PRECAUTIONARY NOTE Be very cautious of SI joint dysfunction or pain If there

is any discomfort, stop immediately and go to the next step, or return to the myofascial work, as needed.

Step 8: Multidirectional Friction

If the client complains of discomfort or pain when he or she contracts against your resistance during the previous stretch, stop the stretch and ask the client to point to the specific spot (Figure 2-31A ■). Put your finger on the spot and ask if the pain is directly under your finger. If so, and pain increases to that specific area when the client contracts that muscle group against your resistance, this is a muscle strain (which may also be described as a tear) most likely at the attachment of the QL on the ilium (Figure 2-31B ■).

force. Press the client’s leg slowly down below the table telling the client to “barely resist, but let me win.” Start with a resistance of only two fingers and then have the client increase resistance only if there is zero discomfort. Repeat this several times (Figures 2-33A ■ and 2-33B ■).

2. This can also be performed in the prone position, but it is not as effective as in the side-lying position shown in number 1. The client is prone with the knee bent and

Perform multidirectional friction to the specific area to soften the disorganized collagen or scar tissue that is causing the pain. Use a supported finger and work for only 20 to 30 seconds so you don’t create inflammation (Figure 2-32 ■). Go to the next step.

Disorganized scar tissue FIGURE 2-31B

Muscle Strain, Right QL.

Disorganized scar tissue

FIGURE 2-32 Multidirectional Friction.

Disorganized scar tissue

FIGURE 2-33A

QL Eccentric Muscle Contraction (Start).

Functional scar tissue

FIGURE 2-33B

QL Eccentric Muscle Contraction (Finish). Step 9: Pain-Free Movement

Ask the client to lower the leg down toward the floor and then bring it back up again several times. If there is no pain, proceed with the next step. If there is pain, return to the multidirectional friction working a little deeper, but still pain-free. Then repeat the movement again.

Step 10: Eccentric Scar Tissue Alignment

Apply eccentric muscle contraction to realign the scar tis- sue. Remember, this must be performed pain-free.

1. Stand behind or in front of the side-lying client and have him or her move close to you. Place two fingers above the client’s knee to apply moderate downward

try to extend the ilia. This will eliminate any lumbar hyper- lordosis and prevent the next technique from compromising any existing problems with lateral or anterior bulging discs. Have the client take a deep breath and then exhale. As he or she relaxes, give an upward lift and slowly push superiorly (Figure 2-36 ■). This will stretch the erectors and connective tissue and take the pressure off the discs of the lower back. Start from the sacrum and repeat the strokes, to approxi- mately the twelfth thoracic vertebra, on the deep intrinsic muscles. Lift and lengthen the tissue. This can create spon- taneous alignment of the vertebrae, as the facet joints may open up. Next, have the client take a deep breath and exhale. As he or she relaxes, use the back of your hands or your knuckles on the erectors, with your thumbs as a guide going deeper into the lamina groove (Figure 2-37 ■). Repeat this several times, working toward the middle back. This will clear out fibrosis in the lamina groove and decompress the discs of the lumbar spine.

the hip laterally rotated. Stand at the end of the table and grasp the ankle. Have the client create mild resist- ance while you slowly traction the ankle to straighten the leg. Make sure he or she keeps the hip on the table (or body cushion) in slight lateral rotation. Lean back and traction the leg, telling the client to “barely resist, but let me win.” Begin with a resistance of only two fingers. Repeat this several times, pain-free.

Step 4: Assess Resisted Range of Motion (RROM)

To reassess RROM, repeat the resisted test by hiking up the hip against resistance—either prone or side lying (Figure 2-34 ■). If there is still pain, return to the multi- directional friction working even slower and deeper and then repeat the eccentric work. If there is no pain, the scar tissue has been functionally realigned (Figure 2-35 ■). Now you can perform the stretch.

FIGURE 2-34

Repeat Muscle Resistance Test for QL.

Functional scar tissue FIGURE 2-35

Right QL Stretch.

FIGURE 2-36

Decompress Lumbar Spine.

I

Alignment Techniques (see the “Suggested Readings” in

Appendix C), or refer out to a chiropractor.

Step 6: Myofascial Release

After the right and left side are in balance, finish the work on the QL and erectors with the following myofascial strokes. Move to the side of the table and perform deep-tissue release using your thumbs and knuckles, upward, on both sides of the spine. First, have the client tuck his or her sacrum and

Step 3: Assess Passive Range of Motion (PROM)

To reassess PROM, with the client prone, go to the end of the table and grasp his or her ankle. Lean back and give a gentle stretch and traction to the body for 5 seconds and then release very slowly (Figure 2-38 ■). Alternate gently pulling (not jerking) each leg to allow each ilium to move separately. You may create a balance of the SI joint as spon- taneous alignment may occur. Reevaluate by palpating the iliac crests, after the stretch, to make sure the QL and erec- tors are balanced on both the left and right sides.

FIGURE 2-37

Evaluate for a Smooth Lamina Groove Using Thumbs.

FIGURE 2-38

Traction to Mobilize the Ilium.

LATERAL HIP ROTATORS OR MEDIAL HIP