Integrated Manual Therapy & Orthopedic Massage
For Low Back Pain, Hip Pain, and Sciatica
Assessment Protocols Treatment Protocols
Treatment Protocols Corrective Exercises
By
Author & International Lecturer
James Waslaski LMT, CPT
Integrated Manual Therapy & Orthopedic Massage
For Low Back Pain, Hip Pain, and Sciatica Todays manual therapist needs to have multiple skills in order to address a wide variety of complicated musculoskeletal pain conditions. Specialization in just one modality is
becoming a thing of the past because of limited patient outcomes. This unique total
system consists of orthopedic assessment, clinical reasoning, multidisciplinary and multi-
modality therapies, and precise corrective stretching and strengthening exercises.
Participants will learn to integrate the skills of leading practitioners from the fields of
massage therapy, physical therapy, athletic training, personal training, osteopathic and
chiropractic to restore balance, posture, function and pain free living. Recent clinical
studies will forever change the way manual therapists look at musculoskeletal pain,
muscle-tendon strain pain, and adhesive capsulitis of the hips. This seminar will teach
manual therapists techniques to help eliminate pain from hip capsule adhesions, hip and
disc degeneration, bulging discs, sacral torsions, sprains and strains, SI joint pain, and
sciatica. Corrective stretching and strengthening techniques will be also taught to keep
the muscles balanced, and joints aligned for pain free living. Our Unique 12 Step
Protocol will be used throughout this presentation.
Twelve Steps: 1. Client History 2. Assess Active Range of Motion 3. Assess Passive Range of Motion 4. Assess Resisted Range of Motion 5. Area Preparation 6. Myofascial Release/ Compression Broadening 7. Cross Fiber Gliding/Trigger Point Therapy 8. Multidirectional Friction 9. Pain Free Movement 10. Eccentric Scar Tissue Alignment 11. Stretching 12. Strengthening James Waslaski is an Author & International Lecturer who teaches approximately
40 seminars per year around the globe. Hes served as AMTA Sports massage Chair and FSMTA Professional Relations Chair. Hes developed 8 Orthopedic Massage and Sports Injury DVDs, and authored manuals on Advanced Orthopedic Massage and
Client Self Care. His new book, Clinical Massage Therapy: A Structural Approach to
Pain Management was published by Pearson Education in 2011. James presents at
state, national and international massage, chiropractic, and osteopathic
conventions including keynote addresses at the FSMTA, World of Wellness, New
England Regional Conference, the World Massage Festival, and Australian National
Massage Conventions. His audience includes massage and physical therapists as
well as athletic trainers, chiropractors, osteopaths, nurses and physicians. He is a
certified personal trainer with NASM. James received the 1999 FSMTA International
Achievement Award and was inducted into the 2008 Massage Therapy Hall of
Fame. www.orthomassage.net
8/3/2013
1
CLINICAL MASSAGE THERAPYA Structural Approach to Pain Management
CHAPTER
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Pelvic StabilizationThe Key to Structural Integration
2
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Chapter Outline
Twelve-Step Approach to Pelvic Stabilization
Psoas Major, Iliacus (Iliopsoas), and Joint Capsule
Quadratus, Lumborum (QL) and Erector Spinae
Lateral Hip Rotators or Medial Hip Rotators and Adductors
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Learning Objectives
Choose the appropriate massage modality or treatment protocol for each specific condition of the hip and lower back
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Learning Objectives
Restore normal range of motion throughout the body and normal muscle resting lengths by first working on the short contracted muscle groups (iliopsoas and quadriceps) and then working the weak, inhibited antagonists (gluteals and hamstrings)
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Learning Objectives
Restore balance between other opposing muscle groups in the hip area such as internal and external hip rotators
Ensure myoskeletal balancebalance of the opposing muscle groups
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Learning Objectives
Ensure that the therapist eliminates the underlying soft tissue cause of the lower back and hip conditions before addressing symptoms
8/3/2013
2
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Learning Objectives
Differentiate between soft-tissue problemsmyofascial restrictions joint capsule adhesionsmuscletendon tension trigger point tension
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Learning Objectives
Differentiate between soft-tissue problemsstrained muscle fibers sprained ligamentsnerve compressionbony fixations
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Learning Objectives
Teach the client self-care stretches and strengthening exercises (if needed) to perform at home to maintain musculoskeletal balance and pain-free movement following therapy
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-1 Examples of Disc Problems.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Precautionary Note
Do not work on a client with a recent injury (acute condition) exhibiting inflammation, heat, redness or swelling. RICE therapy (rest, ice, compression, elevation) may be the appropriate treatment in this situation.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-4 Hip Extension, 3545 Degrees.
