Issue link: https://www.massageandbodyworkdigital.com/i/149404
Traditionally, the iliopsoas is treated by applying pressure deep into the abdomen to contact the muscle, then applying static compression, crossfiber movements, or short stripping strokes to the muscle. However, this technique can be quite uncomfortable for many clients. Applying pressure to the iliopsoas means you are pinning the small intestines against the muscle, no matter how much you try to move them out of the way. Another potential problem is inadvertent pressure on the external iliac artery, which lies directly adjacent to, or on top of, the iliopsoas muscle. Pressure on the external iliac artery can have serious adverse consequences if the client has any type of aortic aneurysm, which he or she may not know about. A safer, alternative treatment of the iliopsoas is to use the modified Thomas Test position, from which you can use a muscle energy technique (also called PNF stretching) to reduce tightness in the muscle. The client is supine on the treatment table with the leg dropped off the end or side of the table (Image 4). Instruct the client to hold the thigh in partial flexion for about 5–7 seconds while you push down on the client's distal thigh. After the contraction is held, instruct the client to immediately relax the contraction as you push the thigh into extension and stretch the iliopsoas muscle. This technique can be repeated three to four times for maximum effectiveness. 4 106 The muscle energy technique for the iliopsoas. massage & bodywork september/october 2013 Sacroiliac-Joint Dysfunction Another key structural issue that results from the increased lumbar lordosis and long periods of standing is sacroiliac-joint dysfunction. As the lumbar lordosis is increased, the sacrum tilts in an anterior direction. The increased anterior tilt puts additional stress on the closely fitting sacroiliac joints, causing sacroiliac-joint pain, which can sometimes mimic other low-back conditions, such as nerve root compression from disc herniation. The condition is notoriously difficult to identify and is often confused with other conditions of the low-back or pelvic regions. Sacroiliac-joint dysfunction can also result from standing occupations if the individual has a structural or functional leg-length discrepancy. A structural leg-length discrepancy occurs when there is an actual difference in length between the bones of one leg compared to the other. In a standing position, the pelvis is pushed higher on the side of the longer leg, causing unequal forces to be applied to the sacroiliac region. A functional leg-length discrepancy results when the pelvis is tilted to one side due to muscular forces pulling on the pelvis. The most common example is when the quadratus lumborum on one side pulls on the pelvis and causes a lateral pelvic tilt. If examined in a supine position, it will appear as if one leg is shorter than the other, but in fact lateral pelvic tilt is causing the discrepancy. In either case, there is an imbalance of force load on the sacroiliac joint. The weight-bearing relationship of the sacroiliac joint is adversely affected by standing at work for long periods and can lead to significant low-back, pelvic, or lower-extremity pain. Sacroiliac-joint dysfunction requires a different perspective than many other joint disorders that might be treated with massage therapy, as there are some unique anatomical considerations in this area. In most cases, we treat joint dysfunction by addressing the specific muscles that span between the two bones that make up the joint. However, at the sacroiliac joint there are no muscles that span directly between the sacrum and ilium. Consequently, treatment should focus on other muscles crossing this joint and also address the numerous connected myofascial chains that span this region. Primary attention should focus on the quadratus lumborum because, when hypertonic, it has the