Effective Treatments for Sciatica

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Effective Treatments for Sciatica
A one day manual therapy course to improve your treatment of
sacroiliac, low back and sciatica pain.
Copyright Garry Adkins © 2011
Effective Treatments for Sciatica
Table of Contents
Introduction………………………………………............................. 3
Dissecting Low Back Pain………………………………………..… 4
Contributing Factors……………………………………………….
7
Moving the Lower Body……………………………………………
7
Assessment is the key………………………………………………....11
Doing it "to" or Doing it "With"……………………………….......… 24
Massage Treatment………………………………………………….….24
Active isolated assisted-stretching ...………….…………..………. 36
Kinesiology tape treatment………………………………...………
44
Self treatment………………………………...………………..……..
45
Bibliography…………………………………………………………..… 47
2
Introduction
Sciatica (or sciatic neuritis) is a set of symptoms that may be caused by general compression and/or
irritation of one of the five spinal nerve roots. Piriformis syndrome while related and many times
confused with sciatica, points more to a specific origin of dysfunction. Sciatic nerve dysfunction affects
nearly 40 percent of adults at some point during their lifetime.
Among the many possible causes of nerve compression, spinal disc herniation leads the list of much
research material, but according to Ben Benjamin, PhD of Cambridge, Massachusetts spinal disc
herniation accounts for only 5 percent in sciatica cases. Other well known compressive causes include:
Spinal stenosis, in which the spinal canal narrows because of bone spurs, spondylolisthesis, or
inflammation or structural irregularities.
Pregnancy, the uterus can press directly on the sciatica nerve, or as a result from muscular tension,
laxity of ligament tightness, or postural imbalance.
Spinal Tumors may form on the spinal cord, surrounding nerve or ganglia.
Because of the position of the sciatic nerve it is also subject to trauma at the point at which it crosses
over the ischial spine.
In order to be truly successful in treating Sciatica the above possible causes may need to be addressed to
rule them out first.
Manual therapy focused on muscular and structural imbalance of the low back and pelvic region,
sacroiliac joint dysfunction, scar tissue of the sacral ligaments of the pelvis, and addressing other
contributing factors have been found to yield surprising results.
The foundation of treating the lower body started for me many years ago with various mentors
and instructors that shared their insight and opinions on how to alleviate pain and bring their
patients body into a better balanced myofascial unit.
Some of my greatest influences in bodywork of the lower region were specific modalities that
would only focus on segments of the whole.
•
Dr. Carol Hartigan, from the New England Baptist Hospital Spine Center and a professor at
Harvard University. She feels back pain is part psychological and part of it is overcoming the fear
that if you use your back it will hurt. It’s natural and normal to think if we have pain, we shouldn't
move.
•
•
Dr. Ben Benjamin on addressing adhesive scar tissue of the sacral ligaments of the pelvis.
John Barnes’ work bringing the fascial system to the forefront and how this system
affects not only posture, but every organ in the body.
Thomas Myers on mapping major fascial bands that increase tonus or inhibit movement.
•
3
•
Eric Dalton’s work on Myoskeletal Alignment, his work opened my eyes. Not specifically
to his techniques, even though ground breaking. It was his reference to a mentor of his,
Vladimir Janda.
Dr. Janda was a Czech neurologist and physiatrist. Dr. Janda has done extensive clinical research
on the pathogenesis and treatment of chronic musculoskeletal pain. In 1979, he identified his
specific upper and lower crossed syndromes of muscle imbalance and continued to be active in
clinical practice, research, and lecturing until his death in November, 2002.
Dr. Janda felt that tonus muscles were tight composed mostly of flexors and phasic muscles
were weak composed mostly of extensors.
In my own clinical practice, my focus has been of the imbalances seen in my patients in a front
to back plane, as in Dr. Janda’s work. I came to the conclusion that the muscular/fascial system is
a series of levers and pulleys. When one side shortens the other side lengthens.
