I promise Ill report more than just Justin updates. But for now heres another one! ( I lied, I quit this job shortly after this entry)
Last time I saw Justin he had just come from the chiropractor (sports). We started in on routine warming and stretching before doing deep work. He reported a diminishing of hamstring pain to barely noticable, and the shin splints/anterior calf pain had nearly subsided as well. Noting an increase in low back pain, we focused more on the hip and low back than the hamstrings and calf/lower leg.
While working I noticed that his hamstrings had a better relaxation quality to them. Meaning the tension gave way much easier than it had in previous sessions. I asked if Justin had been doing anything different in his routine, nothing new. I felt as though about twice the work was accomplished in this session via myo fascial stretching, trigger point & low pressure ‘jostling’ of trpts, and ROM Stretching. This meant that Justin wouldn’t need to be back for at least a month or so, given he doesn’t re-injure the site.
Addressing the low back pain, after warming I started doing deep myo-fascial and muscle release work on his Q.L. muscle. The quadratus lumborum (brick colored) is a relatively small stocky muscle deep in your back, connecting the bottom rib, spin, and upper hip together. It is very strong, and can often become ultra tense, causing a host of other related tension and problems. I have felt this muscle nearly double in length with application of therapy. This muscle react to various therapies with varying successfullness – this really depends on the client! While working on Justins QL muscle on the “pain related” side, I heard a loud snap & Justin totally melted. He asked if that was from me, but I knew where it was from. It was Justins L1 vertebrae spontaneously re-aligning. This was no doubt prompted by the muscles release – but also the work of the chiropractor earlier, to push the bones closer to re-alignment. The work I did, just allowed them to relax fully into place.
I have 2 more entries I will share soon, one about a pre-natal client and one about hot stones and piriformis work! Not enough hours in one day!!
Well there is a LOT to update even though we only had an hour session.
The last time I had seen Justin he had reported still feeling pain in his hamstring injury, although the pain was under 20% of the original level that had required him to seek help. His shin splints were aching with more presence than the hamstring strain, and he had noted a tingling/shooting sensation emanating from his affected Left heel area.
Working on Justin I found the typical tension pattern as before, extremely tight rear line and related musculature. I focused on his left hip (the affected area) and continued on with deep warming and some gentle lengthening MFT. Doing a PNF stretch on his piriformis & quadratus femoris, I noticed an immediate release of the muscles. Typically it took a very prolonged stretch, or multiple stretches, before the muscle relaxed to this point. gently easing some of the tension over the hip and also down the leg, the majority of it dissipated easily. Releasing the hip took about 15 minutes total.
Moving down the hamstrings it was noticed a pronounced relaxation in the musculature. The affected strain area only had minimal surrounding inflammation and tension. Typically it took a good 20 minutes to warm to this point, but based on prior work, and lead in with PNF techniques, the hamstrings were ready to be stripped. I grasped the lateral edge of the muscle and strummed across it with moderate pressure. Justin admittedly takes on too much and has a high tolerance for pain. I can tell he is good at displacing both current and ongoing pains in his musculature. I tried not to push his boundaries with pain, or even reach them. The strumming motion seemed to be very painful but when queried it was noted the pain level was actually quite low, but that it was just an irritating feeling.
Back to the technique. Gently moving back and forth across the stuck area of the injury site, the musculature flattened quite easily. That is to say the tension, swollen, bloated feeling of the tight tissue, turned into a more regular, normalized texture of muscle fiber. Some areas chunked off quite easily, while others crumbled like sandstone into smooth muscle layers. The chunks were later found to incur trigger points. which were engaged and flattened with the lengthening strokes.
Similar to the “side combing” or “pin & strip” technique, the “pin & lengthen” technique is another MFT favorite of mine. Holding the muscle by the tendenous attachment with one hand, while pinching and stripping with the adjacent hand. Moving down the muscle towards the knee, I was able to engage every tiny trigger point and release them fairly quickly. This took about 10-15 minutes for both techniques.
Doing a few mobilizations of the knee, hip & ankle, we both heard and felt a few pops and clicks. Reworking the plantar fascia, attachment sites of the muscles, mobilizing the retinaculii (?) of the ankle and foot, & giving a brief awareness to the knee’s tendons and patellar ligament all took about 20 minutes.
This pretty much ended our session! I felt so amazing to hear that Justin was no longer in direct pain, and his workouts & yoga challenges were being met instead of being re-analysed!
I’ve been neglecting my journal for a few weeks so I’ll update with more case study!
I saw Justin the last two saturdays, and had a LOT OF PROGRESS. The 3d entry is about the DMT session:
DMT is my spas version of Hot & Cold treatment using biofreez and prosag gel. For the 90m session It took a long time to warm up the tissue. I didn’t do any specific MFT, but did 3-4 pnf stretches on the acetabulums’ musculature. Working with the prosage is tricky because it tends to cool down after a few minutes and feel cold, even though the “warming” ingredients are only “warming” the tissue, not really the temperature. It smells really nice though. Anyways Using the prosage I did some deep stripping on the hamstrings, focusing on the medial two tails, the Semi’s.
