SCIATICA. Pelvis P t III $15 ADVANCED-TRAININGS.COM TIL LUCHAU, DIRECTOR NAME: 3514 Nyland Way. Lafayette CO USA.

Transcription

1 A D V A N C E D M Y O F A S C I A L T E C H N I Q U E S SCIATICA Pelvis P t III ADVANCED-TRAININGS.COM TIL LUCHAU, DIRECTOR 3514 Nyland Way Lafayette CO USA tel. 303/ NAME:. 10/16 $15

2

3 RECOMMENDED RESOURCES for More Learning and Review SCIATICA Online Study Guide Free, or for-credit option. SCIATICA & DISK ISSUES Video Course (DVD or Download) Discounted in class or online at: PELVIS, HIP & SACRUM Video Course (DVD) Discounted in class or online at: Private FACEBOOK DISCUSSION GROUP Advanced Myofascial Techniques For questions, discussion, etc Adv. Myo. Techs p. i

4 CONTENTS Acknowledgments and Disclaimers... iii The Advanced Myofascial Techniques Series...iv Certification Information...v Other Learning Options... vi Table: Types of Sciatica...vii Causes of Axial Sciatic Entrapment...viii Axial Sciatic Signs... ix Axial Sciatica Considerations... x Sciatica Stats... xi Appendicular Sciatica Signs... xii Contributors to Appendicular Sciatica...xiii Appendicular Sciatica Entrapment Sites...xiv a. AXIAL SCIATICA Sequence...A-01 Lumbar Tests...A-02 Piriformis Test...A-03 Iliac Crest...A-04 Lumbar Space: Obliques... A-05 Lumbar/Visceral Space Decompression... A-06 Psoas: Medial Aspect... A-07 SI Release: Anterior/Posterior... A-08 b. APPENDICULAR SCIATICA Sequence...B-01 Sciatic Nerve Glide Test... B-02 Gluteus Medius, Minimus (Side-lying)... B-03 Leg Rocking (prone)... B-04 Piriformis Pool-Cue...B-05 Sacrotuberous Ligaments II...B-06 Biceps Femoris/Adductor Magnus...B-07 Sciatic Nerve: Prone... B-08 Sciatic Nerve: Supine A... B-09 Neck Core/Sleeve...B-10 x. SUPPLEMENTAL TECHNIQUES...X-01 Lumbar Test Variations... XA-02 L4/L5/S1 Decompression (Prone)...XA-03 Psoas: Prone...XA-04 Iliolumbar Ligaments: Anterior Aspect... XA-05 L4/L5/S1 Decompression (Side-Lying)... XA-06 Twists... XA-07 Lumbar/Viscera Decompression II... XA-08 Leg-Over Twists... XB-09 Piriformis & Rotators... XB-10 Medial Hamstring Origins...XB-11 Pigeon Pose... XB-12 Pigeon Pose (Supine)... XB-13 Rotator Stretch (Seated)... XB-14 Sacrospinous Ligaments, Coccyx... XB-15 Sciatic Nerve: Supine B...XB-16 Sequence Page Answer Keys...XB-17 p. ii

5 A-01 a. AXIAL (LUMBAR) SEQUENCE Intentions / Goals: Assess and distinguish axial from 1. contributions to sciatic pain; Gentle lumbar and psoas 2. ; Ease overall 3. or splinting from pain; 4. inherent stability or functional adaptations. Indications: 5. back, 6. and/or 7. thigh pain, with: SLT 8. ( ) positive for lumbar involvement.