It wasn’t until I started to focus on working with elite athletes to improve their performance that
I noticed in increasing number of athletes had a rotational imbalance originating from the pelvis.
Volumes of clinical data had been written on front to back imbalances but you would be hard
pressed to find much written on rotational imbalances.
Once I started to apply the theory of levers and pulleys and the concepts of Dr. Janda to
rotational imbalances my results were not only more positive, but conditions like Sciatica and
chronic low back pain, I had previously been unable to affect were now improving. The question
still remained, how did the person get to that point?
Dissecting Low Back Pain
Low back pain is felt by most of us at one time or another in our lives. If
you think about the true mechanism of pain, its purpose is to tell us
when we are doing something wrong. With any luck, this acute pain will
subside quickly in a few days with no lasting effect. If this pain becomes
chronic or a common occurrence, our posture and our emotional state
will be compromised, which in turn can set up degeneration of the
spinal structures over time.
Treatment of low back pain is confusing for many therapists because
once the structural integrity of the pelvis is compromised by injury
every structure that inserts or is associated with the lower body is
affected. It is not uncommon to find pain in one area, but the source is
in another area.
4
To unravel this complicated region let us first look at the foundation of the spine. The pelvis
itself is made up of the Ilium on both sides and the sacrum. Sacral ligaments hold these
structures together. In most cases I have found that the sacral ligaments have developed scar
tissue adhesions from violent falls, bike crashes, or the stress of prolonged sitting, which inhibit
proper support and function of this region.
This faithful reproduction of a lithograph plate from Gray's Anatomy, a two-dimensional work of art, is not
copyrightable in the U.S. as per Bridgeman Art Library v. Corel Corp.; the same is also true in many other
countries, including Germany. Unless stated otherwise, it is from the 20th U.S. edition of Gray's Anatomy
of the Human Body, originally published in 1918 and therefore lapsed into the public domain.
5
The keystone of all of the structures in the low back is the sacroiliac joint. This joint is the
connection point of the sacrum and the Ilium, and is held in place by the sacral ligaments.
This faithful reproduction of a lithograph plate from Gray's Anatomy, a two-dimensional work of art, is not
copyrightable in the U.S. as per Bridgeman Art Library v. Corel Corp.; the same is also true in many other
countries, including Germany. Unless stated otherwise, it is from the 20th U.S. edition of Gray's Anatomy
of the Human Body, originally published in 1918 and therefore lapsed into the public domain.
It is this scar tissue formation of the ligaments that stabilizes the sacroiliac joint that is one of
the main causes of low back pain. Ligament strain or traumatic stretching of these supporting
structures will undermine the strength needed to hold the sacrum in place, thus providing strain
up into the spine. You could treat the muscles of the low back effectively to ease discomfort, but
eventually the pain will return someday without considering the damaged ligaments.
6
Contributing Factors
If no violent falls or traumas have occurred in the low back, many contributing factors can play a
large part in damaging the sacroiliac region and supporting ligaments.
•
•
•
•
Prolonged sitting - The single most stressful event in the low back which puts all of the
weight of the upper body on the sacroiliac area. This posture can lead to tight hip flexor
muscles that encourage weakness in the low back. Bending of the knees in this position
will cause tight hamstrings muscles which pull the ischium downwards that further
strains the low back.
Poor posture - Will magnify strain on the vertebral discs and sacral ligaments. Poor
posture habits are sometimes ingrained from an early age. Many causes include: being
tall in height as a child. Not being encouraged to stand up straight. Wearing shoes with
unusually high heel heights.
Inadequate support - Weak abdominal muscles do not allow the spine to stay balanced
evenly on the pelvis causing more pronounced spinal curvature. Relaxing in soft furniture
will eventually influence posture, which weakens supporting structures of the spine.
Poor flexibility - The body responds to poor flexibility by altered or limited mobility. This
change in mobility results in unnecessary stress on the joints, poor circulation, and
weakness in other muscle groups.
Moving the Lower Body
Before the musculature of the lower body can be examined we must look at the movements we
should be capable of. Primary movement muscles are in bold type, synergistic muscles are
italicized.
