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Hello fellow Massage Therapist's!! I have a client who has had nerve pain in her low back for months now. The pain radiates into the front of her left leg. She gets relief after massage but not for long. Her spine seems to be twisting at the lumbar and sacral. I have done so many techniques however, I am feeling stumped.  Any feedback would be appreciated. Thank you!!

 

Marla

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Hi Maria. This scenario requires the attention of an experienced structural person. There will most likely be cervical, midthorax and lumbar lesions. Good luck! P

Thanks Peter for the feedback.

 

MarLa

As you work the back feel for the lines of tension. These should be followed beyond origin and insertion. Continue following where they lead. Especially check close to the spine. Don't stop there work the pelvis front and back you will probably find tension in the glutes and legs. Stretch it out and loosen the spine with oscillation. Fascia stretches work well but also go deep tissue. It takes a few sessions but they should feel improvement the first time that can last a week or more.

Have you tried NOT working her face down? I never put someone prone with low back or nerve impingement. I would try sideling with knees flexed and work the spine.

Too bad I found this so late...would have liked to join in while it was actually going on. 

I have been that person with nerve impingement....thus, it gave me some insight and tools with which to unravel the nasty thing! (*~*)  What I learned is that the Psoas is the powerful culprit and the tighter it is the more long lasting misery because IT is what is tilting the pelvis and pulling the spine off center.  I would actually, in a situation like this, place the client in several different positions during the session: 1) face down WITH a small pillow @low belly to support low back & pillow at feet.  2) on their side with enough pillows to fully support upper torso, knee & ankle (which are level with hip), neck gets a tiny pillow to keep neck level with spine.  3) on their back with enough pillows under their knees to allow the small of the back to rest 'flat' on the table (muscles finally and fully relaxed).  At home, they need to take rests with knees elevated and relaxed as they are Psoas connected.  No quick fix on this one.

HI Mary-Margaret, I thought so about the psoas!  I have a client who is very torsioned in her pelvis and lumbar spine.  She's a grandmother and no one has ever noticed, even though she's had back trouble since she was a small child.  I have done psoas releases with her when her hip isn't in so much pain that it's the main focus of the session.  Now that she's back on a regular weekly schedule for sessions I will get back to psoas work and send her home with homework.
"Like minds"...I love it!  I send my clients home with homework too!  The Psoas...was not really on my radar screen as a new practitioner...until it brought me to my knees and landed me in bed to essentially do what I call my "Graduate Psoas training" (*~*).  The image that I got of my situation was that my pelvis was trying to fold in on itself like a clam shell and that it was tilted on top of that.  Fellow bodyworkers who tried to do the Psoas release we were all taught did their best to get the job done but the psoas was SO tight and sensitive that I would cringe and try to climb back off the table with just their thinking about it...or so it seemed!  I honestly could not relax into it.  So, it became a situation of self study and exploration to figure out how to get the darn thing relaxed.  That is the point when my practice changed to 'clothed sessions' which allows me to move legs wide open etc. without having to try to chase the sheet at the same time!  I also now, use my shoulder to support said wide open leg and get the heel of my hand under the glute muscles to break the tension.

To finish quickly here...The Psoas has been quite a teacher for me and prompted me to stretch beyond the basic training I got at Massage School.  LOVE this work!!!  What amazing and phenominal vehicles we've got! 

 

Mary-Margaret Mastin said:

"Like minds"...I love it!  I send my clients home with homework too!  The Psoas...was not really on my radar screen as a new practitioner...until it brought me to my knees and landed me in bed to essentially do what I call my "Graduate Psoas training" (*~*).  The image that I got of my situation was that my pelvis was trying to fold in on itself like a clam shell and that it was tilted on top of that.  Fellow bodyworkers who tried to do the Psoas release we were all taught did their best to get the job done but the psoas was SO tight and sensitive that I would cringe and try to climb back off the table with just their thinking about it...or so it seemed!  I honestly could not relax into it.  So, it became a situation of self study and exploration to figure out how to get the darn thing relaxed.  That is the point when my practice changed to 'clothed sessions' which allows me to move legs wide open etc. without having to try to chase the sheet at the same time!  I also now, use my shoulder to support said wide open leg and get the heel of my hand under the glute muscles to break the tension.

Have you used Acupressure? How long do you hold stretches, if you have used them? Sink in and hang out there for a couple minutes or more.

 

Lots of good suggestions above and the variation shows there is more than one method to relieve a pain.

 Ahhh stretching...for myself...I do sort of a Neutral "let gravity do the work" stretch using things like furniture or walls as the support.  I breathe into it and rest until I feel myself "let down".  I tend to also pay attention to what other muscles I might be holding while I'm in that neutral position and like following bread crumps...go to the next one etc.

Stretching clients, I endeavor to get them supported as much in "neutral" as possible and stretch them within that and cautiously just a little beyond, so as not to trigger protection responses.  Not a believer in "no pain no gain" (*~*) 

I often use a Forearm Acupressure on the clients...don't have as much done on myself as I'd like (*~*). 

Daniel Cohen said:

Have you used Acupressure? How long do you hold stretches, if you have used them? Sink in and hang out there for a couple minutes or more.

 

Lots of good suggestions above and the variation shows there is more than one method to relieve a pain.

I am also not a believer in "no pain no gain"!  I have just about abandoned almost all of what I was taught in massage school.  The standard psoas release is painful for me and my clients.  I have also started doing it clothed so they can move their leg around to aid in the release, but I still have my fingers in there.  I think this is THE most important muscle to release.  When I've had people work on mine the pain can be unbearable so I need to do some homework myself!

 

How do you do the Forearm Accupressure?  What position are they in when you do that?  I hope you don't mind questions, but this is an issue for so many of my clients! 

Sorry for the delay in response Therese, I'm only on line Tues and Wed while here in my office. 

Generally, folks are face down when I do the Forearm work.  In doing it....I get a chance to rest while waiting for the release to come to the client.  I also use it while they are on their side and am able to do it on the hip and in the Psoas.  Breaking the tension at the hip seems to help release the tension of the Psoas and visa/versa.  I also have folks take three deep breaths while I am doing this.  Usually by the third, things are nice and smoothed out (*~*).  Also...while they are on their side and if they are able, I lift the top leg (keeping ankle and knee level with each other) and stretch the Psoas open that way.  While doing that, I use my other hand to put pressure on the back side.  Sounds like funny positioning I know...probably looks that way too...but its what guidance has directed me to do and it works!  Like yourself, I use "not much" of what was taught in Massage school except for things like Polarity Therapy and Reflexology (both of which I've expanded since basic training).  Where are you located Therese?   

Therese Schwartz said:

I am also not a believer in "no pain no gain"!  I have just about abandoned almost all of what I was taught in massage school.  The standard psoas release is painful for me and my clients.  I have also started doing it clothed so they can move their leg around to aid in the release, but I still have my fingers in there.  I think this is THE most important muscle to release.  When I've had people work on mine the pain can be unbearable so I need to do some homework myself!

 

How do you do the Forearm Accupressure?  What position are they in when you do that?  I hope you don't mind questions, but this is an issue for so many of my clients! 

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