6 About this Notebook This notebook can help you organize your notes, and serve to remind you of the key points for each technique you learn in your workshop or DVD study. Please note that it is NOT intended to serve as a complete course manual or comprehensive instruction book -- key instruction for the techniques we cover happens only in class, and the photos and brief notes in this book, even when used with our DVDs, cannot substitute for this important personal instruction. Acknowledgments and Disclaimers Many thanks to past participants, assistants, colleagues, teachers, and collaborators for their assistance in the development of this work and manual. Teachers whose influence can be seen here include Jan Sultan, Dub Leigh, Ed Maupin, Emmett Hutchins, Jeff Maitland, Michael Salveson, Jim Asher, and many others. Special acknowledgment goes to the inspiration provided by Dr. Ida Rolf, founder of Rolfing, Philip Greenman, DO, and many other manual therapy pioneers and innovators. Photography credits for the manual go to Loretta Carridan Luchau CMT, John Gillies CMT, Dameron Midgette CAR, and Larry Koliha CR CAMT. Special thanks goes to Larry Koliha CR CAMT, Jeremy Sutton CR CAMT, and to Gary Burns CR CAMT for their many contributions.. DISCLAIMERS: This course teaches soft-tissue myofascial techniques for practitioners and advanced students of hands-on body therapies, and is not a course in Rolfing structural integration or Rolfing technique. Rolfing is a service mark of the Rolf Institute of Structural Integration, which is the sole trainer and certifying body for Certified Rolfers. Please note that not every scheduled course is associated with the Rolf Institute. The Advanced Myofascial Certification Program is administered by and is not associated with the Rolf Institute. This course does not teach osseous adjustments or chiropractic techniques. The methods taught do not constitute medical treatment and a physician should be consulted in advance about any conditions which might contraindicate this work. While every attempt is made to insure the safety of the techniques taught, participants assume all risk for participation and subsequent application of methods learned., the Rolf Institute, and most other sponsors are approved by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) as Continuing Ed. Providers under Category A. Rolf Institute and other types of CE credit are also available: please inquire. All reproduced photo and diagram copyrights are retained by original sources. Special thanks to Primal Pictures Ltd., Jeff Linn, Tom Myers, and others for permission to use their graphics. Manual and material copyright 2005 Adv. Myo. Techs p. iii

7 The Advanced Myofascial Techniques Series Since 1989, this popular series of seminars presents practicing somatic therapists and qualified students with advanced and little-known myofascial techniques which can be easily incorporated into existing personal styles. Drawing on a wide range of disciplines, the focus is on unusual, interesting, and fresh approaches that will both expand technique repertoire and inspire creativity and innovation. Potential topics include: Specific techniques for common structural and functional complaints Relieving pain, restoring lost function, and getting lasting results Utilizing both active and passive movement to enhance effectiveness Precision in working with specific tissue types and body layers Combining indirect or subtle work with deep or direct work Tracking subtle psychophysiological and nervous system responses Ways to work sensitively, safely, and comfortably at very deep levels. The Advanced Myofascial Techniques workshop series presents a comprehensive system for working with the body in its entirety, encompassing over 20 session sequences and more than 200 techniques, tests, and procedures. Workshops in the series may be taken individually, or combined in any order. The five principle courses include: Arm, Wrist, & Shoulder Legs, Knees, & Feet Pelvis, Hip, & Sacrum Neck, Jaw, & Head Spine, Ribs, & Low Back Specialty courses include: Whiplash (2 days) Scoliosis (2 days) Sciatica & Disc Issues Advanced Knee Issues TMJ Headaches Myofascial Essentials Myofascial Mastery Adv Ilia & Sacrum (2 days)...and others. These courses are intended for trained practitioners and students of hands-on body therapies (for example, Bodyworkers, Physical Therapists, Rolfers, Chiropractors, Structural Integration Practitioners, Massage Therapists, Neuro-Muscular Therapists, and other somatic practitioners, etc.) Completion of the 5 principle courses plus electives leads to optional Certification in Advanced Myofascial Techniques (CAMT). Organizer and In-service inquiries invited Adv. Myo. Techs p. iv

