Piriformis Muscle

[Chocolate_eater]

I am having a heck of a time trying to get to the piriformis on my sister.
She gets temporary relief and then after sitting for awhile the pain comes right back....I believe the sciatic nerve must run right thru it or next to it and that's where her pain comes in....seems like the piriformis is shortened and therefore nerve pain? She has been in pain for a long time and nothing seems to help....she is currently going to physical therapy and I give her massages and the chiro I work for is adjusting her but I would really like to know the easiest and best way to handle that muscle.
Any suggestions?

 

[Kelle]

Beck...

You might ask her to pay attention to her body mechanics to see if that's contributing. How is she sitting or standing? When she sits or drives, is her knee flopped to the outside? When she stands, is her anterior leg rotated laterally? Things of this nature would definitely shorten the pirisformis. I have to watch myself on these same things.

Maire

 

[AuthototagBum]

Piriformis

I have found that on some people-runners, skinny folks,etc.- I can palpate the nerve and sometimes irritate it with too much work.
I normally use a technique where I place the palm or heel of my hand beside the sacrum and internally/externally rotate the leg with the knee bent to stretch the piriformis.
I will also place the client's leg in a reverse figure 4. After asking about knee injuries, etc. This slacks the piriformis and allows more contact with it.
Since the muscle attaches to both sides of the sacrum, I'd check the other side too.
Good luck,
Rubmyster.
BTY-I've read that in about 15-20% of the population that the piriformis is bisected by the sciatic nerve.

 

[edwardlova101]

The technique that Rubmyster suggests will definitely do the trick, it is called ruddering. I actually put my elbow into the piriformis, and I would make sure to work both sides, not just the side that there are issues.

And yes, the majority of people with "sciatic issues" their sciatic nerve is actually passing through the piriformis, so when it spasms it causes the pain and other issues.

 

[Ummar]

Hey you guys!

Thanks for the info; I really appreciate it. And I will definitely use your method this weekend on my sister....Actually, I did try bending of the knee this past weekend and she seemed to do better for a longer time. But of course, then she does too much and it starts all over again! So, if I keep it up, hopefully we can nip it in the butt! (get it? LOL)
I also told her to pay attention to how she is sitting with her leg and she promised she would.
Thanks again..

Beck

 

[ep1909]

Check into lower crossed syndrome, too... I'm just beginning to learn about this, but my understanding is that loosening the piriformis without addressing the other muscles involved can make the issue worse over time.

 

[Suzy]

Very good idea about body mechanics paying attention to how she sits... I also use my elbow on the piriformus...
If you loosen up the glutes and the erector spinae it helps too...do some cross fiber friction on the erectors and across the illiac crest..then down the IT (illio tibial) band...loosen everything up and it is alot easier to get it to release...

~Jennifer McColleyLMT

 

[Amanda P]

I agree with Jennifer- try a sustained "hold", or ischemic pressure for a few seconds... (up to 30) you probably already know this... until the referred burning or sensation diminishes. Ice it after treatment.

Acupunture gives amazing results for runners.

I had piriformis syndrome for several years.
I learned yoga, T'ai chi and Pilates
and that takes care of it -for me, daily

I noticed it the most while driving- so know if i feel a tweek, I stop and analyse what I have been doing and stretch, breathe and self massage.

This took over 10 years to recover. It originally began as an overcompensation from a foot injury; I was placing too much load on the piriformis.
No pain, body mechanics for mts!

 

[Tanner]

Reoccuring piriformis syndrome

If the piriformis continues to be an issue it is a good idea to assess the hip position regularly..asis, psis and iliac crests...

Additionaly 1 out of four people has morton's foot or mortons toe..this is when the second metatarsal is longer than the first toes metatarsal..this causes a narrow base for balance.
This narrow base causes the person to compensate by externally rotating that foot, leg etc.. This will shorten and overwork the piriformis...

