stubborn adhesions in QL

[Amay]

I have a client who complains of lower back pain and upon working on him for the first session, I found he has large, marble-size adhesions in both the left and right QL areas. I have come across these stubborn knots before, and found the piezoelectric technique (tapping a warm stone held over the adhesion with another stone) to be particularly effective for breaking them up. It doesn't seem to be working on this client though. The knots have been there a long time (he's a bus driver--30 years!) and are large and hard as rocks. Any advice on other effective techniques would be really appreciated. Thanks!!

 

[J L]

Stubborn adhesions in QL

Cheyene,
You may want to lay this person on their side and do some pin and stretch or soft tissue release where the client stretches the muscle while you strip it. It can be quite effective on adherant tissue.
Good luck,
Rubmyster

 

[Happy Murcia]

Patience. If he has had these adhesions for years and years, it will likely take more than one hour of massage to loosen things up.

 

[Pompal 09.]

Patience. If he has had these adhesions for years and years, it will likely take more than one hour of massage to loosen things up.

I agree with Palpable.

 

[estimator01]

I agree with the above two posters will probably take more then one session. Remember Rome wasn't built in a day. Also there probably is an emotional component of the tension that has to be released also.

Jason

 

[greengirl]

The adhesions described sound a lot like the granulomas that I have and have worked around. From my experience, you can mash them with (insert technique named after someone here) with little change and sometimes it just aggrevates them.

 

[robot_hooker5]

Given the time that has past since you first posted this question, I am assuming that you've tried the soft tissue mobilization (STM) approaches as was suggested above. With my MFR background, I would consider a less intense approach, that is prolonged cross handed releases to the QL region. While intense elbow-type STM is taught by Barnes at his seminars, I've found them to be way too rough on the client (and myself). I prefer a deeper version of the standard cross handed release, using the palm of each hand to slowly work into the deeper layers. Releasing the entire surrounding environment may lessen or even eliminate the knots that you described.

With his history as a bus driver, I would suspect that the anterior structures are just as locked down and may actually be contributing to the QL tightness. Check the psoas, both from a palpatory perspective as well as from a length perspective (Thomas Test).

 

[Misty G]

Is the cross handed thing something that folks could pick up pretty easily without a full MFR class?

 

[Cy impres]

For finding the exact spot that would be of most assistance, you might need training, but I teach clients all the time. Cross your hands over the area to be worked, with fingers pointing away from each other. You might cross at the wrists, or higher.

Let your hands gently sink into the tissues. This works best on bare skin, of course.

When you feel the tissues begin to soften a little, wait until there is no more softening, which might take two or more minutes. Then, again gently and still deep in the tissues, move your hands apart a little, taking up the slack as you feel more softening. You can't rush myofascial release. Wait for the softening.

Then move your hands to the next area to be worked.

Make sure you soften your shoulders and don't tense. You must be relaxed ot you will tire very quickly.

 

[Tales]

It's pretty easy to pick up EgoMagickian, if MarionFM's description isn't working for you I'd recommend having a MFR session (preferably from an experienced JFB MFR therapist).
Once I learned this from a friend who is JFB MFR trained it became immediately adopted into my massages. It feels so awesome on the lower back while prone and can feel really good when done in side-lying also.
As MarionFM says, you have to Go Slow... there's no hurrying MFR. Remember it's not so much about what you're doing but about how much the client is willing to let go.
Explain to your client that it's a new technique you're trying and that even though it seems you aren't doing much (versus swedish or deep tissue for instance) that the results come from the sustained pressure or hold.
Try it on a few friends or long term clients first. Clients with low back pain really love it. I bet you'll be getting rave reviews in no time.

 

[Masta Pimp]

Im bringing up an old post, but have you assessed the position of the sacrum and pelvis?
For example: I recently had a client with a QL that was terrible, but I also assessed a pelvic upslip. I had hoped treating the QL and some stretching would allow the pelvis to return to normal, but it wasn't the case. The next treatment, it was still pretty rough, and the shear remained. I restored the shear through manipulation, and the QL tension decreased dramatically.

Rotational dysfunctions of the pelvis will have a direct influence on the QL, as will Lumbar fixations, sacral torsions and rib torsions. If this isn't your scope of practice, refer to someone who can perform manipulations and see how things progress.