5 minutes: Attendance and Breath of Arrival. 50 minutes: Problem-Solving: Pelvis and Legs

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Alice Edwards
5 years ago
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2 5 minutes: Attendance and Breath f Arrival 50 minutes: Prblem-Slving: Pelvis and Legs

3 Punctuality- everybdy's time is precius: Be ready t learn by the start f class, we'll have yu ut f here n time Tardiness: arriving late, late return after breaks, leaving early The fllwing are nt allwed: Bare feet Side talking Lying dwn Inapprpriate clthing Fd r drink except water Phnes in classrms, clinic r bathrms Yu will receive ne verbal warning, then yu'll have t leave the rm.

6 Pirifrmis syndrme Entrapment f ne r bth divisins f the sciatic nerve by the pirifrmis muscle in the gluteal regin. Divisins f the sciatic nerve Tibial and perneal nerves.

7 Greater sciatic ntch f the ilium (superir and lateral) Pirifrmis (superir) Other 5 deep lateral rtatrs (inferir) Sacrspinus ligament (inferir)

8 Pain r paresthesia in the gluteal regin that radiates dwn the psterir lwer extremity Paresthesia Sensatin f pins and needles. Lw back pain is als a cmmn symptm. Treating it als is wise.

9 Sitting fr lng perids f time (sciatic nerve cmpressin and lcal tissue ischemia) Sitting with a wallet in the back pcket (nerve cmpressin)

Nerve entrapment leads t aching buttck pain and weak hip abductrs.

10 Superir gluteal nerve entrapment Als passes thrugh the greater sciatic ntch. Travels superir t the pirifrmis. Innervates the gluteals. Nerve entrapment leads t aching buttck pain and weak hip abductrs. Myfascial trigger pints in the pirifrmis Sacriliac jint dysfunctin Similar, but n radiating pain dwn the lwer extremity

11 10% f the ppulatin: ne divisin f the sciatic nerve ges thrugh the pirifrmis muscle. The ther divisin passes inferir t the muscle. 2-3% f the ppulatin: ne divisin passes superir while the ther divisin passes inferir t the pirifrmis. 1% f the ppulatin: bth divisins pass thrugh the pirifrmis. Nte: it is nt necessarily true that an individual with the sciatic nerve passing thrugh the pirifrmis wuld be in serius discmfrt all the time.

13 Diffused pain felt in the lumbar r sacral regin Caused by a number f prblems at the sacriliac jint with similar symptms Pain may be referred t the grin r psterir leg Can be mistaken fr lumbar disc pathlgy

14 Acute injury such as an autmbile accident Chrnic dysfunctinal bimechanics such as gait alteratin r leg length discrepancy

15 Sprain Ligament fiber stretching (permanent) r tearing. Frictin between the articular surfaces Jint misalignment r jint lcking

16 The sacriliac jints: Are the jints between the sacrum and ilia f the pelvic bnes Have n muscles that directly span the jints Use lumbsacral muscles, ligaments, and fascia t cntrl mtin Have rugh surfaces t help prduce stability

17 The sacrum: Acts as a wedge between the tw pelvic bnes Hlds the weight f the upper bdy Is held firmly in place by a tight webbing f ligaments Has very slight mvement called nutatin and cunternutatin

18 Nutatin and cunternutatin f the sacrum: Nutatin Frward tipping f the superir surface f the sacrum Cunternutatin Backward tipping f the superir surface f the sacrum Has a ttal range f 7-8 in the sagittal plane Is essential fr prper mechanics (walking, bending ver, etc.)

19 Ligaments f the S.I. jints: Anterir sacriliac Psterir sacriliac (fascially cnnect t Pirifrmis) Ililumbar Sacrtuberus (fascially cnnected t G. Max and Biceps Femris) Sacrspinus

23 Reductin r cessatin f exacerbating activities Effective Stretching and jint mbilizatin Variable effectiveness: dn t take the stretch t far fr t lng. Anti-inflammatry medicatin Variable effectiveness: inflammatin may nt be present Surgery Variable effectiveness Crytherapy Variable effectiveness: nly effective t a depth f 1 cm.