Trunk extension
Iliocostalis thoracis
Iliocostalis lumborum
Longissimus thoracis
Spinalis thoracis
Semispinalis thoracis
Multifidus
Rotatores
7
Trunk flexion
Rectus abdominis
Psoas major
Iliacus
Obliques
Transversus abdominis
Trunk rotation
Obliques
Rotatores
Latissimus dorsi
Rectus abdominis
8
Hip Extension
Gluteus maximus
Semimembranosus
Semitendinosus
Biceps femoris
Hip flexion
Psoas major
Iliacus
Rectus femoris
Sartorius
Tensor fasciae latae
9
Hip lateral rotation
Piriformis
Gemellus superior
Obturator externus
Gemellus inferior
Obturator internus
Quadratus femoris
Hip adduction
Pectineus
Adductor brevis
Adductor longus
Adductor magnus
Gracilis
10
Hip abduction/ medial rotation
Gluteus medius
Gluteus minimus
Tensor fasciae latae
Assessment is the key
In order to effectively treat sacroiliac joint dysfunction, or lower body pain assessment skills
must be practiced and perfected.
These assessment tools will show us three things:
1. Are regions of the body compensating for structure instability?
2. Which specific muscle or tendon is affected?
3. Is it a muscle/tendon injury or ligament/joint injury?
Systematic evaluation of muscular imbalance begins with static postural assessment, observing
muscles for characteristic signs of hypertonicity or hypotonicity. As you inspect, compare each
area bilaterally, noting any indications of pathology as well as the condition and general
contour of the anatomy.
This is followed by a series of question and answers: When did you first notice the problem?
Can a certain movement reproduce any pain? If you used any previous treatment, was it
helpful? Any muscle aches, tension, or problems sleeping?
11
Be sure to address the list of contributing factors in the previous chapter. Encourage the person
to make lifestyle changes if many of the factors are on their list.
To assess joint range of motion I use passive tests to exclude muscle involvement (except for
the first two). Pain often during these movements may point to ligament dysfunction.
Trunk Flexion
Have the subject bend at the waist and
slowly lower their arms as far as they
can to the floor.
Trunk Extension
Have the subject support their back
and bend back at the waist as far as
they can and slowly look up to the
ceiling.
12
Trunk Rotation
In the seated position have the subject
grasp their shoulders and passively
rotate the trunk to one side and to the
other side.
Hip Flexion
Have the subject supine and passively
bend the knee and push the knee
superiorly to flex the hip.
Hip Flexion (alternate)
Passively raise the straight leg superiorly
to flex the hip.
13
Hip Extension
In the standing position with the hands
at the table have the subject put all of
their body weight on the opposite leg to
be assessed. Passively lift the straight
leg backwards in extension.
Hip lateral rotation
In the prone position passively bend the
knee and drop the foot across the body.
Hip Medial rotation
In the prone position passively bend the
knee and drop the foot away from the
body.
14
Hip abduction
In the supine position passively bring the
straight leg out laterally from the body.
Hip adduction
In the supine position passively bring the
straight leg in medially across the body.
Next, characteristic movement patterns are assessed, and specific muscles are tested for
tightness or shortness. This is referred to as Functional Assessment.
There is such a wide variation of the grading scale with normal adults, for our purpose a much
gentler version will be used. In most cases pain will point to muscle or tendon damage during
these tests.
Functional Assessment Protocol
• Resistance or pressure from the therapist is only 1 to 2 pounds.
• Direction of resistance follows black arrows on illustration.
• Test is preformed for a maximum of 5 seconds.
15
Trunk Extension
Position of the Subject: Prone with head and upper trunk extending off the table
from about the nipple line. Arms at sides.
Position of Therapist: Standing at side of table. Lower extremities are stabilized
just above the ankles.
Test: Subject extends spine, raising body from the table so that the umbilicus
clears the table.
Instructions to Subject: “Raise your head, arms, and chest from the table as high
as you can”.
