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Help with a client!

So here's the scoop:

I have a client with unexplained horribly debilitating (can't shower/dress self, etc) low back pain. No obvious event at onset of symptoms (about a week ago). Pain in about the level of L4/L5, mostly on right side. Spinal rotation makes pain worse than flexion/extension does. Getting him on the table showed that pressure on R erectors refers to L S/I jt area, pressure on L glute med refers to R S/I jt area. Getting him on the table also showed that being on the table makes pain unbearable in lower R quadrant of back (with or without bolster) after about 5 minutes, so we couldn't do any work. He's been taking epsom salt baths with eucalyptus, peppermint, lemongrass, lavender oils. He can't feel the pain while stationary in the bath and pain is extremely lessened for about an hour after the bath. Heat helps the pain some. He feels movement (although not painful or relieving) that he hadn't noticed before in S/I jt. Almost two years ago, he had a snowboarding accident in which some ribs were broken and his hip was "messed up". He never got treatment for the hip, just pain killers and crutches. He says sometimes this current pain feels like the pain after the accident.

I'm noticing a trend here which makes me think it is an S/I sprain. Clt wants to be sure before investing in an S/I belt. I don't remember if there are any tests I can have him do, and I don't know how to help him if he can't stand the pain of being on the table for bodywork.
I feel like I should know the answer to this riddle, and the fact that I don't is making me lose confidence in myself.

I would really appreciate any suggestions for how to help the client or myself.

Thanks,
Martha

Replies to This Discussion

Permalink Reply by Erica Olson on November 17, 2009 at 11:08am

Sometimes, lower back/hip pain can be lessened in a prone position by bolstering under the hips (not sure if you were doing it there or under the feet). Psoas/iliacus work may be good for him, but at this point, I'd refer him out, most likely to an osteopath or chiropractor. We can't diagnose, so it's good to hear that the client would like a second opinion.

Sometimes, the only way we can help is by pointing the way to someone else. It may be frustrating and is definitely hard on one's confidence, but we are here to help people, whether it's with our hands or someone else's.

Permalink Reply by Martha Kay on November 17, 2009 at 12:02pm

Thanks Erica,

We tried a bolster under the feet and a small pillow under his hips. I told him that he should see a chiropractor since I wasn't really sure what was going on, but he said he couldn't afford to. He has no insurance and he thinks a DC will make him get xrays. So he wants to stick with massage. However, he had a bad past experience with iliopsoas work, so he's not comfortable with it. I've done some MET stuff for his psoas before and it's helped him a bit, but I'm not sure that's going to cut it for something this bad.

His pain has lessened some. He says it's now like normal bad back pain and he has more mobility. We're going to make another appointment and try to do some work or at least feel around in there and try again to see what's going on.

Permalink Reply by rudy m smith on November 18, 2009 at 6:32am

this client needs and xray and probably a mri and you should promptly ensure he is on his or her way tho a physician.

the pain laying down (face down) may in fact be from too tight psoas. Release the psoas with client on back (supine) before putting face down.

Permalink Reply by rudy m smith on November 18, 2009 at 6:34am

just because a client can't afford a doc doesn't mean you shouldn't insist (with a referal sheet) that they go to a free clinic etc. Bad experience with poas work - sounds like thy've been down this road b4.