Issue link: https://www.massageandbodyworkdigital.com/i/530196
CLINICAL APPS Lisa had pain just superior to the greater trochanter, so it is possible that there is tissue damage at the musculotendinous junction or possibly chronic tendon overuse of the gluteus medius or minimus tendons themselves. Deep friction massage applied directly to these tendons will help encourage healing of any scar tissue that might be present from a tear, as well as encourage fibroblast proliferation that may help repair the damaged collagen matrix if there is chronic overuse tendon pathology. After a few treatments, more specific work can be applied to the hip abductor muscles with active engagement methods similar to what was performed on the piriformis. For this treatment, the client is in a side-lying position, with the leg in a fully abducted position. Instruct the client to slowly bring the leg back down as far as possible, even dropping below the level of the table if possible (Image 6). As she brings her leg down in adduction, perform a deep stripping technique on the hip abductor muscles. This technique can be painful, so proceed slowly and with caution, and adjust to appropriate pressure levels. Note that there may be significant tightness or tenderness in small areas of these muscles, and additional attention can be focused on myofascial trigger points with pressure from a thumb, elbow, or pressure tool. There are other treatment solutions that can be very helpful for addressing Lisa's injuries. It is helpful to address not only the lateral hip region, but also the low back and lower extremity. See these additional treatment strategies, along with video examples, and home- care solutions on the Resources page of the Academy of Clinical Massage (www.academyofclinicalmassage.com/ resources-articles). The Massage & Bodywork digital edition has a video demonstrating one of the active engagement techniques used above. CONCLUSION Lisa's case is interesting because it shows the importance of an integrated understanding of anatomy, kinesiology, and various types of tissue pathology. The skillful clinician can pick up key factors in the client history, tie those with other responses during the physical examination process, and develop a good understanding for how to proceed. Constructing a beneficial and successful treatment plan for a complex condition such as Lisa's often involves taking a bit more time in assessment than more straightforward conditions. Notes 1. R. C. Grumet et al., "Hip Pain in an Athletic Population: Differential Diagnosis and Treatment Options," Sports Health 2, no. 3 (May 2010): 191–6. 2. F. Michel et al., "The Piriformis Muscle Syndrome: An Exploration of Anatomical Context, Pathophysiological Hypotheses and Diagnostic Criteria," Annals of Physical and Rehabilitation Medicine 56, no. 4 (May 2013): 300–11. Earn CE credit for this article and learn about Whitney Lowe's innovative, engaging, and interactive instructional designs. Lowe's texts and courses have benefited professionals and schools for more than 25 years. For more information, visit www.academyofclinicalmassage.com. For a full discussion of additional treatment protocols for this client, visit www.academyofclinicalmassage. com/resources-articles. 100 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 5 Active engagement lengthening for the hip abductors. Image courtesy Whitney Lowe. Pin and stretch technique for the piriformis. Image courtesy Whitney Lowe. 5 6