Sagot :
If a standing assessment doesn’t happen, here are some quick and easy assessment techniques you can perform while the client is on the table in a prone position. You could even do these tests during a relaxing spa massage and gain valuable information while not disturbing the client.
Doing these tests will give you information about where to work to be the most effective, as well as give you and your client something to work toward in future sessions.
With the client prone, use the thenar eminence of your palm to apply a springing pressure to each of the spinous processes of the vertebrae. Do this in about eight spots up the spine to get a quick overview of spinal mobility. Apply quick downward pressure and then release. Start at the lower lumbar and move up the spine all the way to the upper back. Direct pressure straight down toward the table at 90 degrees to the body. (In massage school we are always taught to stay off the spinous processes, but applying this gentle pressure is perfectly safe.)
This is a very general mobility test of each of the vertebrae, and by using this test you can get a quick evaluation of your client’s back health. On a healthy back, each of the vertebrae will move independently. On a back that lacks mobility, multiple vertebrae will move as a column. If the muscles have been tight for a long time, this begins to translate into the facet joints and disks, causing them to become less mobile, and move as a group.
By testing joint movement, you can tell if your muscular work is going to be really effective, or is going to take multiple treatments over a long period of time. For example, if someone has back pain with tight muscles and all the vertebrae move as a column, then you know it is going to take longer to relieve the dysfunction. If you see a client with back pain and tight muscles, but the vertebrae have normal mobility, you know that relieving the muscles will often fix the issue.
After testing about five people, you will start to get a sense of what is normal.
With the client prone, undrape and pick up one ankle, letting the knee bend to 90 degrees. With your other hand on the sacrum, pushing down and stabilizing it so it doesn’t move, pull the leg outward and see how far it will go. Then push the leg across the body and see how far it will go in that direction.
When you pull the leg outward, the front of the femur faces inward. This is hip internal rotation. The leg should be able to go out at about a 40-degree angle. When you push the leg across the body, you are performing hip external rotation. The leg should be able to go to about 45 degrees. Don’t get too caught up in the degree amount. After testing a few people, you will start to get a sense of what is normal. Some people have a greater range, and some less. You really want to pay attention to imbalances between each leg.
If there is a limited internal rotation, you will want to work on the external rotators, which are located under the gluteus maximus and include the piriformis, obturators, gemelli and others.
If there is limited external rotation you will want to work on the hip internal rotators, which are located on the anterior portion of the side of the hip and include the tensor fascia latae and anterior portion of the gluteus medius muscle. After you release the muscles, retest the motion to see if you have increased the range.