If it's a stuructural issue the long term solution is to put a pad under the first metatarsal joint of the big toe of the affect foot...

This syndrome,how to identify and treat it can be found in volume 2 of Travell and Simmons and in Clair Davies the trigger point therapy work book...

by the way 1 out of 4 people have this but of those who do 75% are women...so that fact coupled with the fact the piriformis problem keeps reoccuring means there is a pretty good chance that the mortons structural postural dysfunction is present...


Good luck

 

[Yahoo! Answers Team]

Morten's Toe??? WOW!! I never would have thought!! I have seen plenty of people with a longer 2nd toe and never knew it could do that!! I have seen it in practice and plenty of times outside of practice.

I will have to look into this further. Heck, it could be a topic for my newsletter as it is common enough!!

Thanks for the info!!


Christine

 

[Kareena]

Piriformis is great to work on for me because it responds so well to my style:

consider other lower crossed muscles (psoas and adductors primarily for massage) strengthening for glutes and transversus abdominis.

first I do some very general compressions to the glutes.

I prefer to use my same side elbow so I can face their feet and have the other hand free to work the ankle.

Contact, then sink in slow. Then go slower, then slower still. and finally, go slower. I like to start at the medial end for compressions. Don't go very far in, just try to get a muscle tone reaction.

Then on to the PIRs. Stabalize at opposite illiac crest or sacrum, i like sacrum, and have them resist external rotation of the hip with the knee flexed. A couple of these should tone it down.

Then the fun part: both together. compresses, sink, and strip by dragging the muscle under your elbow with passive IR and ER by way of moving the hip by the ankle.

man I hate verbalizing something so simple when you see it, sounds way to complicated.

strip through it with passive motion a few times, then rest their leg down and do some like this. toss in a dash of extra PIRs in the mix while you do all this when it feels right.

frictions on the trochanteric attachment, bake at 400 degrees for 40 minutes, garnish with a nice long stretch, and season with an ice pack for a few minutes.

tada. now do the affected side, psoas, and some jumping jacks for levity.

 

[Yaqub H]

Nice to see another cheesehead

Nice to see another person from wisconsin on the board...
I'm thinking about posting flyers about the board around town and on bulletin boards...

Alot of MT's work along time on the "piriformis syndrome" when it is seccondary to the structural problem of mortens foot/toe...the work provides excellent but temporary relief...for longer term relief deal with the structural problem...

Travell and simmons deal with thee issue very thoroughly..in VOl II
Clair davies does a quick and adequate job in his (much less expensive)
self trigger point therapy work book...

If mortens isn't present...knowing if the client is hyperlordotic (lower crossed sydrome) has a hip elevation or illiac rotation..is critical in creating a specific theraputic treatment plan...


Good luck

 

[Tom]

Surprisingly, the hamstrings can be a culprit in sciatic issues. Granted, I've only seen it once in my practice, but something to think about if all else fails.

 

[-.-"]

Piriformis Muscle

Hi guys,

Following on from Black Pearl's treatment protocol... when you have sunk into the piriformis, the client is lying prone and you are passively supporting their leg bent at 90 degrees... I've found that jiggling their ankle gently (so their leg gently jiggles) encourages the muscle to soften much quicker. Has anyone else found this?

By the way, jiggling is a technical term of course

x

Henry

 

[HEY LIBS]

accurate location of the piriformis

A good way to find the piriformis.


While your client is prone bend the leg at the knee gripping it at the ankle. Place the fingers of your other hand in the suspected location of the piriformis. While mainting pressure in the suspected location rotate the clients leg into internal and external rotaion. The piriformis will stretch causing it to become more apparent while internally rotating the leg. It will soften and disapear duing external rotation.
once it is located using the internal and external rotation during direct treatment can allow for more complete massage of the target muscle.


like I said earlier, mortons foot/toe is very common and if they are the culprit directly treating the piriformis without addressing the cause fo its tightness will be a losing battle...


Dale