David R. Beatty and Camilia Makyhoun

David R. Beatty, DO, Professor of Osteopathic Principles and Practice, WVSOM

Camilia Makyhoun, Assistant Editor, WVSOM Class of 2016

Thursday, February 28, 2013

PSOAS YOU CAN'T STAND UP STRAIGHT...






The psoas muscle is a hip flexor that
causes low back and thigh pain (WVSOM)

... you probably have psoas ("so-as") syndrome if not a herniated lumbar disc. The former is easily treatable with self-administered manipulation, the latter not so much. An easy way to tell the difference at home is the direction of bending forward : Bending toward the side of back and leg pain is usually due to psoas muscle spasm; Bending away from the side of pain is most often to reduce pressure on a painful disc.







DOCTOR'S NOTE: Back and leg pain making it hard to stand up straight needs to be evaluated by a health professional if the pain makes you bend away from the side of pain.





PSOAS POSITION OF EASE

Right psoas position of ease (WVSOM)

  1. Lie on your back with legs propped up on a chair or stool;
  2. Cross your ankles with the foot on the side of the back or pelvic pain on top;
  3. Allow your knees to fall apart;
  4. If comfortable, take a few deep breaths and rest in this position for 2-5 minutes;
  5. Slowly uncross your legs, bring your feet down to the floor, and proceed to the Psoas Stretch or roll to one side before getting up;
  6. Use this position 2-4 times a day, or as needed for pain relief.







Left psoas stretch (WVSOM)
PSOAS STRETCH
  1. Kneel with one foot on the floor a few feet in front of the other knee;
  2. Slowly lean forward onto the leg in front while using your hand to push the other hip forward;
  3. Take a few deep breaths and stretch for 10-20 seconds;
  4. Repeat for the other side;
  5. If no increase in pain, proceed to the Thoracolumbar Mobilization;



 THORACOLUMBAR MOBILIZATION

    
    Thoracolumbar mobilization (WVSOM)
  1. Sit with your legs straight and hands on the floor behind you;
  2. Bend one knee and place the opposite arm against the outside of the bent leg;
  3. Slowly turn your trunk toward the bent leg as far as it will comfortably go while pushing the arm into the leg;
  4. Add a short quick push of the arm into the leg to twist the trunk slightly farther. If the upper low back doesn't pop, move the hand on the floor a little farther away from or closer to the back of the hip and repeat the short quick trunk twist;
  5. Repeat to the other side;
  6. Do this mobilization up to twice a day. 





Tuesday, February 26, 2013

SCIATICA SCHMIATICA


Piriformis tender point location and
counterstrain position (WVSOM)

Sciatica is a real pain in the buttocks, and sometimes that's where the cause is too. Piriformis syndrome occurs when the hip muscle by that name is tense or in spasm, compressing or irritating the nearby sciatic nerve to produce back and thigh pain and numbness. Such sciatica can also be caused by nerve compression in the back or pelvis, which might also produce leg weakness not present with piriformis syndrome.






DOCTOR'S NOTE: Seek evaluation by a health professional if your back and leg pain are associated with leg weakness, incontinence, fever, or weight loss, or if it doesn't improve with self-treatment for piriformis syndrome.




PIRIFORMIS POSITION OF EASE

Piriformis position of ease (WVSOM)

  1. Lie on your back with legs propped up on a chair or stool;
  2. Cross your ankles with the foot of the pain side on top;
  3. Let your knees fall apart and relax;
  4. If comfortable, take a few deep breaths and rest in this position for 2-5 minutes or until pain is completely resolved;
  5. Slowly uncross your legs, bring your feet down to the floor, and proceed to the Piriformis Stretch or roll to one side before getting up;
  6. Use this position 2-4 times a day or as needed for pain relief.




PIRIFORMIS STRETCH

Right piriformis stretch (WVSOM)
  1. Lie on your back and place the foot on the side of leg pain on top of the other knee;
  2. Grasp the outside of the bent knee with your opposite hand;
  3. Allow your bent leg to slowly fall over the other leg as far as it will go;
  4. If comfortable, take a few deep breaths and slowly pull the bent knee down toward the floor for 10-20 seconds;
  5. Slowly release the pull and straighten out the leg;
  6. If no increase in pain, proceed to the Sacroiliac Mobilization;
  7. Do this stretch 1-4 times a day.





Sacroiliac stretch (WVSOM)
SACROILIAC MOBILIZATION


  1. Lie on your back and bend one leg up, grasping the knee with both hands;
  2. Pull the knee toward your opposite shoulder as far as it will comfortably go. If leg pain worsens, stop the exercise;
  3. Take a few deep breaths and with each exhalation pull the knee a little farther toward the opposite shoulder;
  4. Release the hand on the side of the bent knee and use the other hand to pull the knee across your abdomen as you slowly straighten the leg;
  5. Repeat for the other leg;
    Sacroiliac mobilization (WVSOM)
  6. Do this stretch and self-mobilization up to twice a day if helpful.


Wednesday, February 20, 2013

HOW (AND HOW NOT) TO CRACK YOUR BACK

Everyone has acute low back pain from time to time. Most of the time it will get better on its own and be due to a muscle strain with or without joint pain, which is safe to treat with self-administered manipulation. Sometimes, however, it is better to be evaluated before home treatment:



See a health professional if your low back pain is:
  • right after a fall or accident
  • present for more than a month
  • making it hard to stand or walk
  • causing leg weakness
  • causing loss of urinary or bowel control
  • associated with unintentional weight loss
  • associated with fever, chills, or sweating
  • worse during or right after an exercise
  • no better after a week of home exercises



For safe self treatment it's best to do the exercises in the sequence they are listed. If no relief with a position of ease, stop the sequence and try a different low back pain routine (see subsequent posts). If pain is worse with a myofascial stretch, stop the treatment before attempting a joint mobilization and try again later. Some lower back problems are better treated with more specific routines that will be provided in subsequent posts.




