Massage & Bodywork

November/December 2013

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Page 37 of 141

best practices BUSINESS SIDE | Q & ART | TABLE LESSONS | SAVVY SELF-CARE Commitment to Results By Douglas Nelson "It hurts right here," said K., pointing to a spot just above her left posterior superior iliac spine (PSIS). "It has been uncomfortable but not debilitating for many weeks, but it does affect me when I play." K. is an elite-level collegiate tennis player, one of the best in the nation. Her movement patterns and body awareness are superb, which makes working with her a joy. "Is there any simple movement that you can do now that re-creates the pain?" I asked. "Actually, I feel it as a slight pull or nagging sensation when I simply bend forward at the waist. I only feel it on the left side when I bend straight forward." I observed her flexing forward and we established an exact angle of flexion that initiated the discomfort. This helps track progress; the goal is either greater motion or, at the very least, minimal to no discomfort at the same initial angle of flexion. In my mind, I ran through possible suspects that included muscles such as the multifidi, erector spinae, and quadratus lumborum. The long dorsal ligament and the iliolumbar ligament were also possible suspects, as was the sacroiliac joint. I had K. lie on her side and began by treating the multifidi. Starting on the surface of the sacrum, I treated the multifidi thoroughly all through the lumbar spine, finding only a few tender areas. After I finished, I had her stand up to audit the original movement again. "No real change," she admitted. "OK, I know what it isn't!" I pronounced. "Let's explore another muscle, called the quadratus lumborum. Please have a seat on this stool." Sitting behind her, I carefully examined all three sections of the quadratus. Unfortunately, no spot re-created her pain, even though some points were sensitive. Asking her to stand up, we reassessed forward flexion again. I could tell by her facial expression that it had not improved. "Sorry," she said. "No change." "No need to be sorry," I replied. "Let's examine another possible cause. Please lie on your right side again." At this point, I decided to palpate her iliolumbar ligament, which was located near the epicenter of her pain. Challenging the ligament did not elicit the presenting symptom, however. I moved my finger slightly inferior to be just medial to the PSIS and found a sensitive point. Pressing medial on the anterior superior iliac spine (ASIS), I was hoping that the sensitivity on the point near the PSIS would decrease. (Pressing medial on the ASIS decompresses the sacroiliac joint.) No such luck. I asked her to stand up and again flex forward. Doing so, she looked up at me See what benefits await you. 35

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