Integrated Manual Therapy & Orthopedic Massage For Low Back Pain, Hip Pain, and Sciatica

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1 Integrated Manual Therapy & Orthopedic Massage For Low Back Pain, Hip Pain, and Sciatica Assessment Protocols Treatment Protocols Treatment Protocols Corrective Exercises By Author & International Lecturer LMT, CPT

2 Integrated Manual Therapy & Orthopedic Massage For Low Back Pain, Hip Pain, and Sciatica Today s manual therapist needs to have multiple skills in order to address a wide variety of complicated musculoskeletal pain conditions. Specialization in just one modality is becoming a thing of the past because of limited patient outcomes. This unique total system consists of orthopedic assessment, clinical reasoning, multidisciplinary and multimodality therapies, and precise corrective stretching and strengthening exercises. Participants will learn to integrate the skills of leading practitioners from the fields of massage therapy, physical therapy, athletic training, personal training, osteopathic and chiropractic to restore balance, posture, function and pain free living. Recent clinical studies will forever change the way manual therapists look at musculoskeletal pain, muscle-tendon strain pain, and adhesive capsulitis of the hips. This seminar will teach manual therapists techniques to help eliminate pain from hip capsule adhesions, hip and disc degeneration, bulging discs, sacral torsions, sprains and strains, SI joint pain, and sciatica. Corrective stretching and strengthening techniques will be also taught to keep the muscles balanced, and joints aligned for pain free living. Our Unique 12 Step Protocol will be used throughout this presentation. Twelve Steps: 1. Client History 2. Assess Active Range of Motion 3. Assess Passive Range of Motion 4. Assess Resisted Range of Motion 5. Area Preparation 6. Myofascial Release/ Compression Broadening 7. Cross Fiber Gliding/Trigger Point Therapy 8. Multidirectional Friction 9. Pain Free Movement 10. Eccentric Scar Tissue Alignment 11. Stretching 12. Strengthening is an Author & International Lecturer who teaches approximately 40 seminars per year around the globe. He s served as AMTA Sports massage Chair and FSMTA Professional Relations Chair. He s developed 8 Orthopedic Massage and Sports Injury DVDs, and authored manuals on Advanced Orthopedic Massage and Client Self Care. His new book, Clinical Massage Therapy: A Structural Approach to Pain Management was published by Pearson Education in James presents at state, national and international massage, chiropractic, and osteopathic conventions including keynote addresses at the FSMTA, World of Wellness, New England Regional Conference, the World Massage Festival, and Australian National Massage Conventions. His audience includes massage and physical therapists as well as athletic trainers, chiropractors, osteopaths, nurses and physicians. He is a certified personal trainer with NASM. James received the 1999 FSMTA International Achievement Award and was inducted into the 2008 Massage Therapy Hall of Fame.

3 CLINICAL MASSAGE THERAPY A Structural Approach to Pain Management CHAPTER 2 Pelvic Stabilization The Key to Structural Integration Chapter Outline Twelve-Step Approach to Pelvic Stabilization Psoas Major, Iliacus (Iliopsoas), and Joint Capsule Quadratus, Lumborum (QL) and Erector Spinae Lateral Hip Rotators or Medial Hip Rotators and Adductors Choose the appropriate massage modality or treatment protocol for each specific condition of the hip and lower back Restore normal range of motion throughout the body and normal muscle resting lengths by first working on the short contracted muscle groups (iliopsoas and quadriceps) and then working the weak, inhibited antagonists (gluteals and hamstrings) Restore balance between other opposing muscle groups in the hip area such as internal and external hip rotators Ensure myoskeletal balance balance of the opposing muscle groups Ensure that the therapist eliminates the underlying soft tissue cause of the lower back and hip conditions before addressing symptoms 1

4 Differentiate between soft-tissue problems myofascial restrictions joint capsule adhesions muscle tendon tension trigger point tension Differentiate between soft-tissue problems strained muscle fibers sprained ligaments nerve compression bony fixations Figure 2-1 Examples of Disc Problems. Teach the client self-care stretches and strengthening exercises (if needed) to perform at home to maintain musculoskeletal balance and pain-free movement following therapy Precautionary Note Figure 2-4 Hip Extension, Degrees. Do not work on a client with a recent injury (acute condition) exhibiting inflammation, heat, redness or swelling. RICE therapy (rest, ice, compression, elevation) may be the appropriate treatment in this situation. 2

