Need help with tough combo

[Merrida]

...Long one here,....sit back, grab some water, relax,....it's a read,......


I'm hoping some of the wonderful minds here might be able to let me tap into their knowledge and creativity a bit. I'm hitting a block, and am admittedly a bit confused.

I have a woman who is roughly 70. She's had both hips replaced (at different times 8 years apart), both knees replaced (at different times 3 years apart and one of them when they reattached the insertion, her knee now rolls slightly laterally if her feet are pointed forward. She's had an iliostomy, arthritis in her spine and fingers toes,....same ole same ole.

Given the restrictions that must come with her joint replacements, we've noticed this. When she does any hip flexion, she gets a cramp in one glute cheek deeply, posterior to the glute-max, maybe even to the glute medius. It isn't the piriformis. We've stretched her QL, her IT, her quad and ham, and of course her piriformis. She got excellent stretches (which took forever, she's so guarded, understandably, due to all the joint replacements)....but she's slowly letting me stretch her.

That piriform stretch stretched but wasn't near the location that cramps up on her. Does anyone have an idea what this is or how to access it. For now I have her rolling on a tennis ball because she picks up trigger points which I'm running with as adhesions. I cannot discern which muscle this is or what to do about it, plus work with mandatory guildelines with joint replacement patients.

Laying on a mat, drawing her knee in to her chest on one leg is fine even with the angle. On the other, is fine, then slowly she'll get the cramp (like a charlie horse) that tells her to get out of this position or it will really get cramped up! It's posterior and distal to the iliac crest. I don't know else to describe it. She said it feels like a bundle of bunched up muscle tissue just being squished together and getting in the way.

I'm at a loss.

We have worked through quite a lot together, and I've gotten her out of sticky situations, but this one has me sincerely baffled. Anyone else have any ideas? I think tennis ball for trigger work (it's EASILY accessed as the points are HOT), maybe shiatsu, massage,...but anything I can do as her trainer? (Given her joint limitations?)

The same woman has a frozen right shoulder, but this lady keeps marching on head held up high always knowing there's worse things out there! Amazing inspiration and never complains. I'd like to help her but I feel like I've fallen short with ideas or possible explanations.

So I reach out brothers and sisters for some help to a woman who's trained with me for at least 4 years and due to our work she can now waitress in her son's restaurant for 3 hours at a go to help him out, and she is doing great.

The cramping btw, is not connected to periods of when she does or does not do her 3 hour waiting shift.

Any thoughts or ideas? I see her next week I'd love to show her something wonderfully new. She doesn't move around that well so I mean really we have to keep things simple here. She does not get this pain with hip abduction, just flexion.

I admit it, I'm confused. Any thoughtful insight would be so totally appreciated!

Thanks guys!

Man it's midnight here, time for this ole gal to hit the sheets. But I wanted to write to you guys first. I just want there to be something "I" can do w/o having to ship her off for myotherapy of sorts.

.................................................. ..........................Help?

[Lady C]

Wow. No suggestions for identifying the mucsle/cramping.

I would suggest to keep working with the tennis ball. I have an old friend who is an avid walker. I firmly believe that all the walking has kept her in great shape and she is 74 now. Maybe some non-stressful, low impact things like walking might help.

[Merrida]

Originally Posted by Lady C

Wow. No suggestions for identifying the mucsle/cramping.

I would suggest to keep working with the tennis ball. I have an old friend who is an avid walker. I firmly believe that all the walking has kept her in great shape and she is 74 now. Maybe some non-stressful, low impact things like walking might help.

That sounds great. My concern when getting her to walk is she somehow believes she feels like she's only got a limited amount of steps in her for the day. That's putting it simplistically but it gets the point across. She's proven across the past year especially, that she is particularly sensitive to repetitive stress. I've had to reduce her rep range from 10-12 down to 4-6 on average, and sometimes 8. I'm going heavier in weight, lower in reps and she's doing better. But regardless of the exercise, she'll be in pain with higher reps low/no weight.

She also "waitresses" at her son's restaurant. She often is standing for great lengths of time as hostess (it's a small restaurant, she isn't running around, nothing fast paced or involving a lot of steps). I've been to the restaurant (good food, good business!)

Her shifts are short with a lot of standing or walking very short distances. She'll sometimes be achey or feeling arthritic as she puts it for a day or two later.

If I do walking with her, should I try to focus on longer strides then? Fewer but longer? With both hips and both knees replaced (and one hip is due to be replaced again within the next 2 years) I feel like I'm walking on egg shells.

I'm just curious about identifying that muscle,- I feel clueless. She's doing the tennis ball for now (she used to get shiatsu and said that helped a lot, leading me to think this is adhesion, trigger point related). But still,....what blasted muscle could this be and what deeper movement is triggering it. It can't be purely hip extension or more activities would bother her.

Thank you Lady C for replying and taking the time to share your thoughts.

[CF-OC_gal]

Although I do tend to get hyped over new "exciting" techniques. I say she needs ART -active release therapy. Get her to a certified specialist and ditch the soft music, candles, oils and warm blanket massages.

Everytime I go, I get huge results in getting the muscle knots unbunched. It wasn't that long ago I couldn't do a BW squat or sit comfortably without glute knots.

It really works in combo with simple unweighted physio exercises.

The ART people are very knowledgeable at identifying and getting to the problem source. Just communicate clearly the frustrations. Team work is better than being a one man show in really complex problems.

[Merrida]

Brat, thanks for the input. Interestingly enough Shiatsu isn't all crystals and scented candles. I found it interesting that for her age she prefered the deep trigger point release work that she was getting. Sure it isn't like Rolfing but it was pretty intensive. I'm also not much of a supporter for poofy massage except in very certain circumstances (usually if there are emotional/psychological underpinnings which would contraindicate something more therapeutically aggressive).

She (this client) has multiple joint replacements all of varying ages and a frozen shoulder. She is extremely limited on a biomechanical level, not just muscular level. This one new "twang" that sprung up is fairly recent (I consider recent since she's been with me for years). It only triggers after several hip flexion movements. A few hip flexions, fine. Walking, fine. Standing and other activities, including stretching, fine. But if we exceed a mere 4 flexions, she senses the bunching starting (her description) and she used to teach aerobics and was a prima ballerina, she's actually quite well versed in anatomy so we speak pretty openly between ourselves re: muscles, joints, etc.

What's odd to me is we can pinpoint it with the use of a tennis ball (she's going to give that a try for one or two weeks), but perhaps it's my own curiosity wondering what dog gonned muscle this is, and what it's unique little stabilizing function is that major movements don't bring it about. Not that naming the muscle does much -- but for me it would help. Call it my insatiable need to know curiosity.

[.V.]

If there is a qualified ART practitioner in the area I'd also suggest going to them. The problem with ART is finding someone actually qualified to do it. The whole thing of actually training for two additional years after finishing an education for MD, DO, PT, or DC is kind of off putting to many who want to go ahead and get started on a career.

[CF-OC_gal]

This link should help