Hip and Lumbar Relaxation

[bernard]

Hi SomaSimplers,

I'm using that one to listen to the patient's body. It is very useful to see if some resistance/pain exists while doing a gentle mobilization. It could be done passively at the beginning.

You may find a tighness around lumbar area and some asymmetry in ROM. Amplitude has to be enlarged slowly without any huge change of direction.

http://www.somasimple.com/images/ski/ski_01.jpg

[bernard]

http://www.somasimple.com/images/ski/ski_02.jpg

[bernard]

http://www.somasimple.com/images/ski/ski_03.jpg

[bernard]

http://www.somasimple.com/images/ski/ski_04.jpg

[bernard]

http://www.somasimple.com/images/ski/ski_05.jpg

[bernard]

This exercise can be done with almost every patient. It doesn't hurt if you move slowly and give some trust from the patient.

The amplitude may be very little at start and increased by step (listen to your hands/patient).

Hope that Nari will like it?

[nari]

Bernard

I use this one frequently and have for a long time..the passive action does help to identify resistance areas, and if the arms are in ULNT, and neck flexed or extended, all sorts of interesting things can be dug up.
I also like single hip rotation, if the problem is located unilaterally.

If the patient is not nervous, I take the feet off the plinth and passively continue with increased hip flexion, and sometimes (depending on what I'm looking for) train TransAb at the same time.

Nari

[bernard]

I also like single hip rotation, if the problem is located unilaterally.

Yes, of course. It may help to find some SIJ dysfunctions and hip problems.

[emad]

Very good Bernard.

Cheeers
Emad

[fapt]

hi somasimplers,
This is technique is usefull and some of back pain patients felt better after doing this Ex' .
But sometimes, i used for release lower extremities muscle tone in neurologic disorder patients.:teeth:

[emad]

Hi Fabt :

Using this technique is essentail for me in all lumbar and loer quarter /quadrant disorders , i use it as neuro-slider technique ( tensioning at one side while releasing /shortening on the other side ) .

But the new point , you add in yr last post , that it could release /help in neck disorders , this also share in a point i discussed before which is ;

Moving /neuro-Moblisation could be more effective if it is
applies away as possible /at distance from the site of the pain .

As well , I belive here in more applicable point , imagery motions around the neck could be very effective .

Regards

Emad

[bernard]

Hi All,

Lin,
I'm using it with neurologic conditions, too (stroke, parkinson...)


Emad,
It works fine with shoulders problems and it's a good start to feel the latissimus dorsi tightness. Using it in that case will give some room to painful shoulders.

[mike]

Hi!

I just tried the lumbar/hip technique today on a patient. The patient had pain in his right leg down to his toes and also in his right groin. Slumps with cervical flexion and df of his foot only showed mild discomfort in his right hamstring. reversed SLR in sidelying showed nothing neither SLR. Reflexes where fine for patellar but achilles could not be found bilateral. No decreased or increased sensitivity. Now to the lumbar/hip technique: I found some restricion in what I think was the right lumbar/hip area when I rotated him to the right. He felt no pain when doing this. When I rotaded his legs/hips to the left he felt som diffuse pain in his gluteus medius and upp to his right obliques. How would you now apply the technique? I used some gentle oscillitation in to/short of pain with the thinking of a neuromob. This did not chance his pain but I gave the mob as a home exercice anyway. Told him to stay short out of pain and gentle mob to see if he after a while could take the hip/lumbar in to more rotation before feeling pain. I also used some skin stretch ala Diane to se if i could chance his pain. When I applied skinstrech on his right tight in a cadual direction he didn´t feel as much pain while rotation his legs as without the stretch. I did this for a couple of rotation as a kinde of mulligan but with skin strech. This didn´t change anything either. Now is the approach with the lumbar/hip mob same as for neuromobilization. When do you consider going in and "tease" the pain and when do you mob away from the restriction/pain.
A confused post from a man of confusion
Regards
Mike

[Diane]

Hard for me to mentally track what you were doing, but no matter..
If you're doing skin stretching, sometimes if something doesn't work going one way, try another/the other. Find out what direction works best for you in the moment, or for that particular patient. Skin is anchored down every which way. Something will happen, be patient and go slow. Let the brain on the other side of the skin have a chance to help.
Cheers,
Diane

[bernard]

Hello Mike,


The movement is ever done pain free.
I increase the oscillation/balancing at every move considering the resistance I feel while moving and asked the patient to tell me if something is wrong.
Sometimes I use inhaling for stretching the lumbar area when we are at the maximum inclination. (But no pain!).
I may add skin stretches once the movement is achieved since movement may mask the skin stimuli.