Justin reported having considerable benefit from the treatment earlier, and I had hoped that the DMT session would allow some deeper healing. I still wasn’t able to penetrate the general tightness and tension to truly isolate the hamstrings, but the hip in general was 50% more flexible than the last time I worked on Justin. Progress!
The next time I saw Justin he was walking nearly without limp. This was really good news! We spoke and he gave me a breakdown of the daily progress. A few new issues had started to pop up as the hamstrings became looser. Justin became aware that he was unaware! He had noticed a pervasive numbness running down the back of his leg. This was interesting news, as I had just run some copies of dermatomes and nerve innervations of the human body. So I told him to log where the feelings were, on a daily level, and we would try to investigate the nerves that were possibly becoming impinged. He noted some shin splints and tingling in the affected (L) leg & foot.
So starting this 2 hour session at his quads, we did a lot of work stretching the adductors, quads, and other fascia of the ‘anterior’ body. I did some fascial stretches in diagonals all over the hip & thigh, general deep warming, some stripping, and pnfs. Did some rotations and finished off with a bit of sports pumping, to get some nutrients flowing.
I stretched and tried to loosen up the fascia around his feet and ankles. Stripped the anterior extensors and the tibialis anterior. Found a few trigger points that made his toes jump around electrically. He really likes it when i grasp his tarsals & metatarsals and click back & forth. I’m pretty sure the small connective fascia deep between the bones has become so very rigid over the years of running (hes been running regularly for 20+ years, he is around 50). So stretching all this out, I try to also focus specifically on the retinaculum bands around the ankle and the foot. Loosening this up will help the friction associated with the “shin splint” feeling that extends down onto the top of his foot. The only foot that is affected is his (L) one.So working on the posterior, I found his gluteal & acetabulum musculature to be significantly looser than the last time he came in! I’m not certain if this is from my anterior loosening, but it was more than casually relaxed. I wish I had the time to do proper ROM assessments and to do proper assessment palpation. Anyhow, working I found the usual trigger points in the superficial fascia of the hamstrings and back thigh. His calves were riddled with small and a few large knot/trigger points as typical of his/this type of scenario.I found to my surprise, that I was able to identify the specific deeper muscles making up the hamstrings’ injury.
I found that scar tissue had completely fused the two proximal heads of the semi- muscle group. This was both amazing and astonishing. It would explain a lot of my clients gait and ROM issues. I had only 35 minutes to do as much work as possible, so I set after with modified MFT. Working across the body with the affected leg slightly flexed and rotated, I deeply warmed with my elbow, pinning with my thumb. Justin noted the pain was about a 8. I backed off a little bit, and did some comb stripping technique. Holding the medial portion of the muscle across its entire edge with a soft fist, I combed laterally to strip and seperate the muscle fibres. Justin immediately noted an increase in the pain/pressure ratio. He could tell I wasn’t using as much pressure, but it was registering immediately at a 9/10. I backed off and we resumed with a 5/6 pain relative scale.
After this combing and stripping, I stretched the area a bit and ended with a few fascial stretches. I like to go back along the line that is affected, this rear line. I worked Justins plantar fascia, connective ligaments through the hip, connective structures up the hip and into the back/across sacrum. cat paw the erectors and spinal fascia, and finish with some shoulder work and skull stretches. (Stretching the muscles at the base of the skull/spine).
Justin took a while to get dressed and I prepared some take home information about hamstring injuries, dermatomes, impingement, various ROM/strength tests, and a (cough – cough) trail guide to the hamstring muscles – printout. I’m really hoping his daily log and my private notes can contribute to an adequate case study. I’m very excited that Justin is the type of individual to really push the limits of his body, this shows that my work is actually having a significant impact towards “high yield/use” systems. His constant demands of running and yoga will not change after I stop seeing him, but through investigative bodywork and scientific rigor, I can help him reducethe impact of his injury to a minimum. He injured his hamstrings last year about this time (Dec 2010), and came in for the first time 2 months ago, because the pain had increased to debilitating levels. He is noting absolutely no pain these days, and is having an increase in his ROM, Weight bearing on affected leg, and stamina of muscles.
I LOVE MY “JOB”
I saw Justin a few days ago, and had some interesting results. The affected area was still very tight, and his hamstrings, quads, piriformis, glutes, ITB, and related musculature was just as tight as the first day I saw him!!!
I was slightly disappointed because he said he does a lot of Yoga, is using heat and cold packs as much as he can tolerate (daily), and is easing off his running schedule. He had told me he received a GRADE 2 STRAIN. This was reassuring, but I believe it was a grade 3, and now it is similar to a grade 2. He has every symptom of a grade 3 strain except the immediate swelling.
While I was working, Justin reported a lot of relief when I worked on his plantar fascia. This leads directly into methodology described by Tom Myers, that his rear line is stressed, and one point of impingement is the plantar fascia. Working bi laterally on his plantar fascia, which was extremely tight and rigid, I noticed severe impingement all around his foot & retinaculum (retinaculii?); I didnt have time to do more than gentle working of his hamstrings.
Justin received PNF stretches on his piriformis and gluteals every time I have seen him. Im going to work on more deep rear line muscles, and see if any of the tension can be moved past his hip area & be placed more equally along the body.