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Here's a question sent in by an ABMP member—any advice?

Hi. I have a client coming by who has had some scoliosis and seems to have "flat back syndrome" where he doesn't have the standard lordosis of the lumbar spine. He's 17. He said that several months ago there was a massage therapist who was able to help him find relief for 2 or 3 days after the massage. I did the best I can yesterday, and it gave him relief through the night. He is receiving chiropractic treatments also, and those help, too.

Do you know what would work best? He does respond well to deep tissue. Are we thinking trigger point work on the tight muscles as I find them? Does this type of condition worsen with age, so that after several months, any massage therapist would have difficulty getting better results?

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I find that bodywork alone will only provide temporary relief.  The client needs to do stretching and strengthening exercises on a regular basis to sustain lasting results.  Stretching out the low back and strengthening abdominals so that there is movement and flexibility in the lower lumber.  going through movements that brings awareness and intention to the low back, moving each individual vertebrae.  Hope this helps.

Exercise is the only way to cure this thing.  Look at the abnormality,  decide what muscles are dysfunctioning, and lay out an exercise routine to strengthen those. WAIT-- without seeing photos of the client, I'm thinking iliopsoas could be very tight, pulling the hip into anterior / superior tilt.  In fact, I'm guessing there'll be trigger points in either iliopsoas or the abs. 

I just don't see how chiropractic could help-- it would have to be one hellacious vertebral problem, and individual vertebra are not out of place, right?  In fact, the chiropractic could be exacerbating the problem.

 

Where does he hurt the most? Whats his biggest complaint?

I agree with Gary - my first thought was psoas muscles.  If they are short enough to pull the lumbar spine straight, strengthening them will actually make the problem worse.  They need to actually be longer.  He can lay on the floor with his hips and knees at 90 degrees each (an ottoman is usually good for this) and lay there for several minutes at a time.  Gravity will assist the psoas and other deep abdominal muscles to relax, and it will help his lower back do the same.

http://www.triggerpoints.net/triggerpoints/iliopsoas.htm    If the psoas is a player in his pain problem, here are the typical pain patterns.  What I would do is up regulate(stimulate) the antagonist gluteus maximus thus inhibiting(down regulating) the contracted psoas via the reciprocal inhibition reflex.  Without getting into specific techniques.   Muscle Energy Technique comes into mind.  

Hmm,, when I think about it...Maybe its not Muscle Energy Technique Im thinking about.  A form of it perhaps.  But If the glute tightens, the psoas loosens.  You could also utilize Post Isometric Relaxation to loosen the psoas.

Gordon J. Wallis said:

http://www.triggerpoints.net/triggerpoints/iliopsoas.htm    If the psoas is a player in his pain problem, here are the typical pain patterns.  What I would do is up regulate(stimulate) the antagonist gluteus maximus thus inhibiting(down regulating) the contracted psoas via the reciprocal inhibition reflex.  Without getting into specific techniques.   Muscle Energy Technique comes into mind.  

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