INTRODUCTION
Never mistake motion for action.
(Ernest Hemingway)
When I did the Sport Massage Therapy Course was an moment into my travel and my profession that I was need an sort of new fresh energy of information. So all the information new and knowledge’s from this course give me the chance to mature some points of view respect the work of therapy into the rehabilitation of the body.
I decided to write first my final work in postural assessment and the importance into the therapeutic work with the clients, but some day speaking with my teacher referent, she proposed me find the way to explain my professional experience around the countries where I was working during my travel, explain my professional insertion and experiences, in each place where I introduce new practices of my knowledge.
In this way, giving an different point of view to my professional work and generate a sort of ¨funny history¨ where I can reduce into these pages my incredible experiences working with my profession
This change was put the focus into the evidence of the necessary therapeutic work in any place of the globe, my professional insertion and experiences, speak about the condition of my clients and my work with them, advise others professionals therapist that will like to travel also experiences and points of view about how can insert in easy way in any part of the world, speak and explain about conditions of my clients in general and punctual way.
Anyway, I need to be honest, I believe in the particular way of the human to live and take choices, in my case (also in this time of my life) is this travel, so when I wrote my work I treat to put in evidence something how can give some help into the therapeutic work I use, and I will like make useful In any person which read my work.
The full work are structure in Places, so is easy to find!!! London, Brazil, Greece,Italy and Argentina; into each of the Places, we can find sub-division where have a referents points, Introduction, explaining how arrived to each place and plenty adventures I lived!!! (unfortunately not always the experiences are excellent...); also each Place are describing particular cases studies and clients experiences, list of therapeutic work, full case studies of one client, techniques of sport massage I used in the sessions, and a short synthesis.
The full work is fixed with basics points of connection,
¨The travel and my professional insertion into new cultures¨
¨Professional philosophy, Position and Response to each particular therapy experience¨ ( that continues to grow day by day)
¨Sport Massage techniques used, and my form to introduce into the therapy¨
I did my course in Sport Massage Therapy in London,
at this time my language skill and my really busy time of work gave me a lot of uncertainty in starting the course. I remember my arrived in London to learn english and do some course in my profession.
Was one fantastic moment and experience to myself know and refind the energy of people wich love sport, learning like the art of help people with techniques of massage.
During this time I organized my life in waking up at 5 30 in the morning read the texts and materials of the course, at 7 30 to go running to the current course with lot of ansiety, put my focus in every part of the course. I have to be honest first days was really hard for me understand everything... Jane speak a perfect academic english, but this first days came to me like a new fresh air of productivity time in London.
During every day when the course ended my head was exausted of information, questions and enthusiasm from these knowledges, after that,continues my happy day, at 8 O´clock I had to run and take the underground to start to work in the kitchen of Camden Town until the bar close at night so, when arrive to my home broking in pieces.
I can thought now about this and I can remember like yesterday, after 10 month finished my course and after traveling in 4 countries diferents, may be at these moment of my life something say me I have to move, I have to run, and, I have to put lot of energy in my actions.
This introduction is not for speak about my life, is to introduce about what i will like to speak, in my final work, The travel and bodies cultures, London to Brazil, Brazil to Argentina, Argentina to Greece, Greece to Italy, 10 month of travel and fantastic experience, and the company always of my new little new world of Sport Massage Therapy Techniques.
I meet so many people, and also I work in many diferents places, so I think is a good idea to share my experiences and start to write about these.
I spend 3 month after finish my course in London, at these time I continued working into the Kitchen of Camden Town, and also allow me offer to my partners of work assist with massage, so, I give periodical massages at my manager, barman and cheffs and also some clients.
With my partner of work from Check Republic we run a project in Foto Design about Postural and Range of Movement also during this time, however, something changed into the full time of my ritmica life, in one magical zone in the undergroun zone of Camden Town, London start my Course, changed my life style with nice and funny actions.
When I travel with my girlfriend to Brazil in Belo Horizonte Minas Gerais, I descovered a big city with a lot of productive proyects to do, every weekend (friday, saturday and sunday) I move to one place in the middle of the montagne (Cerro do Cipó) where I work with Pousadas and clients, during week days in the city of Belo Horizonte I start to make up and run my business, I designed flyers and during the morning and midday I walked the city speaking with people and distributed them in locals, shops, restorants and health centers, so in short time I start to get some clients from the street how called for me!!!, I get an fantastic experience in Brazil, and I learned a lot my capacity to make up for myself the compromise and organization.