24 Jint mbilizatin and manipulatin Variable effectiveness: it s nt clear why it reduces pain Strength training and exercise prgrams Effective: stabilizes the jint Prliferant injectins Variable effectiveness: encurages grwth f stabilizing fibrus tissue

26 Prne Sft-Tissue Manipulatin: Overview Draping: uncver the back Myfascial release lwer back Draping: fld sheet diagnally t access upper and lateral gluteals Myfascial release gluteals Lwer back (thraclumbar fascia, latissimus, and erectrs) Swedish Deep lngitudinal stripping S.I ligament deep transverse frictin *Draping: cver the back, and uncver ne leg Deep Massage The Lauterstein Methd Gluteus Maximus Hamstrings Swedish Gluteal Hamstrings Deep lngitudinal stripping hamstrings Pirifrmis Deep lngitudinal stripping Pin and stretch Active engagement deep lngitudinal stripping Cntract-Relax stretch Draping: cver the leg and uncver the lw back S.I ligament deep transverse frictin Repeat starting at the * abve t treat the ther leg

27 Draping: uncver the back Lwer back myfascial release Assess the fascia befre and after t track effectiveness Arms crssed: place hands 10 inches apart n either side f the spine Apply a light degree f pulling frce between the hands Hld. Wait fr a subtle sensatin f tissue release r a wrking sign Slwly release and repeat (between the sacrum and T10)

28 Draping: fld sheet diagnally t access upper and lateral gluteals Gluteal myfascial release Use a light and slw frce t lengthen the superficial fascia Using tw lse fists, strke medial t lateral D nt neglect the uppermst gluteal fibers

29 Lwer back Swedish Address thraclumbar fascia, latissimus drsi, and erectr spinae Effleurage, wringing, pulling, and Lift and Rll BMT Tissues must be thrughly warmed and sftened befre prceeding

30 Lwer back deep lngitudinal stripping Address thraclumbar fascia, latissimus drsi, and erectr spinae Use thumbs r fingertips with hands stacked fr stability Wrk superirly in 2-4 inch sectins Pause and repeat in areas f tensin Prgressively wrk mre deeply as tissues sften

31 S.I. ligament deep transverse frictin Use thumbs r finger tips with hands stacked fr stability Use mderate t deep pressure fr 1 minute Address all ligaments between ilium and sacrum

32 Draping: cver the back and uncver ne leg Deep Massage the Lauterstein Methd Use lighter pressure since the tissues are nt deeply warmed yet Gluteus Maximus Hamstrings

33 Gluteal and Hamstring Swedish Effleurage Fulling Kneading Gluteal and Hamstring cmpressin BMT Nte: be extremely thrugh in warming and sftening the tissues

34 Hamstring deep lngitudinal stripping Start with a very brad frearm strke Prgress t thumb r fingertip stripping wrking prximally Wrk superirly in 2-4 inch sectins Pause and repeat in areas f tensin Prgressively wrk mre deeply as tissues sften

35 Pirifrmis deep lngitudinal stripping Check in with the client. This may feel intense. Pirifrmis runs diagnally frm the greater trchanter tward the center f the sacrum Using tw lse fists fcusing n 1 r 2 knuckles, strip laterally Prgress frm medium t deep pressure

36 Pirifrmis pin and stretch Hlding the client s ankle, flex the knee t 90 Shrten the pirifrmis: take the hip int full lateral rtatin Pin the pirifrmis: use a thumb r finger t melt int it Lengthen the pirifrmis: maintain the pressure. Medially rtate the hip Repeat several times fr maximum benefit

37 Pirifrmis active engagement deep lngitudinal stripping Check in with the client. This may feel intense. Hlding the client s ankle, flex the knee t 90 Instruct the client: Use 50% f yur strength t hld yur leg in this psitin as I try t pull it tward me (ismetric cntractin) Slwly release that cntractin as I cntinue t slwly pull yur ankle tward me (pst-ismetric relaxatin, PIR) As the client releases, pull the ankle tward yurself Simultaneusly use the knuckles f a lse fist t strip the pirifrmis Repeat the Cntract-Relax-Passive Mvement and Stripping

38 Pirifrmis Cntract-Relax stretching Use this fr clients whse symptms are exacerbated by pressure Check in with the client: lateral rtatin may aggravate the knee jint Hlding the client s ankle, flex the knee t 90 Jint mbilizatins: hip medial and lateral rtatins Instruct the client: Hld yur leg in this psitin fr 5-8 secnds as I try t rtate it tward me (ismetric, pirifrmis lateral rtatin) Slwly release the cntractin (pst-ismetric relaxatin) Let me knw when this is a gd stretch fr yu Medially rtate the hip by pulling the ankle tward yurself When the client says its gd, hld fr three f yur breaths Slwly release the stretch and d jint mbilizatins f the hip

39 Repeat n the ther side starting with: S.I. ligament deep transverse frictin End with: S.I. ligament deep transverse frictin

Here are sme ptins: Wrk near the rigin and insertin t avid cmpressing the site f nerve entrapment which can be in the muscle belly Use Cntract-Relax

41 Reduce exacerbating activities such as prlnged sitting r sitting with a wallet in the back pcket. If the client reprts an exacerbatin f symptms during the treatment, mdify the treatment. Here are sme ptins: Wrk near the rigin and insertin t avid cmpressing the site f nerve entrapment which can be in the muscle belly Use Cntract-Relax stretching techniques Cmpletely and fully reduce hypertnicity in the gluteals prir t treating the pirifrmis s that treatment des nt feel invasive. After increasing tissue pliability, stretching is key t imprving flexibility and resetting the resting length fr the muscles.