16
Trunk Flexion
Position of Subject: Supine with hands clasped behind head. Grade 3, arms
outstretched in full extension above plane of body.
Position of Therapist: Standing at side of subject next to the chest.
Test: Subject flexes trunk through range of motion. A curl up is emphasized, and
trunk is curled until scapulae clear table.
Instructions to Subject: “Tuck your chin and bring your head, shoulders, and arms
off the table, as in a sit-up”
17
Trunk Rotation
Position of Subject: Supine with hands clasped behind head. Grade 3, arms
outstretched in full extension above plane of body.
Position of Therapist: Standing at side of subject next to the waist.
Test: Subject flexes trunk and rotates to one side. This movement is then
repeated on the opposite side.
Instructions to Subject: “Lift your head and shoulders from the table, taking your
right elbow toward your left knee.” Then, “Lift your head and shoulders from the
table, taking your left elbow toward your right knee.”
18
Hip Extension
Position of Subject: Prone.
Position of Therapist: Standing next to limb. Hand to give 1 to 2 pounds of
resistance is placed on the posterior leg just above the ankle. The opposite hand
may be used to stabilize pelvis at the Sacrum.
Test: Subject extends hip. Resistance is given straight downward to the floor.
Instructions to Subject: “Lift your leg off the table without bending your knee and
don’t let me push it down.”
19
Hip Flexion
Position of Subject: Sitting on table with thighs fully supported and lower legs
hanging over the edge.
Position of Therapist: Standing next to limb. The contoured hand to give 1 to 2
pounds of resistance over distal thigh just proximal to the knee.
Test: Subject flexes hip, clearing the table.
Instructions to Subject: “Lift your leg off the table and don’t let me push it down.”
20
Hip External Rotation
Position of Subject: Sitting on table, supported by hands.
Position of Therapist: Kneels beside limb to be tested. The hand that gives
resistance grasps the ankle. 1 to 2 pounds of resistance is applied as a laterally
directed force at the ankle. The other hand which offers counter pressure is
contoured over the lateral thigh just above the knee. Resistance of 1 to 2 pounds
is given as a medially directed force at the knee.
Test: Subject externally rotates the hip.
Instructions to Subject: “Don’t let me turn your leg out.”
21
Hip Adduction
Position of Subject: Side-lying with test limb resting on the table. Uppermost limb
is supported by therapist by cradling the leg with the forearm.
Position of Therapist: Standing behind subject. The hand giving resistance to the
lowermost limb is placed on the medial distal part of the femur.
Test: Subject adducts hip until the lower limb contacts the upper one. Using 1 to 2
pounds of resistance.
Instructions to Subject: “Lift your bottom leg up to your top one. Hold it. Don’t let
me push it down.”
22
Hip Abduction
Position of Subject: Side-lying with test leg uppermost. Lowermost leg is flexed for
stability.
Position of Therapist: Standing behind subject. The hand giving resistance of 1 to 2
pounds is contoured across the lateral surface of the knee. The other hand is used
to palpate Gluteus medius and minimus.
Test: Subject abducts hip without flexing the hip.
Instructions to Subject: “Lift your leg up in the air. Hold it. Don’t let me push it
down.”
23
Doing it "to" or Doing it "With"
There are two approaches applied by therapists: "working on the person" and "working with
the person." Working on the person pre-supposes that the person cannot help themselves;
working with the person pre-supposes that the person has some practical responsibility for, and
ability to change, their own condition.
Every massage stroke is one or the other: doing it to the person or doing it with them; it is
either forcing them to relax or helping them discover that they are contracting and teaching
them to relax when, until then, they had forgotten how.
Done passively, tissue manipulation evokes (calls forward) a gradual deepening of the person’s
awareness and control of their muscular actions, but this deepening is greatly limited by the
lack of sensory feedback that active movement provides. Tissue manipulation done with active
participation by the person evokes more than relaxation and flexibility: Because the person
has enhanced awareness of the connection between sensation and movement, their control of
movement (e.g., strength, resting tension level, and coordination) improves much faster.
