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Hi all
Can some1 tell me how to activate the stretch reflex in the iliacus and psoas muscles without lengthening the muscle?i need to bring down pain levels in a low back pain patient.There was a mention of using this technique and im not sure excatly what it means.
thanx
Hey Physiokavs
To activate the stretch reflex without stretching the muscle all you need to do is apply pressure to the muscle and wait until it releases. It is very very important to wait until the muscle has released or you may instigate a spasm if you pull away too soon.
For the psoas and iliacus you must ensure the brain and body is relaxed. Place the patient supine with knees up and feet on the table in order to take the abs out of the picture. This position will also slaken the hipflexors so any "tight" muscle feeling you experience will be the splint. Then gently slid your fingers around the asis and into the muscle belly of the iliacus. Once the muscle is released then move onto psoas. Dig slowly into the belly until you come to the psoas. Apply pressure until hypertonicity no longer exists. Dont stop until you believe the tone has returned to normal. Once done the have them lie on the table until they feel ready to get up. Have them roll onto their side and slowly get them to stand. Dont allow any rapid movement for the first couple of minutes because it may reinstate the splinting.
Feel free to ask questions or come up with a better version. I am always looking to improve my techniques. ;)
Adamo
hello there friendlypain!
Thanks for the help.I tried it out.No probs so far.I also have another case of generalised back ache in a young woman.She has 2 trigger points in the thoracic area and overall all movts are painful(ext>flexion).There has been no known trauma.She presents so vaguely -any ideas as to how to proceed?
Initially she complained of pain in the rt SI jt region,now she complains of pain at multiple areas.She has a mild thoracolumbar kyphoscoliosis(seen on X -ray only)Right now im concentrating on pain relief but any suggestions?
cheers
Hi.
It sounds like she may have an active compression type problem. This is where she is overactive causing excessive pressure onto the facets leading to generalised soreness in the back. My bet is that she has a flat T/S and possibly hyperlordotic in the L/S.
Try teaching her how to relax into normal spinal curves, relaxing her external obliques and upper rectus abdominus, sitting on a wider base...
You have to give some more clues about this lady with 'floating back pain'. Where are the trigger points located? how is the mobility of the spine? What is the back ground? Red / yellow flags? and so on.
Hey Physiokavs
She seems very interesting. But I dont know where to proceed. Where is the new pain going? Does she have muscle weakness? Is she suffering from muscle fatigue? Any signs of fibromyalgia? Does her pain increase with deep breaths? Have you checked levator costae and inter costals?
Looking forward to hearing from you.
Adamo
Almost forgot,
Have you treated ALL the muscles that cross or originate in the hip? Is her PCIR of the greater trochanter off? Sacrotuberous ligament not plastered with adhesions? Hamstrings are normal?
Adamo
Hi - actually, please also include ROM assessment and any functional test resuts. Thanks
Hi all!!
Alophysio is right-this lady does have a hyperlordotic L/S.Her trigger points are upper thoracic paraspinal.She is a tailor by profession and spends hrs sitting-isnt compression the key factor here?in erect standing position,when asked to touch toes she can bend till shin,extension is minimal.She also has tightness of lower limb ms-hams,hip flexors.There is no alteration inpain with breathing.I am at present giving her mosit heat to the low back,trigger release,ms stretches and intermittent traction 20kgs for 15min.I have also advised on postural correction and ergonomics.Any suggestions?
thanks to you all.