42 Clients with S.I. jint dysfunctin may need accmmdatins t lie cmfrtably n the massage table. Have several ptins available. Mdify treatment if it exacerbates symptms Pst-treatment sensatins: Prpriceptin and jint psitin can change substantially when in a nn-weight-bearing psitin after treatment. Encurage clients t mve slwly when getting up frm the massage table. Bearing weight thrugh the S.I. jint again after treatment culd be painful.

44 Overuse cnditin that causes lateral knee pain Caused by repetitive knee flexin and extensin Similar symptms can als be caused by restrictins in lcal fascia and myfascial trigger pints in the vastus lateralis Runners and cyclists cmmnly experience this cnditin Frictin can cause irritatin and inflammatin t the distal psterir IT band and the bursa between it and the lateral epicndyle f the femur.

45 In knee extensin, the IT band is anterir t the lateral epicndyle f the femur As the knee mves int flexin, the IT band mves psterirly, rubbing acrss the lateral epicndyle

46 Reductin f ffending activities Effective: decreased distance r nt running n slped surfaces Orthrtics Variable effectiveness: can address bimechanical patterns Anti-inflammatry medicatin (crticsterid injectin) Variable effectiveness Surgery Variable effectiveness: incisin allws it t slide mre smthly

48 Supine Prne Side-Lying Sft-Tissue Manipulatin: Overview Lateral thigh Swedish Effleurage, full, wring, knead, and BMT t the TFL Deep Massage the Lauterstein Methd Just the TFL part f TFL, G. Medius, G. Minimus IT Band Lateral thigh Swedish Effleurage, fulling, and wringing Figure 4 psitin: Lateral thigh Kneading Deep lngitudinal stripping Trigger pint deactivatin Lateral thigh deep transverse frictin TFL pin and stretch

49 Lateral thigh Swedish Effleurage, fulling, wringing, kneading, and BMT t the TFL Deep Massage the Lauterstein Methd Just the TFL part f TFL, G. Medius, G. Minimus0 IT Band

50 Lateral thigh Swedish Effleurage, fulling, wringing

51 IT band deep transverse frictin T stimulate fibrblasts t repair cllagen and remdel scar tissue Alternate degrees f knee flexin and extensin t address the IT band withut directly pressing n synvial tissue deep t it. In knee extensin, the IT band is anterir t the lateral epicndyle f the femur As the knee mves int flexin, the IT band mves psterirly, rubbing acrss the lateral epicndyle

52 Lateral thigh Swedish Kneading

53 Lateral thigh deep lngitudinal stripping Wrk prximally in 2-4 inch sectins Begin using a lse fist Then prgress t thumbs r fingertips with hands stacked fr stability Pause and repeat in areas f tensin Prgressively wrk mre deeply as tissues sften

54 Lateral thigh trigger pint deactivatin Use client reprt and palpatin t lcate trigger pints Melt in using the steps f the fulcrum. Hld pints fr 8 secnds Use thumbs t hld pints fr 8 secnds

55 TFL pin and stretch Instruct the client: Extend yur leg behind yu and lift it tward the ceiling. (hyperextend and abduct at the hip) Supprt the weight f the leg with ne hand Use yur frearm t cmpress and hld (pin) the TFL Instruct the client: Take the weight f yur leg and slwly lwer it tward the grund behind yu. Repeat several times. Shift t using thumbs t be mre specific

57 If the cnditin is severe, adjust techniques t avid exacerbatin. It is nt a treatment gal t make the IT band as pliable and flexible as the surrunding tissues. Address sft-tissue tensin in all f the lwer extremity muscles, especially the quadriceps. Thermtherapy n the lateral thigh tissues may enhance stretching and massage treatments thrugh increased cnnective tissue pliability.

58 Use cautin with any technique that aggravates symptms. If the tissues are tight and sensitive but prduce n characteristic referral patterns, then myfascial treatments can be effective Address tensin in the TFL and gluteus maximus t reduce IT band tensin

59 Pirifrmis Syndrme, S.I. Jint Dysfunctin and IT Band Frictin Syndrme

BROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:

BROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised: Page 1 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 PROTOCOL FOR: All trained staff PURPOSE: Range f Mtin (ROM) exercises are very imprtant if an individual has t stay in bed r in a wheelchair.