During this time in Brazil I began to draw attention about Postural Assesment, so each client which I worked therapy session, recived a little advise with foto-pictures that also help me to work together with my clients and think about the postural problems and exercises to do during the time work .(didn´t speak very well portuguese at this time!!!)
One day I receive a proposal to work in Greece, one company of Healt Care and Recreations Sport Activities need a PE teacher and Sport Massage Therapist, so I decided run for these experience, first I move to Argentina to see my family in Patagonia, and during my travel stole me one bag with my computer and my foto camera. All my work and recopilations lost in a second!!!, but the travel have moments and I put my confident to arrive to Greece, there are something new waiting for me...
In Greece I get a fantastic experience, every day I give classes of pilates, group bike ride to the montagne, hydrotherapy, circuits and massage; I spend there 5 intense weeks there I saw so many people, I did aprox 5 massage each day.
When I finish my work in Greece I travel to Italy and the first place where I did massage was in Villa Borgognoni Hostel from Jesi, there one group of musician of camera ask me if i can do some session so my experience with musicians was fantastic as well. In Italy call me to work in one camping in one fantastic place called Cinque Terre, there I work of lifeguard but the owners and managers also my partner of work get periodicals massage.
After to finish my work in Camping River, my father call me one day and telling me he fell down from the ladder and suffered complete tear your quadriceps tendon. I change, again my plan to travel for some courses to Thailand and I decided run to help him into the rehabilitation in Argentina.
Here this introductory part about my travel, next parts of my work are describing therapeutic work I can do in each place where I lived.
I prefer don´t give a fixed name to the full work, also could be really difficult for me do it!!!
If the motor of my core ask me more I go to listen you,
Satisfaction about learn day to day and satisfaction to help ´some-body´ during the way...
IF YOU ARE INTERESTING JUST IN READ COMPLETE CASE STUDIES SEE NEXT TABLE TO FINDED QUICK!!!
London with F. | Brazil with A. | Greece with L. | Italy and Argentina with C. |
Piriformis Muscle, Entrampment Ciatic Nerve, Quadratus Lumborum... and more!!. Low back Pain!? | Postural Imbalances. Kyphotic, Scaleness thoracic outlet syndrome Muscles Overcompensation | Hip Joint Disorder. Adhesive Joint. Proprioceptive Stimulation. Frozzen Hip!? | Complete tear Quadriceps Tendon. Complete Protocol of Rehabilitation Post Surgical. Inter Disciplinar Proffessional Work!! |
|
|
|
|
London time...
After finish my course of Sport Massage Therapy my anxiety to get clients and practise’s gave to me the idea to offer to my work colleagues massages (I was working in one bar in Camden Town at these time), some of them came to me asking if I can do a session, so I started working in my home during my days off.
The place was my room, (normally foreign rent the rooms in London where share with others partners, the rent in London is expensive and get the comfort and good location is necessary, the life is really busy there).
I used a mat of massage, which I asked to Jane (at these time was impossible for me buy a bed), I went to an massage shop and bought roll of paper for the bed, plain oil (no contending nuts derivation) and alcohol in gel. I prepare the room with some candles to give a better ambient into my room, and install dimmer control in the lights of the room to create better ambient of relax. The floor of my apartment was with wood and heating with water, so the temperature inside was perfect to do a session of massage.
I worked during 3 month in this place before go to Brazil and I feel happy to create a nice ambient where every person went into the room feel relaxed. At these moment I work periodically with the chef and partner of work, the manager, and one bar man, also the landlord of my apartment got a session. I start to do one and two massage per week and some times three massage per week each session of one hour.
- All my clients at these moment was people that work long hours a day, and not sport people,
- One Ex bodybuilding with impingement in both shoulders, manager in bank in the City. I work 3 session at least, each session of one hour one time a week.
- One Ex football player, manager of bar in Camden. I did 3 session, one time a week. He told me felt very good but exhausted for hard work.
- One Chef guy of 26 years sedentary I did 4 session one per week.
- An Professional musician (guitar and singer), Ex amateur football player, Bar-man, with medic history in rectification of spine and fixation spine (swimming pool recommended by your physio) , at the moment when I saw him was pain in cervical spine and instability of shoulders. I did 3 massages with him.
My experience in London with massages was really good, after finish the course I started to search some people to practice.
When arrive to London was impossible work in my profession PE Teacher and during the time to get my REPS L3 qualifications quickly I start to build my experiences into the kitchen in Camden Town. Then, all the people that I give session with massages was an particular relationship with me and my work. As well I didn’t have a time to do more massages.