LUMBAR POSITION OF EASE

Lumbar position of ease (WVSOM)

  1. Lie face down with a pillow or two under your pelvis on the side of back pain;
  2. If comfortable, take a few deep breaths and rest in this position for 2-5 minutes. If no relief with this position, move the pillows down to in front of the lower thigh just above the knee and rest for another 2-5 minutes;
  3. Proceed to a lumbar extensor stretch or slowly roll to one side before getting up;
  4. Use this position of ease 2-4 times a day or as needed for pain relief.



 LUMBAR EXTENSOR STRETCH
  1. Lie on your back and grasp both knees with your hands. If knee pain occurs, instead grasp the back of the thighs just above the knees;
    Lumbar extensor stretch (WVSOM)
  2. Use your arms to slowly pull the knees toward the chest as far as they will comfortably go;
  3. Take a few deep breaths and stretch for 10-20 seconds;
  4. Proceed to a lumbar self-mobilization or slowly roll to one side before getting up;
  5. Do this stretch 2-4 times a day.




LUMBAR MOBILIZATION
    
    Lumbar mobilization (WVSOM)
  1. Lie on your back with knees bent, feet on the floor, and arms outstretched;
  2. Drape one knee over the other and allow the legs to fall to the floor while keeping the shoulders down;
  3. Repeat to the other side;
  4. Do up to twice a day if helpful.




Thursday, February 14, 2013

TO POP OR NOT TO POP?


That is the question facing those who want to treat their own backs and necks. People say with good reason that there's only one thing better than spinal manipulation and it isn't chocolate. Adjustments that move the joints in the neck and back have been demonstrated to relieve pain, reduce muscle spasm, and improve motion for both the area being treated and neurologically related structures. There's just one catch: Spinal manipulation of the popping variety has a greater risk for side effects and, to a lesser extent, complications than other types of treatment.


Prone thoracic thrust (not for home application)
(WVSOM)


On rare occasions, sciatica (back pain going to leg) gets worse after a lumbar thrust like the one pictured in the previous post (For Every Manipulation There is an Exercise..."). This can be avoided by stopping the technique if symptoms start to worsen. Rib fractures have occurred with upper back adjustments like the prone thoracic thrust and can be prevented by limiting popping techniques when there is osteoporosis. Tension headaches that sometimes worsen after a neck mobilization can be avoided by doing a position of ease or myofascial stretch before the joint mobilization.



Cervical rotation thrust (not for home application)
(WVSOM)





The vertebral artery has a twist at the upper neck
(David R. Beatty, drawing by William A. Kuchera, DO, FAAO)

More concerning is a kind of stroke called a vertebral artery dissection that has been reported following neck adjustments. These are believed to occur because of a stretch injury to the blood vessel as it twists up through the cervical vertebrae to get to the back of the brain. A small tear in the lining of the artery causes a clot to form that can then travel up to the cerebellum to block blood flow, resulting in dizziness, nausea, and uncontrolled eye movements. A few deaths have even been reported, both with adjustments and spontaneous head movements. For this reason self-administered neck joint popping by sudden movement is not recommended in any circumstance. A cervical joint mobilization by sidebending articulation (slow movement through range of motion) will be presented in the post on neck and head pain. Prevention of other side-effects and complications will be emphasized for each individual region of the body in subsequent posts.





Thursday, February 7, 2013

FOR EVERY MANIPULATION THERE IS AN EXERCISE...


Psoas counterstrain (WVSOM)



... that will have a more lasting impact on a person's life than any of my treatments. This blog will teach three types of exercises adapted from osteopathic manipulative treatments - positions of ease, myofascial stretches, and joint mobilizations.








Positions of ease are adapted from counterstrain and indirect techniques. In counterstrain, developed by Lawrence H. Jones, DO in the late 1950s, the patient is positioned to relieve tenderness, thereby triggering muscle relaxation that in turn results in improved mobility with less pain. 





Scapula myofascial release (WVSOM)

Indirect techniques date to Andrew Taylor Still, MD who founded osteopathic medicine in the late nineteenth century, and include myofascial release and functional techniques. The body is positioned away from its restricted motion in order to reduce tension and restore pain-free motion.







Thoracic muscle energy (WVSOM)
The myofascial stretches in this book are adapted from direct myofascial release and muscle energy techniques. These techniques reduce tension and restore motion by initiating tissue creep in response to a slow steady stretch. Creep is the process by which a tight tissue elongates in response to a gradual lengthening force. This tissue give can be interrupted by pain or muscle spasm so a myofascial stretch may need to be preceded by a position of ease. The net result of myofascial stretching is decreased pain and increased flexibility.







Lumbar thrust (not for home application)
(WVSOM)


Joint mobilizations play a special role in relief of pain and stiffness but also have unique risks that will be addressed in the next chapter.








The combination of positions of ease, myofascial stretches, and joint mobilizations can have a powerful role in healing. Most people with musculoskeletal pain are in the midst of a vicious cycle of spasm, restriction, and pain. Positions of ease relieve pain, myofascial stretches reduce spasm, and joint mobilizations restore motion to break this cycle.





Self administered manipulation interrupts the pain cycle (David R. Beatty, DO)