Back Pain: Quadratus Lumborum

How do you evaluate the quadratus lumborum?

What tests do you use to distinguish between psoas, iliacus, obliques and quadratus lumborum [QL]?

These muscles are all involved in flexion, extension, rotation and lateral flexion.

How can we single out the QL from the rest of the muscles that directly affect the lumbar spine?

Side bends test the function of the obliques and QLs. [mobility]

 

Unilateral hip elevation also evaluate the obliques and QLs. [strength]

 

Prone/supine eccentric break testing evaluate both obliques and QLs. [strength]

 

Palpation directly addresses the QL muscles.

 

Combine range of motion, palpation and muscle testing to evaluate the degree of success obtained from your treatment.

 

Correcting the QL.

Insertion points – press directly into the osteo-tendinous junction at the site and angle of most sensitivity and tenderness. [See arrows]

Use a tolerable force. [2-3 on a 1-10 scale]

Apply thumb pressure with 3 to 4 gentle nudges into the most tender insertion

or…

press and hold the tender point for 3 to 5 seconds.

Immediately retest mobility and strength to track progress.

 

 

I read in bed every night

 

is what the patient said that triggered my brain to investigate his Sterno-Cleido-Mastoid [SCM] muscles.

 

His initial complaint was numbness in his right ear, jaw and upper chest.

[Alarms bells should be going off in your head regarding cardiac issues, mine did.]

 

Restoring strength to his SCM muscles eliminated the numbness and improved neck extension and rotation.

 

Evaluation

 

Correction

 

 

 

 

 

Patellar Tendonitis

 

 

 

The doctor said I have “growing pains”.

 

What does that mean?

 

 

 

I see many early to mid teen athletic patients that complain of knee pain.

The most absurd statement a provider can make is to tell the patient they have “growing pains”.

The explanation that usually follows is something like this, “Your bones are outgrowing your muscles and causing you pain”.

In which reality can a bone grow faster and farther than muscle fibers can stretch?

 

It is statements like that which propel me to write articles like this one:

 

“Patellar Tendonitis: Diagnosis and Treatment”

VOLUME 35, NUMBER 7

 

 

Here are some of my notes from the MFT treatment manual on how to apply these concepts.

 

Presentation

  1.  Pain is localized in the sub-patellar/tibia region.
  2. Kneeling may be painful.
  3. Calcification of the patellar tendon at the tibial tuberosity insertion may occur
  4. Squatting fully may not be possible due to pain and/or joint pressure.
  5. The quadriceps muscle will test weak.

 

 

MFT Diagnosis – Quadriceps muscle testing

 

 

MFT Correction

The arrows show which way to push into the insertion points.

The dots represent areas of muscle fiber adhesions that are addressed using perpendicular lines of force.

 

COMING SOON – Look for the blog post on MFT knee rehab techniques.

 

Piriformis Syndrome: A Pain in the Rear

 

I authored an article with the above title in the Dynamic Chiropractic journal.

Here is my short version on how to apply these concepts.

 

Presentation

  1.  There may be pain in the gluteal region.
  2. The patient may have external foot rotation during walking, laying supine or prone.
  3. The knee to opposite shoulder stretch will be restricted.
  4. The muscle will test weak.

 

Diagnosis – Piriformis muscle testing

 

Treatment

Effectively correcting the piriformis dysfunction involves reducing the hypertonic state.

Thrusting and/or pressing into the sciatic notch will affect the fibers at the origin, while forces applied at the femur head will address the insertion fibers.

Press and hold for 3-5 seconds into these areas in order to stimulate the golgi tendon organs and reduce hypertonicity.

 

 

Rehabilitation

Stretching:

With the patient lying supine, bring the involved-side bent leg across the body and up toward the opposite shoulder. While maintaining this stretch, the tender piriformis fibers can be massaged to release more muscle fiber tension.

Strengthening:

I prefer my patients work the good side first and then train the involved side.

Quadruped Hip Abduction: Beginning position is an all-fours position. Instruct patient to keep their knee bent and lift the involved leg in the air to the side until it parallels the floor. This can be done using multiple sets and reps without resistance; or exercise tubing can be used to add resistance.

Side-Lying Clam Exercise: Instruct patient to lie on their side with the involved hip on top; then bend their knees, keep the ankles together and raise the top knee away from the bottom one. Again, this can be done using multiple sets and reps without resistance, or exercise tubing can be used to add resistance.

 

CLICK HERE to read the full article.

Bloody mucus

 

I was doing some dive training with my instructor in the cold Pacific Northwest ocean.

 

One drill included removing my mask underwater for 10 seconds before ascending to the surface.

 

This drill caused my sinuses to contract rapidly which led to some blood being added to my nasal mucus the next morning.

 

What causes bloody nasal mucus?

“The cold air/water can cause cracks in the mucous membranes of the nose, which can lead to exposed blood vessels that can then bleed.”

 

What is Sinus squeeze?

  • a condition where pressure inside a sinus cavity causes pain, commonly occurs when a scuba diver cannot equalize sinus pressure due to nasal congestion. This is also called (sinus) barotrauma.

