16-1

Kinesiology for Manual Therapies

Chapter 16

Deep Tissue of the Low Back and Posterior Pelvis

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16-2

Learning Outcomes

o 16-1 Define key terms.o 16-2 Locate on a human skeleton selected bony structures of the trunk, spine, and pelvic girdle.o 16-3 Palpate bony landmarks and the muscles of the trunk, spine, and pelvic girdle on a partner.

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16-3

Learning Outcomes (cont.)

16-4 Explore the origins and insertions of the muscles of the trunk and pelvic girdle on a partner.

16-5 Review general pathologies and conditions of the muscles of the trunk and pelvic girdle.

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16-4

Learning Outcomes (cont.)

16-6 Discuss treatment protocol for conditions of sciatica, back-pocket sciatica, and piriformis syndrome.

16-7 Demonstrate safe body mechanics.

16-8 Practice specific techniques on the low-back and pelvic girdle muscles.

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16-5

Learning Outcomes (cont.)

16-9 Incorporate dimensional massage therapy techniques in a regular routine or use them when needed.

16-10 Determine safe treatment protocols and refer clients to other health professionals when necessary.

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16-6

Introduction

80 percent of the general population will experience back pain. 50 percent will feel relief from low-back pain within 2 weeks and 90 percent will recover within 3 months. Reoccurrences of back pain are likely, even within the same year.

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Introduction (cont.)

Sources of pain include muscles, tendons, ligaments, bones, disks, and facet joints. Conservative care includes rest, physical therapy, ergonomic evaluation of the work site, postural awareness, massage therapy, stretching, chiropractic, etc.

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Introduction (cont.)

Cryotherapy, the safe use of ice and exercise to reduce inflammation and acute responses, is useful for acute and subacute back pain.

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16-9

Structural Perspectives of the Low Back and Pelvic Girdle

The muscles of the back are layered and interconnected between the pelvic girdle, sides of the abdominal muscles, and occiput. The placement of the pelvic girdle anteriorly or posteriorly affects the spinal curvature and soft-tissue dysfunction of the back. Contracted muscles in the lower extremities contribute to the position of the hips.

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Structural Perspectives of the Low Back and Pelvic Girdle (cont.)

Structural perspectives provide the massage therapist reason enough to design individual treatments based on medical history, postural observations, and palpation of associated hypertonic soft-tissue.

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Injuries and Overuse Syndromes

Axial pain can be sharp or dull, constant or intermittent, and mild or severe and can be confined to the low back. Axial pain gets worse with certain activities, and is relieved by rest. Axial pain is mechanical in origin and benefits from conservative care approaches.

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Injuries and Overuse Syndromes (cont.)

Back pain can also be caused by kidney stones, bladder infections, tumors, and internal injuries. Back pain should be diagnosed by a physician to rule out internal conditions.

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Injuries and Overuse Syndromes (cont.)Treatment Protocol

Reasons for Referral: Fever and/or chills; nausea and/or vomiting History of cancer with recent weight loss Severe trauma Significant leg weakness Sudden bowel and/or bladder incontinence Severe continuous abdominal and back pain

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Injuries and Overuse Syndromes (cont.) Soft-tissue Issues

Lifting items in an unbalanced position directly in front of the client with the back instead of the legs puts the erector spinae and latissimus dorsi at risk. Lifting off to the side of the body with the back may call the quadratus lumborum, erector spinae, and gluteus medius into action.

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Nerve Complaints

Radicular pain is unilateral, deep steady, and reproducible with certain activities, and follows involved dermatome. It can include numbness and tingling, muscle weakness, and loss of specific reflexes.

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Nerve Complaints (cont.)

Sciatica is an inflammation of the sciatic nerve and presents with radicular pain. Impingement can result from a herniated disk, foraminal stenosis, diabetes, nerve root injuries, or scarring from a previous spinal injury.

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Nerve Complaints (cont.)

Foraminal stenosis is a narrowing of the intervertebral space through which the spinal nerve exits. A herniated disk occurs when the gelatinous nucleus pulposus protrudes into or through the annulus fibrosus.

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Nerve Complaints (cont.)

Piriformis syndrome involves the entrapment of the sciatica nerve and the referral of pain down the lower extremity. Back-pocket sciatica is a painful condition caused by wearing a wallet in the back pocket affectively entrapping the sciatic nerve in sitting positions.