Massage Treatment
A combination of techniques and modalities are required to effectively treat the lower body.
The goal is to lengthen short, hypertonic muscles with deep-tissue, myofascial release, friction
massage, and active isolated assisted-stretching techniques which I have found to elongate this
dysfunctional tissue.
If your assessment skills are sound, you should have a good indication as to where you need to
focus your work. Keeping in mind Janda’s upper cross syndrome of predictable sequence of
tightness and weakness. Through experience I have found most problems dealing with muscle
tissue seem to come and go. With chronic complaints over years ligament damage and
structural changes occur.
One of my favorite techniques is a movement I like to call “Dynamic Extension Release”. It is
commonly known as a massage concept called “pin-and-stretch”, which is applying pressure to
a muscle as you elongate it. The first order of business is to position the person on the table in a
supine position.
In this manual, techniques described may only need to be performed on one side only. I have
included stretches to re-educate the effected muscle and to restore healthy resting lengths.
As we begin this work, assessment of the pelvic girdle is paramount because of the structural
relationship as the foundation of the vertebral column and it could point to dysfunction.
24
Assessment of Pelvic Girdle
•
•
•
•
•
With the person lying supine, gently pull the legs to center the person. While doing this,
approximate the leg length.
Rotate the feet left and right to determine flexibility of the internal and external rotators
of the hip. This information may help later to explain hip problems.
Facing the pelvis from the legs, place a finger on the crest of the anterior superior iliac
spine. Determine if the left or right anterior superior iliac spine is more anterior.
If one anterior superior iliac spine is more anterior this points to more tightness than the
other side.
More tightness on one anterior side usually means the opposite side is tighter on the
posterior side. Being this structure is the foundation of the spine. Not only will the spine
be rotated but the supporting muscles and connective tissue will be affected. Keep this
information in mind as you start your work.
25
Posterior legs – Gastrocnemius
•
•
•
•
•
Starting with a small amount of oil or lotion stroke up the entire leg with a gentle flowing
movement. This stroke not only gives you information as to the structure of the leg and
muscle development, but also muscle tightness or dysfunction.
With the calf muscle, using the fingers pull medial to lateral to treat the medial head of
the muscle. As you pull up and around the medial head feel for any muscle fiber
adhesions.
If any adhesions are found, go against the grain and smooth out any restrictions.
To release the outside head, push lateral to medial in the same fashion as the medial
head.
“Dynamic Extension Release” movement is performed by having the person start in
plantar flexion and slowly moves into dorsi flexion while you stroke the Gastrocnemius.
26
Posterior legs – Hamstrings
•
•
•
•
•
Starting with a small amount of oil or lotion, use forearm strokes up the hamstrings to
smooth out any superficial tightness.
Generally dysfunctional tendons that insert around the knee are best treated by stroking
with the tissue, not crossfiber.
Dysfunctional tendons that insert at the ischial tuberosity are best treated by crossfiber
friction.
The hamstring muscles are notorious for adhesions. If any adhesions are found, go
against the grain and smooth out any restrictions. Each hamstring muscle may have to be
treated separately.
“Dynamic Extension Release” movement is performed by having the person start in knee
flexion and slowly moves into knee extension while you stroke the Hamstrings.
27
Low back - Sacral ligaments
•
•
•
•
•
In the prone position, place a rolled up towel under the patient’s hip (optional).
Using finger tips gently crossfiber the length and width of the sacrum.
Noting any sensitive tissue.
Continue until a loosening is felt.
From your anterior pelvic assessment, one side may require additional work.
28
Low back - Sacroiliac fascia
•
•
•
•
•
In the prone position, place a rolled up towel under the person’s hip (optional).
Push straight down just above the sacrum to treat the iliolumbar ligament.
With a series of fascial glides, push from the iliolumbar ligament out and down toward
the greater trochanter, being sure to stay medial of the sacroiliac joint.
Continue until a loosening is felt.