[mike]

Hi,
Diane and Bernard, Thank you for your reply!
Just to clarify. The last picture Bernard showes is the "rotation to the right". Just so you understand what I meant with the rotations of the legs. I wanted to compare this technique to the clinical neurodynamics techniques that you can see in Michael Shacklocks book on page 211 figure 11.34. The lumbar/hip technique dosen´t give you as much lateral flexion but you could probably add that by rotating the lower legs a little bit. This is why I was asking about "teasing the pain", provoke mild discomfort, as Shacklock mention in his book that sometimes the mobilizationes evokes symtomes. Nari mentioned a combination of the lumbar/hip technique and ULNT. Maybe you Nari, or anybodyelse, could give an example of how you apply this technique considering the mild discomfort, time under load, reps etc.
Kindly Regards
Mike

[nari]

Have only just picked up on this thread again.



First off, I have to say that doing such movements painfree won't really achieve the desired result - ie, talking to the brain. At least that is how I do it. Unless the movement is taken INTO the start of pain, the brain won't play.

I would try: Supine lying, as indicated, knees and hips flexed. Painful side uppermost. As the hips rotate away from the painful side, stop once the pain is experienced; then try extending the knee of the painful side. (ie SLR) If no more pain, dorsiflex the foot. Should have some interesting information there.

With each movement (hip rotation, knee extension) just keep nudging the pain three or four times. Brains don't like repetition if the CNS is sensitive; ten reps might be enough to swing into further sensitisation. This is why I don't like the recipe 10-15 reps of orthopaedic exercise if we have a sensitive CNS. With respect to time under load, 3-4 seconds is quite enough; and the patient needs to say what is happening to the pain.

I asked Michael Shacklock about the suitable number of reps, but he does not know yet and nobody does; I pick 3-5 reps as a pretty arbitrary figure.

If the pain is more centralised, the same exercise with bilateral hip rotation can be done with the upper limbs in comfortable neural tension. I might add SLR in the supine positon on the painful side, and just deflex/flex the knee a few times. It really depends where the pain is being experienced, which hints at where the nerve is a bit scrunched (for want of a better word). As a progression, add neck rotation to the contralateral side as the hips rotate. That gives a global touch to desensitising several dodgy spots along the CNS.

All the above can easily be done by the patient at home, as well. Plus lots of education that the pain they feel is not nice at all, but cannot harm.;)


Nari

[bernard]

First off, I have to say that doing such movements painfree won't really achieve the desired result - ie, talking to the brain. At least that is how I do it. Unless the movement is taken INTO the start of pain, the brain won't play.

Hey Nari, it is a relaxation "exercise". Relaxation is not intended to aggravate (or recreate) the patient condition. I use this one as an education tool since patient are unaware that their body (told as painful and immobile) is a perfect machine...


As Nari stated it, I do not use more than 5/7 repeats.
It is a conscious relaxation because the same movement that was unpleasant (painful) at the previous attempt is now pain free because the patient relaxes his muscles (and relaxing muscles is achieving a neuro-gliding).
The pictures found in the book of Michael Shacklock are far from this trial. They may be the top most ends of this one. If you pay attention to the pictures, you may understand that it is quite the same movement but with a rotation.
You may increase the "stretching" if you cross a leg over the other.
Mike, Nari is a "traditional" neuronut and I'm a "moving" neuronut.:D

[nari]

Bernard

I'd forgotten that you were demonstrating relaxation...oh well.:(

What is your definition of a traditional neuronut? Just curious.....because in my definition, traditional 'nuts' used stretches (about 20 years ago)...me, no way, Jose! ;) Movement is essential.


Nari

[bernard]

I'd forgotten that you were demonstrating relaxation...oh well.:( Doesn't matter because it may be used also in your way! Just kiddin' ;)

Traditional neuronut is already a nonsense since neuronuts aren't traditioonal PTs. :D
I may say that you use stretches as intended movement :rolleyes: and a moving neuronut may use movements that incorporate streching components :confused:.

A subtle difference just for playing with words! :embarasse

[nari]

Bernard, you are tricky - your English is becoming too subtle for me!

Nari