At these time also I tried to do some practice in practitioner volunteer into the Hospital of Queen Crescent but my travel to Brazil became first.
I think London is a good place where one Therapist can make up your own – self businessmen, the competition is big so I think is good also work as well in some voluntary organization, to start could be good Hospital, Club or Equip of rehabilitation and do some privates work with private clients.
London is a place where have a lot of people who need treatment and no always the population can permit to pay one treatment, in these way I always like work with organizations like charities where one therapist can starting and do the firsts professional practices.
England culture is really open to foreign professionals and also the range of possibilities is massive and always the challenging to do thing new is coming.
My idea and project during these time was get an position into the hospital in voluntary practitioner, the opportunities in London are available for every one... but is really important get focus and idea also the attention to build every day the personal profession and practice as well make good contacts to open new doors.
The hardest situation for me was some factors, time and language skill, may be my inexperience in one of the most vertiginous city of the world which I felt all the time like... I m loosing my time, I can do more, but at the same time I didn’t felt enough strong to affront the city (is my particular situation).
I moved to the most vertiginous city with lot of projects in my profession and during the second round of play, I learned is no so easy... I think is an aspect of anxiety form myself!!!
CLINIC CASE STUDIE
Treatment with F (Conserve name) Piriformis Syndrome. Sciatic. Or QL ???
F spoke with me complaining for pain in the lumbar zone, him showed me felt pain in low back zone and that situation described gave problems during all day. He started to take medicine (two weeks before to see me) also he didn’t remembered feel these condition before.
F. is a sedentary young man of 27 years, works 8 to 11 hours per day into the kitchen (chef), during the time free him spend long time seated in front of your computer.
In my first session,
I see F. him was with your computer into the room, he was seated on the bed, (bed without legs) with the computer on the bed and your legs crossing in really estrange position.
QUESTIONS
I quickly asked him if him always sit in these position to work in computer.
He respond, Yes always,
And how long time you are there?
Every day, spend long hours like this, actually now, He can´t sit good (in this position) cause of pain and He have to sit short time and change position.
I ask him if he has practice some sports, stretching or body movements, exerciser.
No at all.
Where is the pain?
He touch the zone of low back and he say to me, I take anti-flamatory from 2 weeks
I ask if him felt this before or if he have any antecedent before can remember any condition similar.
No.
I asked witch moment and when he felt these pain (during the morning time, during work, night time) and also if the pain increase when he do any particular movement.
He say feel pain all the time, and when put the body weight in the right side and flex the trunk he felt the pain.
I asked when he start to feel the pain.
May be one month ago the pain increased.
When the problem start in your body?
May be 3 months ago
You remember any situation or action in two month ago you do it, how can produce this pain?
No.
This pain you feel in with moment of the day, you feel more or increased?
When I finish to work
Can you say to me your profession? You do any sport?
Chef, no, only I go in bicycle... (approx 3 month ago)
Can you show me which part of your low back is painful?, and if you remember in which action or movement you feel the pain?
Yes, (zone near sacrum, and lumbar), F. can not described the zone, but I can note painful action when extend the hip, twist the leg or rotate the leg during my observation
OBSERVATION AND PALPATION
I asked to F. I will to do a postural assessment view to check any postural dysfunction.
I can see in the painful zone affected Low Back of F, one rigid area with strong stiff muscles, could be dysfunction product of bad habits posture (F. is a sedentary person), could be evident inflammatory process, he move to find always any posture in stand position where not feel the sensation, so he never stop to move!!!
I get information about the postural Assessment...
I can see Lumbar zone really tight, (give to me the idea of loose T.A, Psoas and Abdominal) as well left leg in external rotation, (front view). The pelvis in forwards and into a posterior tilt, Sway Back Position. Because the pelvis has moved forwards, the upper back sways backwards to counterbalance. This posture places the knees into hyper extension, hips into extension, lumbar spine, particularly the lower lumbar, into extension, the thoracolumbar junction and thoracic spine into flexion, the cervical spine into extension and the scapula into elevation. So it exaggerates the normal curves and joint positions of standing.
Postural gluteal contraction, particularly gluteus maximus, appears deficient in sway back positions. This is because the line of gravity drops behind the hip joint producing passive hip extension via body weight. This passive hip extension renders active extension from gluteus maximus unnecessary and it ‘switches off’, the hamstring muscles however maintain activation to
control postural sway. Common presentations include recurrent hamstring strain due to overloaded
hamstring muscles and SIJ dysfunction due to lack of postural gluteal support. It appears when
palpating multifidus that it is difficult to recruit in the sway position. Certainly patients have much more success at activating their multifidus when their alignment is corrected. The deficiency of multifidus recruitment is probably similar to that of gluteus maximus. If the deep segmental portion of multifidus were affected by this mechanism then there would be implications for the local stability system.
