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98 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 5 www.SacredLomi.com (818) 865-8813 Agoura Hills, CA • Lomi Lomi • Sept. 18-20, '15 Upcoming Cities: Las Vegas, Atlanta, Philadelphia Advanced Retreat • Harbin HotSprings, CA • Oct 10-14 Hawaii Retreat • Big Island Hawaii • Feb. 20-27, '16 Hawaii Retreat • Big Island Hawaii • Feb 18-25, '17 Tom Cochran Donna Jason However, she has a lingering pain during palpation of the soft tissues superior to the greater trochanter. Lisa's lateral hip pain was also reproduced during resisted abduction. The gluteus medius and gluteus minimus muscles are primary hip abductors, so there may be something occurring in those muscles associated with the lateral hip impact. It is also notable that she reported a mild pain sensation in this region prior to the accident, so there may have been an underlying dysfunction in those tissues prior to the fall. The gluteus medius and minimus play a key role during the normal running and walking gait, and face an interesting biomechanical challenge as the body seeks to accommodate the alternating changes in weight during stride. When weight is fully on one side, like the stage of running stride shown in Image 4, these muscles contract to maintain a level pelvis. Lifting weight off the right leg would cause the pelvis to drop to the right. The hip abductors on the left contract to pull the pelvis level as the non-weight- bearing right leg swings through. During evaluation, it is helpful to attempt reproduction of this biomechanical challenge for the hip abductors with a procedure called the Trendelenburg test. From a standing position, the client lifts the leg on the side opposite the leg with the potential problem. In Lisa's case, that would mean she would lift her right leg. If the pelvis drops to the right side, that indicates a weakness in the hip abductor muscles. These muscles might be weak if they were injured in her fall. Often, pain that is produced on the affected side with this procedure indicates damage or dysfunction in the associated tendons of the gluteus medius and gluteus minimus muscles. 1 Lisa had a mild pain sensation in the left lateral hip region when this procedure was performed. If there was damage to the distal tendons of the gluteus medius and minimus, it could also explain why there was some potential tightness developing in the piriformis muscle from the accident. The distal tendon of the piriformis muscle blends with fibers of the gluteus medius and minimus tendons, as they all attach on the greater trochanter. 2 Trauma to this area could have caused tendon damage or reactive muscular splinting from the impact. This could aggravate existing tendon pathology that could have already existed from overuse. INTERPRETING THE RESULTS The assessment findings indicate hypertonicity in the piriformis and a likelihood of compression of the sciatic nerve in the gluteal region by the piriformis muscle. In addition, there is Trochanteric bursa at lateral hip.Image is from 3D4Medical's Essential Anatomy 5 application. Trochanteric bursa 3