From your anterior pelvic assessment, one side may require additional work.
29
Low back – Lateral rotator tendons
•
•
•
•
Bring the person’s knee up (flexion) and hip flexion to produce lateral rotation.
Push gently behind the great trochanter and crossfiber the rotator tendons.
If any adhesions are found, go against the grain and smooth out any restrictions.
“Dynamic Extension Release” movement is performed by having the person start in knee
flexion and slowly moves into internal rotation of the hip while you stroke the lateral
rotator tendons.
*Hip flexion will expose the Sciatic Nerve from under the Gluteus Maximus muscle.
30
Low back – Lateral rotators
•
•
•
•
Bring the person’s knee up (flexion) and hip flexion to produce lateral rotation.
Begin superior to the greater trochanter, using the elbow or palm of the hand.
Slowly stroke down toward the Ischium.
If any adhesions are found, go against the grain and smooth out any restrictions.
31
Lateral Raffe – Quadratus Lumborum
•
•
Start where the lateral thorcolumbar fascial and the base of the 12th rib meet. Compress
medially at least 45 degrees to reach underneath the lateral side of the Erector Spinae,
compress down until the Ilium bone is reached.
If this area is tender to the touch or in a contracted state, hold static pressure until it
releases.
32
Mid back – Erector Spinae
•
•
•
•
Start your forearm stroke up the back from the hip, just lateral from the spine,
concentrating on the erector muscle area about T12 up to T6. (This area receives a lot of
abuse and generally can withstand deep pressure).
Continue laterally to reach the Lateral Raffe.
Compress the lateral edge into the center of the spine to further release this muscle
group.
“Dynamic Extension Release” movement is performed by having the person start by
arching their back (flexion) and slowly lowers to the table while you stroke the area from
T-12 through T-6 lateral of the spinous processes in a superior and inferior direction.
33
Anterior legs – Quadriceps
•
•
•
•
•
•
In the supine position, using the fingers to push lateral to medial.
If knee problems are present with tight quadriceps, hook around the lateral side of the
patella with the thumb or fingers and push lateral to medial over the top edge of the
patella to treat the vastus lateralis tendon. Continue diagonally up to the adductor
muscles.
To treat the medial quadriceps, hook around the medial hamstring tendons behind the
knee and pull medial to lateral.
With “Dynamic Extension Release” make sure the knee can bend by placing the lower
leg off of the table.
Straighten the knee and demonstrate the movement of bending the knee to the patient.
Start by having the knee straight and instruct the person to slowly bend the knee while
you stroke proximal to distal (or reverse) to release the quadriceps.
34
Anterior hip - Inguinal ligament
•
•
•
•
•
Concentrate with earlier determined ASIS if it is more anterior. Place one hand inferior to
the ASIS on the inguinal ligament. Slowly press into the ligament.
With the other hand, flex the hip and the knee and rotate the leg, feeling the tendons
tighten as you rotate the leg. Rotate clockwise and counter clockwise.
Follow any restriction and hold until a release is felt.
Continue the pressure medially one inch toward the pubic area searching for restrictions.
With one hand on the ankle and the other hand on the knee. Rotate the flexed hip while
applying a mild torque clockwise and counter clockwise.
35
Active isolated assisted-stretching
These movements will not only elongate tight muscles and ligaments that you
have just released, reeducate the injured tissue, but will also strengthen weaken
areas without activating the stretch reflex.
Posterior Calf stretch (prone)
•
•
•
•
Bend the knee and place the hand on plantar side of the foot.
Instruct the person to bring their foot downwards into dorsi flexion as far as possible,
contracting the anterior shin muscles and exhale during movement.
Therapist provides gentle assistive stretch at the end of the movement by using the
hand to provide a gentle pushing effort.
10 repetitions.
36
Hamstring stretch (supine)
•
•
•
•
Place one hand behind the bent knee; push the knee superior to flex the hip.
Instruct the person to straighten the knee as far as possible, contracting the quadriceps
muscles and exhale during movement.
