I am stumped

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JLWmassage
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I am stumped

Post by JLWmassage » Thu Jul 09, 2009 5:02 am

I have a female client that I have been working on for about 4 years that has me scracting my head wondering what more I can do.

She has a spinal fusion about 10 years ago in her low back and there is metal in there holding stuff together. The women is in pain all the time and has been for many years. Now this is the part that is making me wonder what the heck is going on.

She is a horse trainer (Can teach up to Grand Prix Dressage). She rides 5 horses a day painfree and she takes yoga 2 - 3 times a week and is painfree there to. But walking and climbing stairs is very painfull for her.

Here is what I do when I work on her. I work on her groin and psoas hip flexors, IT Band I stretch her out a lot. Work on the glutes and entire back. I can't help but feel like I am missing something. I have no problem finding where she is in pain, but it is not the right place to be working.

I need someone eleses thoughts. So what is being over worked during walking and stairs that would not be during riding and yoga?

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Re: I am stumped

Post by cy » Thu Jul 09, 2009 8:33 am

You say you work on her glutes, but have you checked for trigger points there? There are many trigger points in gluteus medius and g. minimus that refer to the low and mid-back. I would also check quads, adductors, and lats.
Last edited by cy on Thu Jul 09, 2009 9:25 am, edited 1 time in total.
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Re: I am stumped

Post by JLWmassage » Thu Jul 09, 2009 8:43 am

I go all around her upper leg. There are trigger points in the glutes but the trigger point work does not last very long, maybe a day or 2. Where as MFR will last about a week, but then the pain comes back full force.

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Re: I am stumped

Post by Breathe » Thu Jul 09, 2009 8:58 am

Probably need more detail. Does she hurt going downstairs, walking on level ground or downhill? Or is it only stair climbing and walking up an incline? One side or both? Lumbar or sacral? SI joint or acetabulofemoral joint? Any other activities painful? Driving? Has she ever broken her tailbone? Where is the spinal fusion? Was she painfree following this surgery? Are there ANY yoga poses that are painful? Is the pain in the joint(s) or muscle(s)? When she says "pain," what kind of pain? sharp and localized? achy and generalized? burning? nerve?

In addition to adductors, (which can be problematic for horsemen-women,) and glute min/med, as cy points out, I'd be looking at the deep lateral rotators, and their painfree range of motion in stretch (internal rotation,) both in neutral position and in abducted position. Look at pelvic tilt (sounds like you've done that with psoas/quads,) check hamstring strength, and also look for injury to the hamstrings, which would prevent them from contracting properly to aid postural stability. Also check lateral pelvic tilt. If present you may need to look for a one-sided origin of pain and imbalance, either legs or in lower back.

When you find yourself chasing pain, step back to the evaluation. Do the entire eval again if you need to. Get nit-picky about details: location, quality, quantity, activities, history, other injuries sustained (even if she doesn't think other injuries are relevant to current pain, you might be surprised at what you can find out from this.)

If you are still stumped, get a large bodymap and map out all of your findings and her history directly on the picture. Sometimes this leads to a great big "arrow" pointing at or surrounding the source.

Just a few ideas to get creative juices flowing again. :)
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JLWmassage
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Re: I am stumped

Post by JLWmassage » Thu Jul 09, 2009 3:57 pm

She did break her ribs, this past November, taking a dump off of one of her horses. This seem to really exacerbate her pain.

When I work on the groin and psoas it causes her low back to burn. And the pain is more on the right, but it is on both sides. And the burning pain is from BL QL through the gluteus and down the IT bands and stops at the knees. Driving to long periods of times causes problem to. The SI joint was out on the right, but I found her a chiro. that would adjust her low back so that had taken care of that issue.

The fusion is above her tail bone and it seem the 2 incision are the problem bc of all the scar tissue.

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Re: I am stumped

Post by JLWmassage » Wed Jul 15, 2009 7:57 am

All the reading and talking to the MT's I know says to keep doing what I am doing, but I am not achieving the results I am looking for. I can't help but feeling what I am doing is not the right approach. What I am doing is just dealing with the systems and not the problem.

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Re: I am stumped

Post by squash_blsm » Wed Jul 15, 2009 8:20 am

JLWmassage wrote:All the reading and talking to the MT's I know says to keep doing what I am doing, but I am not achieving the results I am looking for. I can't help but feeling what I am doing is not the right approach. What I am doing is just dealing with the systems and not the problem.
Sometimes, especially when someone has a structural problem (like her spinal fusion), you can't expect to "fix" the problem or acheive total healing.
I look at it more as necessary maintenance work - you can't fix what's wrong but you can help her manage it.
I talk to my clients all the time about this.
When they do other things to help - such as Yoga and chiropractic - this is all part of the total approach to wellness.
And of course, depending on their goals, I might not be able to help them improve if they come in once a month (just maintain), we might be able to progress if they come in more often.
In addition -
Next time you are working with her you might try a little intuitive work. You don't need to have cranio-sacral & somato-emotional release training in order to "tune-in" to a client's body (although it would be extremely helpful). You just need to trust what your hands tell you.
Your client can help too - I always suggest that they pay attention and tune in to their own body...what have they done in the 1-3 days prior to increased discomfort? Then we look at how they were moving, how they might have "overdone" it, or anything that makes sense.
By using intuition and by dialoguing with the client we almost always come up with that missing piece.
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Re: I am stumped

Post by JLWmassage » Sat Jun 16, 2012 7:46 am

Wanted to give an update. I am still working with this client :D And she is doing better. I have since learned MFR and that has seemed to make a big difference in her healing.

And I have also learned a lot about the body just by having the chance to work with her. She is a great client one that is open to try anything.

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Re: I am stumped

Post by MarionFM » Sat Jun 16, 2012 10:42 pm

Well done - I love MFR, it is my passion.

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