Massage & Bodywork

July/August 2012

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best practices BUSINESS SIDE | Q & ART | TABLE LESSONS | SAVVY SELF-CARE or sacroiliac joint (SIJ) dysfunction, to name just a few. Let's reason through this partial list together. When Mrs. G. first came to me, my first question was whether the pain was worse sitting, standing, or walking. "Sitting is fine, but I cannot stand or walk for very long," she responded. Pain during walking that is relieved while sitting could implicate arthritic changes in the hip. However, standing does not typically bother an arthritic hip. I asked Mrs. G. to lie supine on the table while I checked her left internal femoral rotation, which was even greater on the involved left hip than the right. External rotation of her left femur against resistance also elicited no pain. With full range (external rotation and flexion were also normal) and nonpainful contraction, neither hip pathology nor piriformis issues seemed likely. Careful palpation of the iliocostalis A "Software" Problem Troubleshooting Sources of Pain By Douglas Nelson "Thanks for checking in with me," I said, taking a call from a client I had seen three weeks earlier. "I hope you are a bit better, especially since you drove so far for the appointment." "Not just a bit better, a lot better," she said. "The pain is almost completely gone. I am thrilled!" Given that Mrs. G. had been suffering from nearly constant pain in her left buttock, this was great news. With any presenting problem, the old adage applies: one symptom, many possible causes. Mrs. G.'s pain could have been due to a multitude of factors—hip joint pathology, piriformis issues, trigger point referral, a spinal facet issue, and the costal attachments of the quadratus lumborum revealed sensitive areas, though none that referred to the buttock. I crossed trigger point referral off the list. To explore facet compression, I rotated her lumbar spine to the right (which did not recreate her pain), but rotating the lumbar spine to the left caused an immediate reaction. "Oh my gosh," she said. "That feels great. I feel a wave of relief from my spine to my hips." Score one for facet compression. Lying on the right side with the left hip forward and the spine rotated left decompresses the left lumbar facets, so I continued to hold Mrs. G. in that spinal position as long as it provided her relief. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. 35 PAIN

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