Therapist provides gentle assistive stretch at the end of the movement by using the
hand to provide a gentle pushing effort of the foot to help straighten the knee.
10 repetitions.
37
Hamstring/Glutes (Additional)
•
•
•
Lie on the floor with towel in both hands, place one foot in the middle of the towel.
Pull towel toward the body, while contracting the quads to straighten the knee.
10 repetitions.
•
•
Lie on the floor with knee bent, placing hands on the sole of the foot.
Pull the foot toward the center of the body and to the floor, while contracting the hip
flexors.
10 repetitions.
•
38
Sacroiliac fascia stretch (passive movement supine)
•
•
•
Instruct the person to bring the knee to the opposite side as far as possible, contracting
the adductor muscles and exhale during movement.
Therapist provides gentle assistive stretch at the end of the movement by using the
hand to provide a gentle pushing effort at the knee.
Change the angle of rotation of the hip until the person feels the tension at the sacrum.
Erector Spinae Stretch (passive movement standing)
•
To stretch the right side, cross the elbows overhead. Bend laterally to stretch. Repeat on
the opposite side.
39
Quadratus Lumborum stretch (passive movement supine)
•
To stretch the right side, cross the left leg over the right. Place the fingers in between
the two ankles and pull both legs to the left. Repeat on the opposite side.
40
Quadriceps stretch – (prone)
•
•
•
•
Stabilize the low back by placing the hand on the sacrum. With the other hand cradle the
bent knee and lift to extend the hip.
Instruct the person to bring their knee away from the table as far as possible,
contracting the gluteal muscles and exhale during movement.
Therapist provides gentle assistive stretch at the end of the movement by using the
hand to provide a gentle lifting effort of the knee.
10 repetitions.
41
Inguinal ligament stretch (passive side lying)
•
•
Facing the feet, place your hip into the person’s sacrum. Grasp the bent knee and the
ankle into hip flexion.
Rotate your body outward from the table while holding the knee and ankle to stretch the
hip into extension.
42
Quadriceps/Hip flexor stretch (additional)
Isotonic Active stretching (seated on the edge of the table) is used to lengthen muscle by
contracting against resistant and then relaxing into a further stretch.
•
•
•
Have the person hold the bent knee of the opposite leg to be stretched, while
supporting the head lower the person to the table.
Place your hand on the knee of the straight leg, pushing the hip into extension.
Instruct the patient to flex the hip and flex the knee while “pushing against your hand”
using 20% of their effort for 5 seconds and repeat 5 times, then reverse.
43
Kinesiology tape treatment
By using the addition of kinesiology tape after treatment it has accomplished 2 objectives.
1. Affects the sensory receptors to help the person to be aware of areas or positions they
might have forgotten about.
2. Aids in mechanical correction by utilizing the stretching qualities of the tape with
pulling where it is needed to stimulate a sensation which results in the body’s
adaptation to the stimulus.
Application essentials
•
•
•
Clean the area with alcohol before application to remove any oil residue.
For overused or tightened muscles, the tape is applied from insertion to origin.
For chronically weakened muscles or where increased contraction is desired, the tape is
applied from origin to insertion.
•
Spilt the 2 halves to make
a “V”.
Have the person flex their
hip.
Apply the anchor point
with no tension at the
Ischium.
Attach the 2 ends with
25% tension around the
center of the gluteus and
posterior or behind the
•
•
•
greater trochanter.
44
Self treatment
Other than the treatment you have given, the person’s best chance of success with their pain is
realizing that the management of their lower body is their responsibility. Self treatment will be
more effective in the long term management of their pain than any other form of treatment.
•
•
•
•
Present the person with a stretching card on the following page.
Demonstrate each movement for the person.
Have the person perform these stretches daily as often as possible.
Instruct the person to go to their end range with minimal discomfort.
Encourage the person to be as active as possible even if they are experiencing pain. Awareness
of improper posture and self stretches will reeducate the lower body, retard scar tissue
formation and will continue to improve range of motion.
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