Hi Melanie!
I recently attended your gait seminars in May, and wanted to relay to you that my clients are absolutely loving the work and the results. Thank you so very much!
If possible, I would so appreciate your input relative to ischitis or ischial bursitis. Recently, two clients have been referred to me with this diagnosis, one of which has a R hip replacement, L knee replacement, and its the L ischium that’s affected. Both clients spend too many hours at desk and chair, likely sitting behind their sitzbones. I’ve referred both to a PT for cranial/visceral work to hopefully release the area of the coccyx.
Naturally, they have hip flexor hypertonicity, but because of their symptomology I avoid hip extension and work only within their comfort range in neutral pelvis/spine. Any “pearls of wisdom” you could share with me, would be hugely appreciated!
Thank you very much, and I look forwarding to seeing you again soon!
Best,
Tina Strickland, LMT
Stott Pilates Certified Instructor
Response from Melanie:
Hi Tina!
Ischial bursitis is an interesting and complicated issue to help resolve. Things that characteristically contribute to, or leads to ischial problems include: hamstring dominance over the gluteals/deep rotators, stiffness of the feet or ankles, poor positioning of the pelvis (either anterior or posterior rotation) which places the hip adductors and gluteals in a position of inefficiency, and lumbar spine problems.
Developing gluteal strength in the presence of a hip replacement can be tricky. We like to lie such a client prone over the cadillac or ladder barrel and work on hip extension there where the gluteals are working in midrange. Start out by assisting with the concentric lifting of the leg, make sure that the glutes are set, then have the client control the lowering. Assist as much as required so that the client does not experience the ischial pain.
Try to develop as much ankle and foot mobility as possible. Your client requires the full 20 degrees of ankle dorsiflexion to be able to walk normally and not have to alter the hip to compensate.
See how these ideas work and report back to us.
good luck!
Melanie Byford-Young
