Therapy question

[azam d]

I have my first client seeking therapy work. She has seen the chiro and he has worked his magic and now it is my turn. She is experiencing low back pain on the right side that radiates down her right external upper leg. She also experiences pain in upper adductor region bi-laterally.

After a PA, I only found a moderate posterior pelvic tilt. After her first session, I found that she is very sensitive on her right IT band and TFL causes much pain. I worked her low back, Swedish gym on adductors and worked the right IT band, glutes and hamstrings. She did not test positive for IT band contracture but it seemed very tight and adhered. I really wanted to work more psoas but didn't have a lot of time and I'm still not confident that I am getting deep enough yet to do any good.

Her second session was today and she only scheduled a 30 minute. She was still having pain. I focused on glutes, LB, TFL and IT band. I sent her homework with TFL, adductor, psoas and glute stretches; and contrast hydro on the right hip. Also asked her to self massage her IT band alternating days.

She has 4 more 30 minute session scheduled and I really want to be able to help my clients. Just being out of school, I'm a little nervous. Does anyone have any suggestions? Are these questions appropriate on this forum?

 

[Randy]

Hi Angela! Try checking the piriformis to see if it is hypertonic or has trigger points. That can clamp down on the sciatic nerve and cause the pain and the rest of the tightness you are finding. Work out TP's, stretch her piriformis and hold the stretch a good 2-3 minutes, and show her how to stretch it herself at home.

 

[Billys]

yes, your questions are appropriate, I'm impressed with your knowledge...I need to go back to your school...

 

[Happy-2]

Get in and work the adductors and psoas... the TFL is (probably) feeling tight because her adductors are tight and straining the outer part of her upper thigh... work the inner thigh and anterior hip to relieve the pressure on the outer thigh.

 

[Mejo]

Hi Angela! Try checking the piriformis to see if it is hypertonic or has trigger points. That can clamp down on the sciatic nerve and cause the pain and the rest of the tightness you are finding. Work out TP's, stretch her piriformis and hold the stretch a good 2-3 minutes, and show her how to stretch it herself at home.

I agree about the piriformis trigger points. You can also show her a technique for self-treatment at home: Lie on floor with tennis ball under hip, on the spot of the trigger point (tender area). Relax and breathe deeply until tenderness lessons (signaling trigger point release). There are probably trigger points in other gluteal muscles as well, and both hips should be treated (sometimes the tension's actually coming from the opposite side of the symptoms). She should move the tennis ball to different points, stopping anywhere there's tenderness, and then treat those points.

As for stretching, I've had better luck with active stretching protocols (rather than long static stretches). I recommend AIS or PNF stretching for the piriformis.

 

[/cfreese 68IOU1]

Thank you everyone for the great advice!! I appreciate it

 

[Igggy]

yes, your questions are appropriate, I'm impressed with your knowledge...I need to go back to your school...

aww... Thank you I had very awesome teachers.....a well rounded bunch! One was the best kines and treatment expert ever! Another was very spiritual and had great intuitive skills (and knows everything there ever was to know about EO's and spa). While yet another was the sports expert. I loved school and wish I could just live there....lol

 

[HatOnenue]

Cosmic touch

If she is getting pain into the hip that is radiating down the outside of leg try working glute medius & minimus.

Cheers
Oz