Quadratus Lumborum.
Myofacial pain
If a patient has back pain & his posture shows one shoulder higher than the
other then they have Quadratus Lumborum myofacial pain disorder. To confirm this
have them stand on two weight, one foot on each machine. If one side is heavier
than the other this again confirms the Q.L. myofacial pain. A quick treatment is
to give a heal inseart in the shorter side or where the weight is less.
To assess the thickness required I use test boards made to exact thickness. I have the patient stand on a large board and then put smaller test boards under the foot. These are made up to thickness of 1mm, 2mm (x 2), 5mm and 1cm.
With patience and trial and error an estimate can be made of the LLD "theoretically" to an accuracy of 1 mm. In practice this is quite unrealistic, but the method produces a starting point and the EVA heel inserts can be thickened or diminished by 1mm steps as required. This simple method is valuable in simple cases. If the LLD is large or if correction by heel raise alone is not producing the desired result then a more rigorous approach is needed. Review by podiatrist who makes up an orthotic to correct the bio-mechanical factors at the ankle and foot level without adding a heel raise.
Procaine injections to trigger points in quadratus lumborum muscles bilaterally, followed by spray and stretch and heat. Immediately following the procaine injections the patient proceeds to the X-ray department. There an AP pelvic X-ray weight bearing is taken. This is done with the orthotics in situ.
The difference in the height of the femoral heads now provides an accurate measurement of the leg length difference. The patient is then reviewed as soon as possible by the podiatrist with the data from the X-rays. The orthotics are now adjusted with the appropriate heel raise.Follow-up reviews by the podiatrist and medical practitioner allow for fine adjustment of the orthotics.
Small hemipelvis
Assess patient in seated position. Release quadratus lumborum if possible before assessment. Advise patient on a trial of butt lift using a folded towel or a magazine.
Nutritional inadequacies
The prescription of nutritional supplements by the practitioner will depend upon three things. How much importance the practitioner places on this form of therapy.
There is a commonly held belief that by eating the Standard Australian Diet (SAD) sufficient nutrients are obtained to do all things in all circumstances. I strongly recommend the course run by the Australasian College of Nutritional and Environmental Medicine (ACNEM). This provides the supportive evidence for the prescription of nutritional Supplements. Details can be obtained by telephoning (03) 9589 6088
The patient's attitude to taking supplements and the cost of the program are influential factors.
Basic Vitamin Program
The rationale behind prescribing nutritional supplements is primarily to improve the efficiency of the body to neutralize free radicals. Damage by free radicals is thought to impair the capacity of the body to repair itself.
Anti-oxidants are substances that counter the oxidative process and formation of the potentially highly toxic free radicals.The main anti-oxidants are C,E,Selenium, Zinc and A. Listed below is a basic program that offers a good high dose anti-oxidant support at a cost of $7.00 to $10.00 per week.Basic Program $7.00 to $10.00 per week.
High dose multi B & multi mineral ( this will contain vitamin A)1 daily
Vitamin C 1gm daily, Vitamin E 500 IU daily, Zinc 20-30 mg of elemental zinc daily
Selenium 200 mcg daily. Sodium selenite drops.
Selenite B tablets -Vita Glow. Formula 33 Note: Increase vitamin C supplement according to the level of physical, chemical, and emotional stress. Patients should take 1g of C before & after sessions of injection therapy and increase to 1g four times daily for several days until post treatment soreness is gone. Athletes normally require 500 IU twice daily of vitamin E to assist tissue repair after training and decrease post training muscle soreness.
A higher dose multi B is often needed in the early stages of treatment. The brand name multi B preparations are balanced. Use thiamine as the parameter looking for 100-200mg daily in divided doses. This adds another $1.00 - $4.00 per day.
Magnesium20 to 200mg of elemental magnesium per day (an extra $1-$15 per week)
Powerful muscle relaxant. Now used intravenously in many coronary care units.
Indicated where skeletal muscle is generally tight, exhibits tics or fibrillations, or cramps easily, or where cardiac palpitations are present. Excellent for athletes before & after intensive training sessions or competitions.
Metabolic & endocrine inadequacies
The most important perpetuating factor in this category is the pathology caused by oestrogen /progesterone imbalance in women.
I strongly recommend the book Natural Progesterone by John R Lee MD. This makes the treatment of this problem so simple and provides an efficient, natural way of removing this very common and powerful perpetuating factor.
