, and will pull forward on the lumbar spine, forcing the erectors and longissimus to tighten protectively.  Put them side-lying and you will have much more success.  Also, make sure their hamstrings are not adaptively shortened.  Short hamstrings pull downward on the ischial tuberosities, changing the position of the illia relative to the sacrum which changes how the SI functions, creating more work for the stabilization muscles of the lower back.

This should get you started.

Kay Warren

I'd like to suggest that you review your anatomy.  The muscular attachment of the posas begins antero-medial on vertebrae T12 - L5. From there, it progresses down through the pelvic cavity, is joined by the illiacus, and its tendinous attachment is at the lesser trochanter, which is on the femur.  Thus, when the client is flat & prone, the legs hold the psoas in a lengthened position.  If the posas is adaptively shortened, as it is in many people who have desk or other sit-down jobs, or a physical job that keeps you in a crouch, like someone who lays tile floors, the lengthening that occurs with a flat & prone position creates a drag forward on the lumbar section of the spinal column. This forces the erectors and lower longissimus to protectively contract. Not everyone has this condition, but in cases of chronic back pain, it often combines with hamstring tightness and creates all sorts of hassles.  Just massaging the "tight" muscles of the lower back won't cut it.

Now to be fair, the therapist who posed the Question did not state what her client's chief complaint was, I have made an assumption based on the pain location, and the fact that little is working to soften up the muscles. If indeed the chief complaint is low back pain, I would do a Thomas Test, an Ober test, and a proper Straight Leg Raise test to determine which of the three is the biggest contributor to the pain and work from there. Chronic low back pain is best worked on from a side-lying position.  It's less work for the therapist, you can get right to the muscles with little effort, and you dont' bruise the upper tissues as much. This means it's more relaxing to the client, and you will get better results.

It's true that psoas can act as antagonist of QL and erectors...that a tight iliopsoas on one side will pull that hip forward, which, as Gordon said, will overstretch the erectors and QL as well.  Speaking of QL,  It's unofficial name is "hip hiker." A hypertonic QL pulls up on ipsilateral side, stretching the opposing QL creating tension in the lumbar erectors between the two QL. IOW, the erectors may be defensively tightening to resist uneven pull of one or both QL.  

 

Gary W Addis, LMT said:

Why would prone position place the psoas of anterior hip into stretch? the anterior hip is supported by the table, so how can it be pulling the lumbar spine forward?  I'm assuming the table is positioned flat, for normal prone massage, and neither thigh has been allowed to hang off the table.

Kay Warren said:

if their psoas is hypertonic, when they lie facedown, it is being stretched, and will pull forward on the lumbar spine, forcing the erectors and longissimus to tighten protectively.  Put them side-lying and you will have much more success.  Also, make sure their hamstrings are not adaptively shortened.  Short hamstrings pull downward on the ischial tuberosities, changing the position of the illia relative to the sacrum which changes how the SI functions, creating more work for the stabilization muscles of the lower back.

This should get you started.

Kay Warren

I am familiar with the anatomy of the hip.  As you graciously told me in your anatomy lesson, its origin is anterior vertebrae, it does pass beneath the internal organs to the bowl of the hip, where it joins the illiacus and becomes iliopsoas.  However, lying prone, the thigh and hip are supported in its natural neutral position; it is neither stretched nor shortened.  

Compare it to the biceps brachi: when the arm is hanging down, it is neither stretched nor flexed: it is only as  tensed as its antagonist triceps forces it to be.  Likewise, the triceps will be as relaxed as its opponent biceps allows it to be.  A well-developed bodybuilder's upper arm muscles will be balanced, neither flexed nor fully relaxed when the trainer is standing prone.  Likewise, sans injury to any of the muscles involved, when standing erect, anterior thigh and posterior thigh work as a unit with the QL and the psoas and the glutes and the parapspinals to stabilize the body.  None of the muscles will be fully relaxed; none will be fully flexed.  

Resting prone on a massage table, the need to flex to provide equilibrium will be minimal; therefore, the body can relax.  Psoas won't be flexing, trying to pull the hips forward through the table--the hips and thighs are supported. 

However, I certainly don't deny that hypertonia can exist even in a sleeping body.  Overworked, overstretched muscles become hypertonic as a protective mechanism...can maintain the partial contraction through weeks of inactivity.  Thus, the need for therapeutic massage.  A rock-hard muscle is tight for a reason--maybe due to emotional stress, but more likely due to the CNS trying to force the sufferer to give the muscle(s) time to heal.  Which, left to its own devices, might take months.  The mechanism for creating the hypertonia will almost always be the creation of trigger points. 

Back to Joyce's client's problem: tight erectors.  The replies have all concentrated on lower lumbar spine.  She didn't specifically mention the lumbars.  If the tightness is located in upper lumbar or thoracic spinal erectors, an entirely different set of muscles are involved.  Serratus posterior superior/inferior and the rhomboids all attach to the spine and therefore could be acting to create tension in the paraspinals.  For instance, serratus posterior inferior could be clamping down on the longissimus dorsi, keeping this thick, long erector muscle in a state of contraction.

Certainly, examine the psoas.  But with so little info to go on, pronouncing tight psoas to be cause of tight erectors is a step too far.  BTW, Joyce didn't mention pain.  If the erectors are hypertonic but not a source of pain, maybe the tightness is due to nothing more than great muscle tone.  Like Gordon has said, if it hurts to move it, accept that as a CNS hint, and don't stretch it.  IOW, if it ain't broke, don't try to fix it! As Erik Dalton has said, if it is tight but not painful, maybe it's supposed to be tight. 

 

Kay Warren said:

I'd like to suggest that you review your anatomy.  The muscular attachment of the posas begins antero-medial on vertebrae T12 - L5. From there, it progresses down through the pelvic cavity, is joined by the illiacus, and its tendinous attachment is at the lesser trochanter, which is on the femur.  Thus, when the client is flat & prone, the legs hold the psoas in a lengthened position.  If the posas is adaptively shortened, as it is in many people who have desk or other sit-down jobs, or a physical job that keeps you in a crouch, like someone who lays tile floors, the lengthening that occurs with a flat & prone position creates a drag forward on the lumbar section of the spinal column. This forces the erectors and lower longissimus to protectively contract. Not everyone has this condition, but in cases of chronic back pain, it often combines with hamstring tightness and creates all sorts of hassles.  Just massaging the "tight" muscles of the lower back won't cut it.

Now to be fair, the therapist who posed the Question did not state what her client's chief complaint was, I have made an assumption based on the pain location, and the fact that little is working to soften up the muscles. If indeed the chief complaint is low back pain, I would do a Thomas Test, an Ober test, and a proper Straight Leg Raise test to determine which of the three is the biggest contributor to the pain and work from there. Chronic low back pain is best worked on from a side-lying position.  It's less work for the therapist, you can get right to the muscles with little effort, and you dont' bruise the upper tissues as much. This means it's more relaxing to the client, and you will get better results.

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