Treatment Indications for Acute Symptoms

Heat may be applied to the lateral aspect of the thigh while the patient is in a position that gives in to the tightness. This is done by abducting the leg in either back-lying or side-lying. To support the leg in abduction in side-lying, firm pillows are placed between the thighs and lower legs, making sure that the foot is also supported. A pillow at the back or abdomen helps to balance the patient comfortably in this side-lying position. As soon as the patient can tolerate it, which may be during the first treatment or may be 2 or 3 days later, massage may be started. Massage should be firm but not deep. Often, a superficial stroking is more irritating than a firm, gentle massage. Massaging downward may be more effective than the usual upward stroke. Patients frequently describe their reaction to the massage as "a hurt that feels good." They are aware of a feeling of tightness and describe "wishing they could make the muscle let go" or that "it would feel good if somebody stretched it." Patients should avoid exposure to cold or drafts, because even the slightest exposure often causes an increase in the pain.

The almost immediate relief of symptoms that occurs in some instances indicates that the condition is basically one of tight muscles and fascia. (These treatment reactions differ from those in sciatica. The same procedures applied to the painful area along the hamstring muscles in cases of sciatic irritation would give rise to increased pain.)

For Subacute Stages: As acute pain subsides, succeeding treatments should be directed toward stretching the tight fascia. The position and movement for assisted stretching is illustrated below.

Self-stretching in the standing position (as first described by Frank Ober [4]) may be done if the hip does not internally rotate or flex, but that is hard to control (see p. 398). Instead, more precise stretching should be used, as described and illustrated below.

To stretch left tensor fasciae Iatae, have subject lie on right side with right hip and knee bent. Relax left leg on pillows placed between thighs and lower legs. Apply heat and massage to left lateral thigh. Remove the pillows. Bend right hip and knee enough to flatten low back. Stabilize the pelvis firmly with one hand, draw the thigh slightly back, and press gently (on thigh, not leg) downward toward the table, stretching the muscles and fascia between the hip and knee. (The knee should not be allowed to rotate inward, and care should be taken to avoid strain at the knee joint.) To stretch right tensor, have subject lie on left side and reverse the procedure.

For mild to moderate unilateral tensor fasciae latae tightness, place a heel lift of ' / B to /i6 inch thickness in the shoe on the side of the tightness to level the pelvis and provide a gradual stretch in the standing position.

The shoe correction indicated for treatment of the lateral pelvic tilt associated with tensor fasciae latae tightness also aids in gradual stretching of the tight fascia. For this reason, such shoe alterations may not be tolerated until acute symptoms have subsided and until some active treatment, in the form of heat, massage, and stretching, has been instituted to relax and stretch the tight fascia.

STRETCHED TENSOR FASCIAE LATAE AND ILIOTIBIAL BAND

Even though the condition of pain associated with a contracted tensor fasciae latae is the more common, there are instances of strain on the high side of the pelvis. When a leg is in a position of postural adduction, there is continuous tension on the abductors of the thigh on that side. Symptoms of pain may become quite acute. If present, they are treated by relief of strain—that is, by leveling the pelvis and correcting any opposing muscle tightness that may be causing the persistent tension. Because the chief opponent is the opposite tensor, this problem may sometimes be resolved by treatment of the contracted muscles and fascia on the low side, even though symptoms of strain are present on the side that is higher.

There are instances in which the tensor and the fascia lata are stretched by a fall sideways or a sideways thrust in which the pelvis moves laterally on the fixed extremity, thrusting the hip joint into adduction.

On several occasions, adhesive taping has been successfully used in a way that limits the adduction. The illustrations on the facing and the information below explain the procedure.

Adhesive tape, preferably 1V, inches wide, is cut in lengths that will extend from the area of the anterosupe-rior spine of the pelvis to just below the lateral knee joint

The subject removes the shoe on the affected side, or if both shoes are removed, a raise of approximately half an inch is placed under the unaffected side. The subject stands with the feet apart to place the affected leg in some abduction. It is not expected that the tape will hold that same degree of abduction—there is always some give in the tape.

It is very important that patients be checked for skin sensitivity to adhesive tape, particularly if the weather is hot Tincture of benzoin has been used on the skin each time the taping procedure has been used.

Adhesive tape, preferably 1V, inches wide, is cut in lengths that will extend from the area of the anterosupe-rior spine of the pelvis to just below the lateral knee joint

The subject removes the shoe on the affected side, or if both shoes are removed, a raise of approximately half an inch is placed under the unaffected side. The subject stands with the feet apart to place the affected leg in some abduction. It is not expected that the tape will hold that same degree of abduction—there is always some give in the tape.

It is very important that patients be checked for skin sensitivity to adhesive tape, particularly if the weather is hot Tincture of benzoin has been used on the skin each time the taping procedure has been used.

IFG PAIN

IFG PAIN

The tape is directed from anterolateral pelvis to posterolateral area of the knee in such a manner that hip and knee flexion will not be restricted in the sitting position.

Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

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