8 Get CERTIFIED in Advanced Myofascial Techniques Top-Quality Training, Simple and Flexible Program Designed for practicing manual therapy professionals and advanced students, the Advanced Myofascial Techniques Certification Program allows you to earn a credential that will set you apart from other practitioners in the eyes of clients, referral sources, clinics, and schools. Simply complete the 5 weekend seminars in the Advanced Myofascial Techniques series, complete at least 4 days of specialty workshops, and earn additional Elective CEU's through a variety of local or at-a-distance methods. Go as quickly or as slowly as you wish: there is no deadline for completion. Credit for past trainings and work is available, and enrollment in the Certification Program makes you eligible for discounted tuition on many of our trainings. Your savings and increased earning power will pay for your investment many times over. Advantages and Benefits * Flexible program: individually tailor your learning * Self-paced: go in any order; no deadline for completion * Full credit available for past Myofascial courses * At-a-Distance elective CEU options * No renewal fees or membership dues * Four-year term with easy, automatic renewal * Special discounts on select courses and telecourses * Individualized advising and program design assistance * Get trained and accredited by, a leader in the manual therapy field since 1985 * Earn CEU's: NCBTMB Category A Credit (up to 98 units). Rolf Institute and other types of CE Credit are available. Sign up now to start getting your discounts and earning credits! For more information and complete details, go to: /certification.html Adv. Myo. Techs p. v

9 LEARN MORE Earn Additional CE Credit A variety of distance learning options are available. Many online options are free, or charge only if a Certificate of Completion or CE is desired. Advanced Myofascial DVDs 1-Hr Study Guides and Certificate Courses Ethics for the Real World series Live and recorded webinars Articles & Books YouTube Technique Library...and more. Visit our site or your course s sales table for more info. Adv. Myo. Techs p. vi

10 vii

11 viii

12 ix

13 x

14 xi

15 xii

16 xiii

17 xiv

18 Lumbar Tests Lumbal-Tests A-02 P Straight-Leg Test (SLT) or Lasègue Test: client raises straightened leg at the hip (with knee extended). Increased pain can indicate lumbar or disc involvement. (Pain in opposite leg can be due to more severe disc herniation and is cause for referral). Criteria for positive SLT: 1. Sciatic pain at 30 to 70 degrees of hip flexion (70 is pictured); 2. Aggravation of pain with ankle dorsiflexion; 3. Relief of pain by knee flexion. Slump test variation: client curls spine and neck into slight flexion, while raising leg. Increased pain with slumping considered positive for dural tethering at nerve roots. Positional variations: Client can also be supine, or tests can be performed passively. Bowstring variation: with practitioner stabilizing client s hip at angle of maximum change in sciatic symptoms, knee is slightly flexed, usually relieving symptoms. Pressure with thumbs into the popliteal space will worsen symptoms when sciatic nerve is involved, due to stretch on nerve. Positive sign indicates peripheral sciatic nerve involvement.

19 Piriformis Test Piriformis-Test A-03 P Increased pain with hip flexion and adduction can indicate piriformis or hamstring involvement in sciatic pain. Variations: Client can be sitting (as pictured) or supine. Test can be active (as pictured), or performed passively. Increased pain with resisted active external rotation of a straight leg can also indicate piriformis involvement. Some sources suggest that including the passive and supine variations in assessment increase the accuracy of the Straight Leg and Piriformis Tests. Other sources purport that positional differences in results suggest malingering (purposeful feigning of physical symptoms for secondary gain).

20 Iliac Crest Crista iliaca A-04 D 06.99

21 Lumbar Space: Obliques Lumbalraum: Mm Obliqui A-05 D

22 Lumbar/Visceral Space Dekompression Lumbal- / Viszeralraum A-06 D Feel for anterior release of viscera from lumbars, while counter-rotating lumbars by lifting knees (or rolling pelvis with ASIS--lower photo). Modified version of one of Peter Schwind s Fascia & Membrane techniques. Variation: client supine with knees up; counter-rotate knees and viscera (as in side-lying version).

23 Psoas: Medial Aspect Psoas: Medialer Aspekt A-07 D Drop both knees off to one side to roll psoas away from lumbars. Passive or active. Ventral nerve roots of L3 and L4 nerves run through and medial to psoas. (L4 joins nerves L5-S3 to form the sciatic nerve.)

