QL Trigger Point Release

What’s your go-to strategy for a QL release? We’ve got a guy with a high hammy strain and upslip on the same side.

The quickest fix for an upslip is a leg pull manip.

Have him hold on to the table, try a diaphragmatic breath, let it out, and almost at the end of exhale, then you do a quick yank on the leg downward. You can try some distal joint play to see where/if there is a stronger direction of resistance.The pull must be quick like a cobra.  Not trying to sound silly, but  do it almost when they are not expecting it.

It can be scary to try this when it’s acute, but that’s when manipulations work the best according to the literature.

Otherwise I would go pillows on the opposite side in side lying and look for the trigger lateral to the TVerse processes of L1 to L4. It can be anywhere in there, but you’ll know you’re on it id the referral is to the sacrum, high hamstring (is it really a high hamstring strain?), or same side pelvic rim or greater trochanter.

Follow this with a length with breath technique of keeping the pillow in there, let the top leg drape backwards and breathe. Or you can let the top leg drape forward and let it hang. Use the myofascial position that feels better or allows for a perfect breath.

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5 Responses to “QL Trigger Point Release”

  1. Bill Deganti says:

    Charlie,

    While this isn’t directly-related to this post, it got me wondering about what types of suggestions you’d make to your patients/clients/athletes in terms of selecting an optimal sleeping surface and position for their needs. Perhaps at some point int he future if you have the time and the desire to do so you can throw out any pertinent suggestions you might make on these fronts.

    Given that many hours are spent in bed, this seems like one of those stealth areas that can make or break an effective treatment process (or at least greatly throw a wrench into the works if the person is essentially undercutting himself during these hours).

  2. Darcy says:

    Charlie,
    Something that has worked very well and also works in the hammy is a seated active partner stretch. Start with the TP and then
    1. Have the person sit on the floor with legs apart as far as comfortably possible.
    2. Standing behind the patient/athlete have them put their hands behind their heads and sitting up as tall as possible.
    3. Have the athlete/patient rotate taking up all their thoracic rotation around a vertical axis and then have them side bend to the side opposite of the rotation taking the elbow to the knee or along that path.
    4. Briefly hold the position for 1-2 seconds and only go to the first barrier of resistance and not beyond. I do 10 reps and they always seem to open up after the 3-4 rep.

    Also always keeping in mind the breath thing and less is more…. It has worked very well for me. Good luck with it and let me know your results.

    Darcy

  3. Mitchell’ s Muscle Energy Procedure for QL is very solid – fig 19.23 in my book. But, QL is usually reactive to other things w/ it’s short chronaxie. Typically, glut medius insufficiency & reduced fatigue resistance in side plank.

  4. Charlie says:

    Bill – The only recommendation I would have for sleeping is try to stay off your stomach and try to keep the arms close to the body. Dr. Greg Rose has suggested that they have tied golfers’ arms to their body while they sleep.

  5. Hi! Nice blog, I’m just very amazed cause there is not any spam comments on this site as there is on a lot of blogs on the web these days, so you have done a good job of controlling your blog. Anyway, keep making great posts on your blog and I’ll keep coming :) Bless, Daniel.

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