I have a new client who had both of his knees replaced 4 years ago. They give him no problems, but he often gets back ache, which is why he has come to me. The initial screening shows that he is positive pretty much everywhere(!), but obviously I am starting with the pelvis. He is managing the hip flexor release Ok, but finds the 4-sign release pretty uncomfortable because of the position he needs to get his knee in. I'm not sure whether to have him continue these, or find another way to release piriformis (external rotation, as per Tor's link re. Piriformis). What would you suggest?
Great to hear from you Paula. sorry for the tardy reply, but i've been stuck in Stuttgart with the snow causing havoc at Heathrow! You are quite right to question the 4-sign with artificial knees. You should avoid 4-sign in this example. i agree you should look at another way of hitting piriformis - what do you think would do the job without loading the knees?
Thank you Martin and Tor! I'm thinking that I could try sitting my client on the floor with legs extended in front, then getting him to cross one foot over the other knee on the floor, and then resist internal rotation of the crossed over leg. The angle at the hip and knee is less extreme than in 4 sign and should be more comfortable. If thats still uncomfortable, then perhaps he could resist external rotation from standing (hip joint extended) using a wall/table for resistance. What do you think?
-- Edited by Paula on Tuesday 22nd of January 2013 03:34:16 PM
Sounds good. if when they're sitting on the floor their hips are more than 70-90 degrees into flexion, then ankle crossed and resisting internal rotatiion could well work. as you rightly say if they do not like this then a posiiton with the hip more in extension and then resisting lateral rotation can work really well, so that could be in standing or lying. well done!