24 SI Release: Anterior/Posterior Lösen der ISG: anterior / posterior A-08 I Lift on one side of sacrum from under client, while applying counter-pressure on ASIS; feel for anterior/posterior release

25 B-01 b. APPENDICULAR SEQUENCE Intentions / Goals: 1. and reduce any neural: 2., 3., or 4. tethering. Indications: 5. back, 6. and/or 7. thigh pain, with: Positve 8. Test.

26 Sciatic Nerve Glide Test Ischiasnerv: Gleittest B-02 P Direct client to compare the sensations of straightening the affected and unaffected legs. If straightening the affected leg increases sciatic pain, nerve tethering could be a factor (at or proximal to the site of reported pain). Use Sciatic Nerve techniques to locate and release neural sheath adhesions. In general, work proximal to distal, retesting to track improvement. Straightening leg (extend knee). [If pain increases with knee extension:] Where do you feel it most? (Can often indicate site of tethering.) Can be helpful as a take-home client exercise/stretch. Clients should be cautioned not to overdo it, so as to avoid irritating an inflamed sciatic nerve. Variations (not pictured): 1. Positive test result when bringing leg across the body (knee extension with hip flexion with adduction) can indicate piriformis or hamstring involvement. 2. Placing the sole of the passive leg on the table by raising the knee can help differentiate between lumbar and non-lumbar tethering. Since knee-up position decreases lumbar extension, suspect tethering at lumbars if having passive leg s knee up decreases pain.

27 Gluteus Medius, Minimus (Side-lying) Gluteus medius, minimus (Seitenlage) B-03 D

28 Leg Rocking (prone) Beinschaukeln (Bauchlage) B-04 P Rhythmic femur rotation at hip joint. Feel for release of hip and leg tonus. Client can be supine or prone

29 Piriformis Pool-Cue Piriformis: Billardstock B-05 D Passive internal and external femoral rotation; Passive traction with abduction (by wrapping lower leg around practitioner s back); Active external rotation. SI variation: slight leg abduction, passive hip flexion (lifting leg off table). Keep lumbars long and in neutral. Thanks to Erik Dalton ( Piriformis and SI Joint Release Technique ).

30 Sacrotuberous Ligaments II Ligamentum sacrotuberale II B-06 D Ligament lies anterior to Gluteus Maximus. Working from opposite side, press into inferio-medial margin of ligament and wait for release. Since some fibers of piriformis attach to the sacrotuberous ligament, use passive or active femur rotation to differentiate tissues around ligament. Explain and ask for permission first

31 Biceps Femoris/Adductor Magnus Biceps femoris / Adductor magnus B-07 D Roll biceps femoris laterally, adductor magnus medially to free the passageway for the sciatic nerve.

32 Sciatic Nerve: Prone Ischiasnerv: Bauchlage B-08 D Passively flex and extend knee to glide nerve.

33 Sciatic Nerve: Supine A Ischiasnerv: Rückenlage A B-09 D Knee up. Feeling between hamstring bellies for nerve track. Client gently pulls knee towards chest; or extends knee; or brings leg across body (hip flexion with adduction). Hamstring variation: work bellies of hamstrings themselves.

34 Neck Core/Sleeve Hals: Kern / Hülle B-10 I

35

36 X-01 SUPPLEMENTAL TECHNIQUES (Demonstrated on DVD)

37 Lumbar Test Variations Lumbal-Tests XA-02 P 1. Slump test variation: client curls spine and neck into slight flexion, while raising leg. Increased pain with slumping considered positive for dural tethering at nerve roots. 2.Bowstring variation: with practitioner stabilizing client s hip at angle of maximum change in sciatic symptoms, knee is slightly flexed, usually relieving symptoms. Pressure with thumbs into the popliteal space will worsen symptoms when sciatic nerve is involved, due to stretch on nerve. Positive sign indicates peripheral sciatic nerve involvement. Positional variations: Client can also be supine, or tests can be performed passively.

