Issue link: https://www.massageandbodyworkdigital.com/i/296580
I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 103 The hypertonic muscles through his low-back region will be most effectively addressed with deep stripping techniques. Static compression methods will address the specific trigger points. The focus with the deep stripping techniques will likely be on the lumbar paraspinal muscles, as well as the quadratus lumborum. Because of the role in maintaining spinal stability, it is important to treat the deep intrinsic spinal muscles that lie in the lamina groove as well (Image 4). Because of the muscular and fascial connections throughout this region, one should be comprehensive and thorough in treating all of the superficial and deep layers of the gluteal muscles, hamstrings, and posterior calf muscles. Specific attention should also focus on the hip abductor muscles, because that is where the key trigger points reproduced Darren's primary pain complaint. One way to effectively address the trigger points in the hip abductors is to modify the assessment method used during the evaluation process by pressing on the trigger points during active concentric and eccentric contraction. Compression with active engagement is very effective for addressing trigger points in these thick muscles. To perform this procedure, have the client in a side- lying position and locate the primary trigger points in the lateral hip abductor muscles. Apply pressure to those muscles and then have the client actively contract the muscles by lifting the leg in abduction. Compression with active engagement for the hip abductors. Image courtesy of Whitney Lowe. 5 It is likely to feel quite sore when he does this, so do not use too much pressure at the outset (Image 5). Another effective variation for addressing this muscle group and trigger points is to perform a reverse method, where pressure is applied during the eccentric elongation. This is essentially a pin and stretch technique. Have the client bring the leg up into abduction, then apply pressure to the hip abductors and instruct the client to slowly lower the leg as far as possible while you maintain pressure. The eccentric activation of those muscles while pressure is maintained can be painful for the client, so be sure to gradually measure your progress and pressure level. CONCLUSION Darren's case illustrates how important it is to be thorough in the evaluation process, because it is common for different conditions to have similar symptoms. Also, the key point illustrated here is the importance of clinical reasoning using analytical skills to go outside of traditional evaluation methods. In this case, it was the application of deep pressure applied with a contraction of the muscle that revealed deep trigger points in the gluteus minimus that were not immediately evident during the initial evaluation. By developing your analytical skills and your technique, you will become a far more effective clinical practitioner for your clients. Whitney Lowe is the author of Orthopedic Assessment in Massage Therapy (Daviau-Scott, 2006) and Orthopedic Massage: Theory and Technique (Mosby, 2009). He teaches advanced clinical massage in seminars, online courses, books, and DVDs. You can find more ideas in Lowe's free enewsletter—and his books, course offerings, and DVDs—at www.omeri.com. Compression with active engagement is very effective for addressing trigger points in these thick muscles.