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Nerve Complaints (cont.)

Referred pain can be achy, dull, migratory, and intermittent with varied intensity. It can radiate from the low back to groin, buttock, and upper thigh. It is different from the referred pain of myofascial pain and trigger points.

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Nerve Complaints (cont.)

Myofascial pain is associated with soft tissue. It may or may not hurt at the location of the trigger point and is not linked to the distribution of a nerve. Myofascial pain is often treatable with conservative care.

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Arthritis, Osteoarthritis, Degenerative Disk Disease, and Lumbar and Sacroiliac

Subluxations

The low back is vulnerable to degenerative disk disease and osteoarthritis. In the surgical procedure, a laminectomy, the posterior arch and spinous process of the midline of the vertebrae are removed freeing the spinal cord from stenosis.

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Unwinding the Muscles of the Low Back: Prone or Supine?

Educate the client with the correct sequence. Positioning should be part of the expertise of the therapist aiming to make the treatment more successful.

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Unwinding the Muscles of the Low Back: Prone or Supine? (cont.)

Use the supine position first to unwind the head, neck, and shoulder soft-tissue areas. Attend to the comfort and support of the client and use an appropriate sequence.

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16-24

Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic

Girdle

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16-25

Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic

Girdle (cont.)

Adequately prepare the entire back with introductory strokes of effleurage, compression, petrissage, and rocking along with myofascial strokes and stretches, elliptical movements, parallel thumbs, before using specific deep-tissue techniques.

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle

Prone Elliptical Movement of the Hips

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Myofascial Stretches and Techniques

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Myofascial Stretches and Techniques

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Elliptical Movement for Lower-Back Muscles

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Alternating Effleurage

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.) Prone Figure Eight of the Low Back

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Petrissage External Oblique

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Edging the Hip

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Thumb Friction

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Deep Transverse Friction to the Erectors

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Forearm Effleurage to the Erector Spinae

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Trigger Points for Quadratus Lumborum

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Quadratus Lumborum Stretch

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.) Prone Quadratus Lumborum Stretch

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont. )

Prone Erector Spinae Stretch

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Sacrum – Parallel Thumbs

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Deep Transverse Friction to the Sacrum

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Forearm Effleurage on the Posterior Crest

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.) Prone Gluteals – Elliptical Movement

on the Gluteals

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.) Prone Gluteals – Elliptical Movement

on the Gluteals

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Circular Effleurage on the Gluteals

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.) Prone Anchor Hip and Separate Fibers

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Palm Compress Effleurage to the Gluteus Medius

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Closed-fist Stripping of the Gluteus Medius

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16-50

Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.) Prone Deep Petrissage of the Gluteals

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Parallel Thumbs to the Gluteus Maximus

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16-52

Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Bent-knee Compression with Passive Movement

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Deep Transverse Friction the Tensor Fasciae Latae

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16-54

Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Deep Transverse Friction of the Anterior and Posterior Crest

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Deep Transverse Friction to the Piriformis

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Trigger Points in the Lateral Rotators

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone Forearm Effleurage of the Sacrum and Crest

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Dimensional Massage Therapy for the Muscles of the Low Back and Pelvic Girdle (cont.)

Prone

Repeat sequence to the other gluteal region. Assess the success of the treatment. End with a full-back effleurage and ending strokes.

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Chapter Summary

This chapter discussed the structural perspectives of the low back and pelvic girdle and injuries and overuse syndromes including inappropriate lifting and gave reasons for referral for undiagnosed clients with specific signs and symptoms.

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Chapter Summary (cont.)

Nerve complaints were explored. Arthritis, osteoarthritis, degenerative disk disease, and lumbar and sacroiliac subluxations were reviewed.

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Chapter Summary (cont.)

Treatment protocol and sequence of the muscles of the low back and posterior pelvic girdle areas were outlined for unwinding these muscles.

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Chapter Summary (cont.)

Dimensional Massage Therapy techniques for the muscles of the low back and posterior pelvic girdle were depicted for the prone position.

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Chapter Review

The Chapter Review is divided into true and false, short answers, and multiple choice questions. The questions are designed for the students to test their knowledge.

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Explore and Practice

Activities in this section are for practice and demonstration. Every opportunity should be utilized to locate muscular attachments on as many different bodies as possible to support kinesthetic learning.

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Explore and Practice

Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes.

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