Issue link: https://www.massageandbodyworkdigital.com/i/1358392
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 89 to minimize irritating load and ease compression in neighboring tissues. Recall that the lateral fi bers of gluteus medius are hip abductors, and the anterior fi bers are internal hip rotators. Therefore, in Image 5, I begin by slightly adducting and externally rotating the client's thigh. With his knee fl exed 90 degrees, a graded exposure pin-and-stretch maneuver is performed by bringing the client's thigh into more external rotation while resisting the motion with my soft left palm. As the fi rst restrictive barrier is reached, the client is asked to gently push their leg toward me to a count of fi ve and relax. I repeat the maneuver by increasing external hip rotation with my right hand and resisting with my left to the next pain-free restrictive barrier. After repeating three times, I position the client face up and apply another more direct "shotgun" stretch to the gluteal tendons and lateral hip rotators. By placing the client's foot on the outside of their contralateral knee and bracing my left soft palm on their ipsilateral anterior superior iliac spine (ASIS), I'm able to control the client's leg into adduction. A counterforce is created as I gently push with my right hand and resist with my left. The client is asked to gently push their knee back toward me to a count of fi ve and relax. The hip is then taken to the next pain-free restrictive barrier (Image 6). Typically, I'll repeat all three of these techniques and retest for diminished hip pain. SUMMARY Since words like pinched or entrapment can evoke fear, I fi nd it less threatening to tell the client with DGS the sciatic nerve may be getting irritated on its path from the spine through the buttock and into the thigh. If the client asks for more details, I may refer to their pain as "nerve- related buttock pain," then specify which nerve is most likely involved. Anatomical models are great teaching tools for nerve compression and tendinopathy syndromes as long as the description is informative and nonthreatening. Note 1. Hal David Martin, Manoj Reddy, and Juan Gómez- Hoyos, "Deep Gluteal Syndrome," Journal of Hip Preservation Surgery 2, no. 2 (July 2015): 99–107, https://doi.org/10.1093/jhps/hnv029. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfi ng, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit erikdalton.com. Greater trochanteric bursitis. Addressing gluteal tendinopathy and trochanteric bursitis. Shotgun stretch for the gluteal tendons and external hip rotators. ‰ Š ‹ Œ Decompressing the sciatic nerve from external hip rotators. Gluteus medius IT band Infl amed bursa