Client with challenging (for me at least) symptoms

[fizzyfitzy]

Hi guys,

Firstly, sorry for such a long post.

I have a regular client who came in last week. He had been circuit training and doing an exercise where he stands feet shoulder width apart, knees bent, he dangles a dumbbell in his left hand between his legs at ankle height, and then in one movement hefts the dumbbell with his arm straight in an arc from between his ankles forward and laterally til he's standing straight with his left arm abducted at 130 degrees. Makes sense?

At the end of the movement, he experienced an arc of pain from his left QL region, through his left buttock, and down his left ITB, with a secondary arc following his sartorius.

He stopped training immediately. He came to see me 2 days later and he was experiencing the shooting pain whenever he would try and lie on his front (he literally can't lie prone - had to treat him side-lying) or when put his left leg into hyperextension. Funnily there were only two areas that were sensitive to touch:
1. the piriformis region of his glutes, especially near the attachment with the greater trochanter... but no pain when I get him to laterally rotate his left leg against resistance
2. also his sartorius (or certainly the area following his sartorius)

His left QL, TFL and ITB were not tender to touch at all and he had quite good ROM in that left QL region. I treated him with lots of MET all around the glutes and QL, slow compression on the piriformis with gentle active engagement, gently stripped the sartorius etc... but I must say I was kind of fishing when I was treating him.

It's got me stumped. Sciatic nerve irritation? Disc issue? SIJ issue? Psoas? Help! Any feedback, ideas would be gratefully and warmly received.

x

Henry

 

[Hope Has A Headache]

When he stands up out of a chair or off the table, does he feel like a 90 year old man and can't quite stand up straight, at least with any speed? Psoas.

If it is piriformis or sciatic nerve, the exact middle point of the glutes would be a problem as well as the attatchement site at the sacrum. (You mentioned the head of the trochantor already.)

My first thought however by your description, is a possible disc problem. If he is still hurting at the same pain level after working on him, I would have him see a doctor. The path that you describe is about L3-L4 nerve pathway.

Hope this helps.

 

[ian s]

Client with challenging (for me at least) symptoms

Thank Dodab,

I have refered him to an excellent osteopath. I will forward the findings for all your interest.

Kind regards

Henry