Massage & Bodywork

SEPTEMBER | OCTOBER 2019

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2 3 4 5 Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 99 by faulty sensory input, brain processing problems, or weak motor output. Physically, it manifests as weak abductors, valgus (knocked) knees, internally rotated femurs, and overpronated feet. In my experience, clients exhibiting Trendelenburg posture are more likely to experience GTPS due to increased IT band and gluteus medius compression as their tendons are forced back and forth across the inflamed bursa sac. However, we must remember these are just symptoms of an underlying central nervous system disorder. Brain-based tests, such as single-leg standing, can help identify coordination and balance problems, whereas pain provocation tests work best to pinpoint strain patterns caused by reactive muscle guarding. Many people with GTPS experience generalized femoroacetabular stiffness and restricted range of motion. With these clients, I've had success using graded exposure hip-stretching techniques, such as the one demonstrated in Image 5, to restore alignment and function. Just remember, you must be patient when treating clients with chronic GTPS. This is not a quick- fix situation. The brain needs time to re- evaluate the new sensory input, determine the degree of threat, and allow more pain- free movement throughout the injured area. Gluteus medius tendinopathy resisted abduction pain provocation test. Hip de-rotation test: The therapist's left hand flexes, internally rotates, and adducts the humerus while his right resists the client's abduction efforts. Trendelenburg gait: Weak abductors on the stance leg allow the contralateral hip to drop during the swing phase. Graded exposure stretch for tensor fascia latae, gluteus medius, and gluteus maximus muscles. Psychosocially, the client must be reminded their pain is not pathologic and that, in time, it will resolve itself. To help lower the client's threat level, encourage them to make peace with their pain during the therapy process and to practice self- care in the form of novel proprioceptive exercises, such as mini-trampoline bouncing or dancing. In addition, make a special effort to assure the client they have come to the right place for help, and that by working together as a team, their hip symptoms will be relieved. Note 1. T. D. Bunker, C. N. Esler, and W. J. Leach, "Rotator-Cuff Tear of the Hip," Journal of Bone and Joint Surgery 79, no. 4 (1997): 618–20. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. Watch "Hip Pain Provocation Tests"

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