8/3/2013
3
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-10 Passive Assessment for Hip Extension End Feel.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-12B Evaluate Internal Hip Joint RotationEnd Feel.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-12A Evaluate External Hip Rotation End Feel.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-11 Joint Capsule and Inner Fascial Mobilization Techniques.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-13 Traction Hip After Releasing Joint Capsule Adhesions.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-18 Pain Free Psoas Release (Hand Placement).
8/3/2013
4
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-16 Pain Free Iliacus Release (Hand Placement).
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Core Principle
You must change the protocol and return to joint capsule work anytime that you find a bone-on-bone-like end feel during the rest of the hip session.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Core Principle
Always get the clients permission before you treat this area. Use a visual aid, if needed, to explain where you are going to be working. This can be a very personal, emotional area of the body.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Core Principle
You must continually check in with the clientis he or she guarding? Pay attention to the clients face, voice tonality, and breathing. What is his or her comfort or discomfort level? The iliacus release must be performed pain-free.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-20 Anterior Joint Capsule Release.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-10 Contract- Relax IlioPsoas Stretch
8/3/2013
5
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-22 Quadratus Lumborum.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-23 Erector Spinae.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-24 Palpate Iliac Crests.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-25 Palpate PSIS.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-26 Myofascial Release, Erectors/QL.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-27 QL/Erector Cross-Fiber Gliding Strokes.
8/3/2013
6
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-31A Muscle Resistance Test, Right QL.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-32 Multidirectional Friction.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-33A QL Eccentric Muscle Contraction (Start).
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-33B QL Eccentric Muscle Contraction (Finish).
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-35 Right QL Stretch.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-36 Decompress Lumbar Spine.
8/3/2013
7
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-39A Sciatic Nerve.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-40 Sciatic Nerve May Run Through Piriformis.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-41 Internal (Medial) Hip Rotators.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-42 Adductors.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Core Principle
You must evaluate both the lateral and medial hip rotators as this will determine what protocol to follow. Focus on treating the tight, restricted muscle groups first. If the client cannot achieve 30 to 45 degrees of medial hip rotation and has a tissue-stretch end feel, the problem is most likely tight lateral hip rotators.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Core Principle
If the client cannot achieve 60 degrees of lateral hip rotation with a tissue-stretch end feel, the problem is mostly likely tight medial rotators. If there is a bone-on-bone-like end feel in either direction, the problem is probably inner fascial and capsular adhesions and that changes the treatment technique completely.
8/3/2013
8
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-43A Evaluate Internal Femoral Rotation.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-43B Evaluate External Femoral Rotation.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Precautionary Note
If the client has any joint pathology (degenerative discs, SI joint dysfunction, etc.), push the femur into the hip joint just until you make contact with the ilium (about 1/8 inch). This is a subtle movement.
Pushing forcefully may create pain or discomfort in the lower back and could severely compromise the lumbar spine!
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-45 Internal Joint Capsule Work.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-44 External Joint Capsule Work.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-46 Deep Six Lateral Hip Rotator Myofascial Release.
8/3/2013
9
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-48 Release Quadratus Femoris to Release Sciatic Nerve
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Precautionary Note
Stretching is not suggested for the muscle groups around a hypermobile joint. Strengthening would be more appropriate to stabilize any joint that has excessive movement due to ligamentous laxity.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Precautionary Note
Do not rotate the tibia during this distal hamstring stretch, unless it is needed to correct abnormal or excessive knee rotation.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Precautionary Note
In order to stretch tissue there should be a tissue stretch end feel. The stretch must also be done pain-free to make sure the therapist is not compromising a preexisting clinical condition such as a strain, sprain, or any unresolved capsular adhesions.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-87 Iliopsoas Stretch (Start).
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-88 Iliopsoas Stretch (Finish).
8/3/2013
10
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-89 Right QL Stretch.
Clinical Massage Therapy: A Structural Approach to Pain ManagementJames Waslaski
Figure 2-90 Lateral Hip Rotator Stretch.
JW-PelvicStabCoverJW-PelvicStabHandout [Read-Only] [Compatibility Mode]
/ColorImageDict > /JPEG2000ColorACSImageDict > /JPEG2000ColorImageDict > /AntiAliasGrayImages false /CropGrayImages true /GrayImageMinResolution 150 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 300 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict > /GrayImageDict > /JPEG2000GrayACSImageDict > /JPEG2000GrayImageDict > /AntiAliasMonoImages false /CropMonoImages true /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 300 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict > /AllowPSXObjects false /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile (None) /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName (http://www.color.org) /PDFXTrapped /False
/CreateJDFFile false /Description >>> setdistillerparams> setpagedevice
Top Related