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So you've got a client with complex hip/low back/sciatica pain, and you'd like to really mobilize their body as you work with it. A solution I've found is to do a pre-massage routine while the client is still fully clothed. It allows you to be more vigorous, move the body in an easy and natural way, and work from lots of different angles, all without having to worry about draping.
0:00 Introduction
2:09 Communicating with your client about this clothed massage routine
2:48 Starting the routine
4:25 Working with the IT band
4:54 Working with tensor fasciae latae (TFL)
6:35 Cradling the leg to reduce client engagement ("helping")
8:20 Working with gluteus maximus while the client is supine
9:40 Stretching the hip extensors and external rotators
11:00 Working with iliacus
12:55 The "ilium sandwich"
14:10 Turning the client to side-lying
15:48 Hip flexor (iliacus and psoas) stretch
18:35 Massaging/stretching the external hip rotators (piriformis and its friends)
I've found this type of massage quite useful for clients with sciatica and anterior hip pain. If they're experiencing either (or both) of those symptoms, it's likely that there is a tug-of-way going on between the posterior and anterior pelvis. Psoas and iliacus are staying short and becoming irritable (and irritating the inguinal ligament and iliopsoas bursae), and all of the posterior hip extensors and rotators, like gluteus maximus, piriformis, and their friends, and inflexible and tight. There may even be some spasm.
This is an arms race, and we need to calm tensions between the two parties. To do this, I find it useful to incorporate lots of rocking, jostling, and joint motion. By doing this as I work on the legs, hips, and hip flexors, I can encourage tight muscles to release their guarding and tone. While this effect is temporary, it can provide some excellent information to the nervous system about what the body is capable of doing, and how relaxed it can safely be.
Note: Some of the techniques that I demonstrate are easy for me because I'm pretty tall, and I don't have much in the way of mammary tissue. If you find that you can't cradle the leg without breast tissue being in the way, try turning your torso more to the side and using your lateral rib cage. You can also bring the leg further up and onto your shoulder (thanks for the tip, Beth!) as you work. Experiment, and stay in good communication.
If you've got any tips, alternative methods, or clothed massage routines of your own, please let us know in the comments. Thanks!
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