Issue link: https://www.massageandbodyworkdigital.com/i/72093
Helping her onto my table, I mentally ran through some potential possible causes. My first thought was to lift her leg to create passive hip flexion. As I did this, she winced in pain. If passive movement created pain, that could indicate intra-joint pathology. Or … "Completely relax and allow me to lift your leg," I said. "I will go slowly and we can do it several times if you'd like." Indeed, as she relaxed, the pain during passive hip flexion disappeared. In all likelihood, the muscles of the joint were hypersensitive to length changes and fired reflexively. This was defense, not defect. I did this at first with her knee straight, then with the knee flexed. Movement was fine until somewhere around 90 degrees of hip flexion, when she felt a pinching pain in her groin. "Describe the position you were in again. You were sitting in a chair and forcefully pulling down and forward correct?" I asked, demonstrating this action to her. "Actually, most of the work was to my left, so I was leaning that way while I was pushing my right leg outward (abduction) a bit for stability." At that moment, the muscle that took the brunt of the strain became very clear. I suspected that the muscle was a hip flexor; possible culprits were the psoas, iliacus, and tensor fascia latae. Unfortunately, I could not use resistive testing to differentiate them; when such irritation exists, every muscle tests positive. Of the aforementioned muscles, the iliacus was the perfect functional match, as it creates pelvis on femur flexion, where the psoas creates femur on pelvis flexion. Because Ms. D. was sitting, she was forcibly creating pelvis on femur flexion for hours. In addition, the iliacus, unlike the psoas, is very sensitive to abduction, which she was doing with her right leg to stabilize movement to the left. After carefully treating the iliacus, Ms. D. was surprised to discover that getting up from my treatment table was much easier. She gingerly took a few steps, finding them less painful than expected. I encouraged her to alternate sitting and standing often in the next day or so. Improvement was rapid indeed, with a relatively good sleep in her own bed on the first night. In about two days, the pain was completely gone, and so was the wallpaper. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at doug@nmtmidwest.com. I suspected that the muscle was a hip flexor; possible culprits were the psoas, iliacus, and tensor fascia latae. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 33