Issue link: https://www.massageandbodyworkdigital.com/i/1338685
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 89 hip into extension while the left palm resists. Discontinue if you encounter a bone-on- bone end-feel or the client reports pain. The thigh should be able to extend about 10–15 degrees off the therapy table without pain. To address a restricted hip capsule that does not have an osteoarthritic (bone-on-bone) end-feel, ask the client to gently push their thigh toward the therapy table to a count of fi ve and relax, then give the hip capsule a gentle stretch. Repeat three times and retest. Maintain the same position to assess and stretch the rectus femoris, but this time place your left hand above the ischial tuberosity anywhere on the client's buttocks (Image 4). As you step to your left foot and lift the client's leg, the rectus femoris should be fl exible enough to allow 20–30 degrees of pain-free hip extension. If a fi xation is felt, raise the leg to the fi rst restrictive barrier and ask the client to gently push their leg toward the therapy table against your resistance to a count of fi ve and relax. Apply another graded exposure stretch to the next restrictive barrier, repeat three times, and retest. To assess and treat for iliopsoas fl exibility, the side-lying client grasps their left knee and pulls toward their chest. Place your left hand on the buttock and pull the client's leg into extension to the fi rst restrictive barrier (Image 5). Perform three contract-relax maneuvers and retest for improved iliopsoas fl exibility. SUMMARY The use of skilled joint-stretching interventions, supplemented with a complementary self-care program, often brings much-needed relief for clients with achy backs. However, the clinician must always consider whether joint stretching is an appropriate strategy for a restricted hip. In clients with bony morphologic changes, mobilizations may be inappropriate, so if in doubt, refer them out. Note 1.²Michael P. Reiman, P. Cody Weisbach, and Paul E. Glynn, "The Hip's Infl uence on Low Back Pain: A Distal Link to a Proximal Problem," Journal of Sport Rehabilitation 18, no. 1 (February 2009): To assess and mobilize rectus femoris, the right hand extends the hip while the left braces at the buttocks above the ischial tuberosity. With the client's knee extended, the therapist stretches the iliopsoas by pulling the leg with their right hand and resisting with their left. Retest for improved hip extension. „ Ž ' Anterior hip capsule assess and stretch. Note the left hand braces below the ischial tuberosity on the proximal femur as the hip is brought into extension. SCAN AND WATCH "Hip Capsule, Quad, and Psoas Stretches" 24–32, https://doi.org/10.1123/jsr.18.1.24;²Clinton J. Devin et al., "Hip³Spine Syndrome,"²Journal of the American Academy of Orthopaedic Surgeons 20, no. 7 (July 2012): 434–42, https://doi. org/10.5435/JAAOS-20-07-434;²Scott A. Burns, Paul E. Mintken, and Gary P. Austin, "Clinical Decision Making in a Patient with Secondary Hip-Spine Syndrome," Physiotherapy Theory and Practice 27, no. 5 (July 2011): 384–97, https:// doi.org/10.3109/09593985.2010.509382. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfi ng, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit erikdalton.com. MYOSKELETAL ALIGNMENT TECHNIQUES