38 L4/L5/S1 Decompression (Prone) Dekompression L4 / L5 / S1 (Bauchlage) XA-03 D Prone, knees up, slowly rolling pelvis with knees. Use gentle pressure to feel for evenness of left/right lumbar vertebrae mobility. Avoid pushing lumbars too far forward and so creating more lordosis.

39 Psoas: Prone Psoas: Bauchlage XA-04 D

40 Iliolumbar Ligaments: Anterior Aspect Ligamentum iliolumbale: anteriorer Aspekt XA-05 D Hip flexion, maintaining length in lumbers. Variation: use knuckles or even forearm (carefully) in clients with longer waists. Use with caution when lumbar disc issues are known or suspected.

41 L4/L5/S1 Decompression (Side-Lying) Dekompression L4 / L5 / S1 (Seitenlage) XA-06 D Client position: side-lying, knees bent and at table s edge, lower legs off table to sidebend and open lumbar spine. Decompress and de-rotate lumbars with local work on lumbars as well as global work between segments. Use listening touch, direct pressure, gentle twists, etc. Use with caution when lumbar disc issues are known or suspected.

42 Twists Drehungen Torceduras Intention: length in lumbar space; integration. XA-07 I Spinal foramen are usually opened by contralateral rotation. For example, leftside foramen symptoms will typically be relieved by rotating the truck to the right (lower photo). Use with caution when lumbar disc issues are known or suspected. Avoid rotation with acute disc issues

43 Lumbar/Viscera Decompression II Dekompression Lumbal- / Viszeralraum II XA-08 D Feel for lateral release of viscera from lumbars, while counter-rotating lumbars by dropping knees. Modified version of one of Peter Schwind s Fascia & Membrane techniques.

44 Leg-Over Twists Beine über Kreuz drehen XB-09 D Use position to locate and release any sciatic nerve tethering in hip or leg

45 Piriformis & Rotators Piriformis & Rotatoren XB-10 D Feel and release rotators around their attachments on greater trochanter, and piriformis attachments on sacrum. Indicated for sciatica, etc. Avoid irritating sciatic nerve with excessive direct work on the nerve itself

46 Medial Hamstring Origins Mediale Ursprünge der hinteren XB-11 D Pelvic rocking, knee flexion 07.99

47 Pigeon Pose Taubenstellung XB-12 I Salamba Kapotasana Variation: supine

48 Pigeon Pose (Supine) Taubenstellung (Rückenlage) XB-13 I

49 Rotator Stretch (Seated) Dehnen der Rotatoren (im Sitzen) XB-14 I Equalize contact of left and right ischial tuberosities with the floor. Feel for stretch in rotators and hip joints. Variation: forward bend; or, varying amounts of hip adduction and abduction. Guptasana

50 Sacrospinous Ligaments, Coccyx Ligamentum sacrospinale, Coccyx XB-15 D The sacrospinous ligament is anterior to sacrotuberous ligament; medial fibers attach to coccyx.

51 Sciatic Nerve: Supine B Ischiasnerv: Rückenlage B XB-16 D From underneath, feeling between hamstring bellies for nerve track, as in lower photo. (Upper photo shows hand position only.) Client slightly flexes and releases knee to lengthen nerve.

52 A. TIBIA/FEMUR Sequence SEQUENCE PAGE ANSWERS Intentions Assess and release any restrictions to tibia/femur 1. mobility Indications 2. Flexion or 3. extension restrictions Knee 4.pain 5.Chronic effects of knee Injuries or surgery. B. PATELLA Sequence Intentions 1. Assess and release any to restrictions balanced patella mobility Indications 2. Patellar pain, discomfort, crepitus, or noise. C. LEG INTEGRATION Sequence Intentions Assess 1. alignment and balanced tone across knee joint Re-establish 2. continuity and supportive capacity of entire leg Indications Knee pain or discomfort when accompanied by genu 3. valgum or 4. varum Pes Anserinus or 5. popliteal bursa pain. After 6. deep work with knees, ankles, or feet. Adv. Myo. Techs: Knee p. X-12