I wanted to share some quick ways to restore limited toe touch with the perception of lumbar pain and "tight" hamstrings."
The case was a fit 45 yo female who presented with left lumbar pain, radiating to left posterior thigh. In terms of Lower Quarter Clinical Practice Patterns, you should be looking for
- lumbar sidegliding in standing to the involved side
- lumbar extension in standing deviates away from the involved side
- hip flexion ASLR that improves with passive testing on the involved side
- hip IR on the involved side
In most cases, if either lumbar movement test is asymmetrical or painful, you start with repeated motion strategies in the lumbar spine and direct your manual therapies there if needed. In the case I saw today, her lumbar SGIS was symmetrical and extension was full and pain free.
From a variability standpoint, she has been a patient in the past, and knows enough to try SGIS for unilateral lumbar/hip pain, and to perform REIS prophylactically. These movements would no longer be perceived as novel by the CNS and would not change perception of the movement or area under threat.
Her ASLR and passive hip flexion were both moderately painful and limited on the left, and FN on the right. Hip IR was also limited/painful actively and passively on the involved side. The interventions I chose were
- pain free psoas release
- pain free positional inhibition for hip flexors
- hold relax to improve hip flexion
- moved her hip into hip flexion barrier (supine hip and knee flexed)
- The verbal cue was "meet my resistance"
- light pressure to posterior thigh was applied
- resistance was provided 2-3 seconds and upon relaxation, the hip was further passively moved into flexion
- this was repeated 3-4 reps until full passive hip flexion was improved
- this was reinforced with core activated ASLR
After restoring full ASLR, standing toe touch was tested and was now full and pain free. She was instructed on passive hip flexion, held or repeated loading to inhibit her hip flexors and ASLR to reinforce the new motion actively.
Lumbar pain and "hamstring tightness" were abolished in walking and standing after this. Just in case, she was instructed on performing REIS as in the past, this was her directional preference.
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Keeping it Eclectic....