5 Figure 2-10 Passive Assessment for Hip Extension End Feel. Figure 2-12B Evaluate Internal Hip Joint Rotation End Feel. Figure 2-12A Evaluate External Hip Rotation End Feel. Figure 2-11 Joint Capsule and Inner Fascial Mobilization Techniques. Figure 2-13 Traction Hip After Releasing Joint Capsule Adhesions. Figure 2-18 Pain Free Psoas Release (Hand Placement). 3

6 Figure 2-16 Pain Free Iliacus Release (Hand Placement). Core Principle You must change the protocol and return to joint capsule work anytime that you find a bone-on-bone-like end feel during the rest of the hip session. Core Principle Always get the client s permission before you treat this area. Use a visual aid, if needed, to explain where you are going to be working. This can be a very personal, emotional area of the body. Core Principle You must continually check in with the client is he or she guarding? Pay attention to the client s face, voice tonality, and breathing. What is his or her comfort or discomfort level? The iliacus release must be performed painfree. Figure 2-20 Anterior Joint Capsule Release. Figure 2-10 Contract- Relax IlioPsoas Stretch 4

7 Figure 2-22 Quadratus Lumborum. Figure 2-23 Erector Spinae. Figure 2-24 Palpate Iliac Crests. Figure 2-25 Palpate PSIS. Figure 2-26 Myofascial Release, Erectors/QL. Figure 2-27 QL/Erector Cross-Fiber Gliding Strokes. 5

8 Figure 2-31A Muscle Resistance Test, Right QL. Figure 2-32 Multidirectional Friction. Figure 2-33A QL Eccentric Muscle Contraction (Start). Figure 2-33B QL Eccentric Muscle Contraction (Finish). Figure 2-35 Right QL Stretch. Figure 2-36 Decompress Lumbar Spine. 6

9 Figure 2-39A Sciatic Nerve. Figure 2-40 Sciatic Nerve May Run Through Piriformis. Figure 2-41 Internal (Medial) Hip Rotators. Figure 2-42 Adductors. Core Principle You must evaluate both the lateral and medial hip rotators as this will determine what protocol to follow. Focus on treating the tight, restricted muscle groups first. If the client cannot achieve 30 to 45 degrees of medial hip rotation and has a tissue-stretch end feel, the problem is most likely tight lateral hip rotators. Core Principle If the client cannot achieve 60 degrees of lateral hip rotation with a tissuestretch end feel, the problem is mostly likely tight medial rotators. If there is a bone-on-bone-like end feel in either direction, the problem is probably inner fascial and capsular adhesions and that changes the treatment technique completely. 7

10 Figure 2-43A Evaluate Internal Femoral Rotation. Figure 2-43B Evaluate External Femoral Rotation. Precautionary Note Figure 2-45 Internal Joint Capsule Work. If the client has any joint pathology (degenerative discs, SI joint dysfunction, etc.), push the femur into the hip joint just until you make contact with the ilium (about 1/8 inch). This is a subtle movement. Pushing forcefully may create pain or discomfort in the lower back and could severely compromise the lumbar spine! Figure 2-44 External Joint Capsule Work. Figure 2-46 Deep Six Lateral Hip Rotator Myofascial Release. 8

11 Figure 2-48 Release Quadratus Femoris to Release Sciatic Nerve Precautionary Note Stretching is not suggested for the muscle groups around a hypermobile joint. Strengthening would be more appropriate to stabilize any joint that has excessive movement due to ligamentous laxity. Precautionary Note Do not rotate the tibia during this distal hamstring stretch, unless it is needed to correct abnormal or excessive knee rotation. Precautionary Note In order to stretch tissue there should be a tissue stretch end feel. The stretch must also be done pain-free to make sure the therapist is not compromising a preexisting clinical condition such as a strain, sprain, or any unresolved capsular adhesions. Figure 2-87 Iliopsoas Stretch (Start). Figure 2-88 Iliopsoas Stretch (Finish). 9

12 Figure 2-89 Right QL Stretch. Figure 2-90 Lateral Hip Rotator Stretch. 10

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