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How to treat acute pain / Quadratus Lumborum best
I'm relative new in this forum and find at quite interesting. I've worked as a massage therapist for 1.5 years. My favorite style is trigger point treatment and deep tissue. I don't apply much pressure on trigger points.
How do you help clients best with acute pain especially when it comes from the Quadratus Lumborum which seems to be especially sensitive.
Thank you very much for your advice,
Barbara
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Replies to This Discussion
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Permalink Reply by Gordon J. Wallis on
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Its really impossible to answer that question without actually being there. Any way....So the Quadratus Lumborum is sore? or? It seems to be especially sensitive? What does that meant?
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Permalink Reply by Barbara Gropl on
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Yes, the QL is sore and has very painful trigger points. When I treat these the client is even more sore afterwards although I don't use much pressure.
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Try this.. have the client lay on their back. You place your palm on the QL trigger point (the client is laying on your hand). Have the client raise their head off the table and have him(her) look at their feet. At the same time as they lift their head, with your free hand pull firmly( but never hurt the client. Number one rule) on the abbs where they attach to the pubic bone. Pull towards the head. You and the client hold that position for 20 seconds. Then have the client relax and you release the abb pull for five seconds then repeat. Do that five times...That will often down grade or eliminate TPs in the lower back. Now if that procedure hurts the client. Of course dont do it. The client is not working hard. They are not doing a sit up. They are simply lifting their head off the table 20 seconds at a time. You are not directly working on the TP. Your hand is resting over the TP. So if the procedure does not hurt the client, you are causing no irritation of the trigger points.
Barbara Gropl said:Yes, the QL is sore and has very painful trigger points. When I treat these the client is even more sore afterwards although I don't use much pressure.
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Thank you, Gordon, that sounds terrific. I was looking for something like that. Where did you learn this?
One thing isn't clear to me :How do I pull up the client on his apps? I mean where do I place my free hand exactly?
Thanks,
Barbara
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The tendon of the Abdominals attach at the pubic bone. You don't want to pull skin. You want to pull muscle tissue toward the clients head. Don't hurt the client. I learned it from studying for thirty years.
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That's my own technique after accumulating knowledge from a lot of other people and reading a lot on pain and muscle function
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Thank you, Gordon. I'll try it with my husband! :-) Barbara
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Permalink Reply by lauren stewart on
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Hey Barbara, Lauren here, lmt practicing for 5 years. TPT has worked well for me tx QL. I go in from the lateral border and press medially. Veeery tender on most everyone. Also treat elevated hip side with longitude strokes from that same angle going from rib origin down to illiac creast. Just a few times with moderate pressure. Also I found stretching them helps. I push at hip inferiorly and with NO lotion on other hand press superiorly and hold for ten seconds or so. do that a few times. That's myofascial stretching. Getting to the psoas is awkward in most spa settings and done very infrequently but it can work like magic with chronic back pain people who sit all day and do not exercise (psoas shortend and weak). I try to get them interested and thinking about exercise they would enjoy. Just something to get them started. I've seen great improvements with this little hint.
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I just read Gordon's post. Yes, reciprocal inhibition -getting the antagonists of the muscle you are working on to fire causes the treating muscles to lengthen/relax. By having client raise their own head (we dont hold their head up) their own neuro-muscular system is working.
Gorden, Could you explain why you pull/stretch the abs? It seems that would negate the contracting force which causes R.I. in the QL. Maybe it's stretching the psoas? So they fire Abs, while we treat psoas and the gentle TP pressure on QL?
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The QL and Abbs are antagonists. When the client lifts their head, the abbs contract. When the abbs contract it pulls on its own tendons. By further pulling on the tendons the brain thinks the abbs are really working hard. The QL has to relax. When a muscle contracts all its synergists contract, and all its antagonists relax. The psoas is an antagonist of the QL. The psoas and abbs are synergists.
lauren stewart said:I just read Gordon's post. Yes, reciprocal inhibition -getting the antagonists of the muscle you are working on to fire causes the treating muscles to lengthen/relax. By having client raise their own head (we dont hold their head up) their own neuro-muscular system is working.
Gorden, Could you explain why you pull/stretch the abs? It seems that would negate the contracting force which causes R.I. in the QL. Maybe it's stretching the psoas? So they fire Abs, while we treat psoas and the gentle TP pressure on QL?
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Permalink Reply by Gary W Addis, LMT on
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I've used Gordon's technique on QL trigger points and attest to its effectiveness. The psoas is antagonist to QL more in this manner than others: a tight right psoas will pull that right hip forward, stretching the hell out of the left QL. The QL in that instance may be sending the pain, but the psoas may be the answer.
But my understanding of Barbara's client's complaint is not hip rotation but multiple trigger points across both QL (and possibly in spinal erectors as well). So, in this instance, the psoas are not likely to be involved. Therefore, Gordon's abdominal tug is just the thing.
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The Psoas does refer pain to the QL low back area. But Psoas trigger points would be palpated in the abbs and upper thigh. If those areas are not tender. The Psoas is not a player.
Gary W Addis, LMT said:I've used Gordon's technique on QL trigger points and attest to its effectiveness. The psoas is antagonist to QL more in this manner than others: a tight right psoas will pull that right hip forward, stretching the hell out of the left QL. The QL in that instance may be sending the pain, but the psoas may be the answer.
But my understanding of Barbara's client's complaint is not hip rotation but multiple trigger points across both QL (and possibly in spinal erectors as well). So, in this instance, the psoas are not likely to be involved. Therefore, Gordon's abdominal tug is just the thing.
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