Issue link: https://www.massageandbodyworkdigital.com/i/68174
ACTIVE ENGAGEMENT TECHNIQUES ACTIVE ENGAGEMENT TECHNIQUE FOR LOW-BACK PAIN Active engagement (AE) techniques are an effective way to address the quadratus lumborum. • Begin with the client side-lying and at a slight diagonal position on the table so the leg can be dropped fully off the side of the table. • Instruct the client to abduct the thigh as far as possible. While the quadratus lumborum does not abduct the hip, it must contract to hold the pelvis stationary during this movement. Static compression with active eccentric lengthening to the infraspinatus. The client is slowly lowering the arm into medial rotation while static compression is held on a tight region of the muscle. Images 10, 11, and 12 courtesy of Orthopedic Massage: Theory & Technique (Elsevier, 2009) • With the client's thigh in full abduction, instruct him or her to slowly lower the leg in adduction as far as possible. Gravity provides the resistance and requires eccentric activation of the quadratus lumborum. (Image 10). This technique is a variation of what is sometimes called the pin and stretch technique. A more effective method of reducing • As the client slowly lowers the leg, perform a static compression or deep stripping technique on the quadratus lumborum from the transverse processes to the upper margin of the iliac crest. • Only cover several inches during each full motion. • Repeat until the entire muscle is addressed. Keep in mind that this technique can feel painful, so consult your client about appropriate pressure levels. muscle tightness and enhancing myofascial elongation is using deep longitudinal stripping performed during the eccentric contraction. The client engages an isometric contraction of the affected muscle from a shortened position as in the previous procedure. Use a lengthened initial starting position if muscle cramping is a possibility. The client slowly releases the contraction as the practitioner simultaneously lengthens the target muscle by applying deep longitudinal stripping on the target muscle (Image 11). This technique greatly magnifies the effect of deep-stripping techniques. The intensity of muscle contraction can be altered with either of these methods by adding additional resistance. A greater number of muscle fibers are recruited with additional resistance, which intensifies the pressure level due to increased tissue density. Increase muscular recruitment with resistance bands, weights, or manual resistance (Image 12). However, Longitudinal stripping with active eccentric lengthening to the elbow flexors. The client is slowly releasing the contraction as the practitioner pulls the arm in the direction of the white arrow (extension). keep in mind that using additional resistance can be more painful for the client, so this method is best suited for later stages of injury rehabilitation or with muscles that are already well conditioned. WHEN/WHERE TO USE AE When to use AE techniques is determined by assessing your client's goals and his or her stage in the rehabilitation process. AE methods are most effective in addressing some type of soft-tissue pain or injury condition. Thus, knowing where the client is in his or her recovery process is particularly important for knowing how you will address the problem. In the early stages of an injury, it is important not to further stress the soft tissues attempting to heal. Consequently, AE techniques are too taxing for certain soft-tissue pain or injury conditions until they are at a particular stage of the healing process. The practitioner must use sound assessment and clinical reasoning to determine when it is appropriate to begin use of AE methods, as it will differ for each person and condition. AE techniques can be used in almost any region of the body. However, there are certain regions where AE 38 massage & bodywork may/june 2010