TEST
When we see the test in pictures (extension) I can thinking tight muscles of low back, also the legs in flexed position gave me the information of weak abdominal s, at the same time strong tight hamstrings.
In Extension is evident the position of the head zone in tight neck, also rigid muscles of low back. In lateral flexion again evidence of tight QL, and gluteal zone, also Ilio tibial band.
In Rotation also with lot lost of ROM in lumbar zone.
SPECIAL TEST
Thomas Test give to me good information about of flexibility of the hip flexors, hamstrings, and ITB, also I used Ober Test and Sciatic Test.
Pain refered during test
Flexion (negative), extension (some pain in low back zone right side), lateral side (negative both sides), rotation (some pain in right side).
I test sciatic with Thomson´s test (some pain in right side).
I can see the legs bended go in out side or external side, in both sides, gave me idea of tight gluteal.
My first sensation when I saw first day F, was Sciatic Nerve Inflamed, also when I did Test to F, he complaining about some pain, but when we did Ober Test the pain become strong with QL muscle, (I remember some pain in lateral flexion) so during my first session with F. I put focus in
Realise Soft Tissue Massage, MET, Stretch, trigger points in gluteal zone and in the spine zone and QL.
I find an external rotation in the right leg (posterior view, see pictures) and I thought in piriformis muscle, could be in compression, inflamed, tight or trapped with sciatic nerve, again when did stretching the gluteus zone (I find really implicated muscles in this area) F showed to me some pain, special when I did Stretching in internal or external rotation.
I worked most of the session with stretching of QL, Gluteus and Piriformis muscle, I find really stiff and rigid. Most of the work I used stretching, MET, and STR techniques.
MUSCLES
Piriformis. Origin and Insertion , anterior (front) part of the sacrum, the part of the spine in the gluteus region and from the superior margin of the greater sciatic notch (as well as the sacroiliac joint capsule and the sacrotuberous ligament) Action. Lateral rotation hip abducts flexed hips, rotate laterally (outward) the thigh
Gluteus Maximus. Origin and Insertion Fascia and from the transverse processes of the last sacral and first caudal vertebrae. Fascia Lata and greater trochanter. Action. Abductor of the thigh, Extend and lateral rotation hip
Gluteus Medius. Adjacent fascia crest of the ilium and lateral surface of the ilium, and transverse processes of the last sacral and first caudal vertebrae. Action abductor of the thigh
Semitendinosus. Ischial tuberositi and Tibia. Action Extensor of the thigh
Semimembranosus Ischium and medial epicondyle of the femur and proximal end of the tibia. Action Extensors of the thigh
Biceps femoris. Tuberositi of the ischium and Patella And Tibia by the tendon and Fascia of the shank. Action. Abductor of the thigh and flexor of the shank
Tensor Fascia Latae. Origin and Insertion, Ilium and neighboring fascia to Fascia Lata. Action. Tightens the fascia lata Flex and medially rotate hip. Abduct the hip
Quadratus Lumbaris. Origin and Insertion. Posterior Iliac Crest to Last ribs and transverse processes of L1/L4 Action. Laterally Tilt the pelvis, Laterally Flex vertebral column, Assist to extend the vertebral column. Fix last ribs during inhalation
Actions of Quadratus Lumborum and some relationships
The quadratus lumborum can perform Four actions:
- Lateral flexion of vertebral column, with ipsilateral contraction
Where the pain was present during the TEST
- Extension of lumbar vertebral column, with bilateral contraction
Lost of ROM, also painful.
- Fixes the 12th rib during forced expiration
I find this interesting function of QL who surprise myself, I worked also with fascia stretch with SGA, RPG. see also next pictures.
- Elevate ilium, with ipsilateral contraction
Indications
The quadratus lumborum, or “QL,” is a common source of lower back pain. Because the QL connects the pelvis to the spine and is therefore capable of extending the lower back when contracting bilaterally, the two QLs pick up the slack, as it were, when the lower fibers of the erector spine are weak or inhibited (as they often are in the case of habitual seated computer use and/or the use of a lower back support in a chair). Given their comparable mechanical disadvantage, constant contraction while seated can overuse the QLs, resulting in muscle fatigue. A constantly contracted QL, like any other muscle, will experience decreased blood flow, and, in time, adhesion in the muscle and fascia may develop, the end point of which is muscle spasm.