 

One way to prevent sinus squeeze is to treat allergies and sinus conditions before diving or flying, and make sure you descend and ascend slowly using valsalva manuevers (swallowing or yawning on an airplane) to equalize pressure.

 

How can we treat these issues without drugs?

 

I have developed several manual manipulation tools that help address these issues:

 

 

  • A-P compression of the skull

 

  • Rope compression of the skull

 

  • Equalization with one ear elevated

  1. Inhale and hold breath
  2. Hold nose closed
  3. Elevate ear by tilting the head to one side [perform bilaterally]
  4. Perform Valsalva [force air out thru the ears]

 

If you have found other approaches to these problems I would like to hear from you. You can email me at DrT@DrToddTurnbull.com.

Upper Extremity seminar preview

 

Come join me, Dr. Todd Turnbull, in this hands-on workshop.

  • Walk away with practical tools ready for immediate application.
  • Gain deeper understanding of functional evaluation.
  • Experience the MFT “WOW” factor and
  • Reproduce the “WOW” factor with patients.

 

August 12, 2017 – Shoulder

August 26, 2017 – Elbow, Wrist and Hand

 

CLICK HERE for all the details and in-depth preview with cool videos.

 

 

How do I know if my concussion is all better?

One of the common questions patients with concussions ask is, “How will I know when I am all better from this concussion?”

Patients that received a head injury 10 years ago may still be suffering from neurological deficits as a result of that injury. They want to know why they are still having issues…”when that injury happened so long ago. Why am I not better?”

How can you validate their concerns and show them how their nervous system is still not functioning at 100%.

Let me introduce what I refer to as …’THE GOLD STANDARD’ for quick concussion evaluation.

I check the patient’s ability to rotate their neck pain free before proceeding. Then I ask them to perform 2 quick rotations and return to neutral. I want to look at their eyes and observe for any nystagmus (eye twitching), balance disorder and/or symptom aggravation.

Usually the patient will describe a sense of light-headedness and/or slight balance challenges. This is the result of disturbance of the inner ear, vision and cerebellum reflexes. When neurological deficits are present there will be dysfunction.

 

 

The reason the patient is still suffering (after possibly many years) is their nervous system has excess tension altering function.

 

THE GOOD NEWS…these patients can improve and the nerve deficits can be corrected.

 

A second concussion evaluation tool that is quick and can reveal nerve dysfunction is the CONVERGENCE DEFICIENCY exam.

 

Convergence is evaluated by having the patient watch the clinician’s fingertip while it is moving slowly toward the bridge of the nose from about 60 centimeters away. The normal reaction is turning the eyes inward to focus at close range.

 

Errors include the inability to perform the task accurately, nystagmus, and/or the aggravation of symptoms. Closely watch the eyes during this exam to see if one reacts differently than the other.

 

ANY DEVIATION indicates the possibility of neurological deficit. Confirm with the patient any challenges they experienced while performing the exam.

 

FREE Download – of my detailed Visual Error Scoring System exam sheet.

 

Get more Concussion Resources

Mfticonsmall

Subscribe to get updates to Dr. T's concussion protocols.

We won't send you any spam. Unsubscribe at drt@drtoddturnbull.com Powered by ConvertKit

 

 

Low Back Pain – Core issues

I have noticed in my 26 years of practice that the majority [greater than 80%] of the back pain cases I have seen are caused by excess strain and tension from the core muscles. The core muscles include the transverse abs, obliques, ab rectus and quadratus lumborum. These muscles are responsible for the bending, rotation and flexion/extension of the low back.

Excess tension in these muscles creates compression in the lumbar discs and spinal joints causing pain. If we can reduce/eliminate the excess muscle tension the pain should disappear. How do we do that?

Correcting the core muscles involves pushing into the GTO’s at the musculo-tendinous junction near the insertion points [see arrows]. We can also release tension in the muscle belly by gently squeezing into the tender fibers [see dots].

This slide shows the correction for the transverse abdominal muscles. These principles are also applied to the ab rectus and obliques to reduce tension at the lumbosacral joints.

 

FREE Herniated Disc Course

Mfticonsmall

Subscribe for my FREE 3 day initial Herniated Disc Training Course

We won't send you any spam. Unsubscribe at drt@drtoddturnbull.com Powered by ConvertKit

Concussion Treatment – Palming

Patients that experience vision and headache issues related to their concussions can find relief using a technique called palming.

Cup each eye with the palms of your hands in such a way that there is no pressure on your eyeballs and no light enters the eye.

– Palm until your eyes are relaxed  [Take 3 to 10 slow breaths. Rest elbows on the table while sitting.]

Photo on 3-24-16 at 12.48 PM #5

Palming

Palming

More information about palming can be found at www.seeing.org/techniques/palming.htm.

Get more Concussion Resources

Mfticonsmall

Subscribe to get updates to Dr. T's concussion protocols.

We won't send you any spam. Unsubscribe at drt@drtoddturnbull.com Powered by ConvertKit