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F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 97 Following the range-of-motion and resistance testing, two other additional testing procedures were performed to help clarify a possible cause for her symptoms. Lisa described having gluteal pain and neurological sensations down her posterior thigh. In addition, there appeared to be significant limitation to internal hip rotation, which indicated tightness in the external rotators of the hip. This pattern of symptoms is frequently present when the sciatic nerve is entrapped by the piriformis muscle. The position shown in Image 1 is a familiar one for stretching the piriformis muscle and is also used for assessing neurological involvement of the sciatic nerve. If the position increases or aggravates existing neurological sensations, there may be compression of this nerve. The sciatic nerve runs just adjacent to the piriformis, and fibrous or tendinous bands within the muscle can compress the nerve (Image 2). The sciatic nerve can also become compressed if the muscle is overly tight. Cadaver dissections show that variations in the position of the two sciatic nerve divisions are not uncommon. In some cases the nerve may separate its peroneal and tibial divisions as it passes the piriformis muscle, and the nerve may even go directly through the middle of the muscle. These anatomic variations can make the nerve more susceptible to compression pathology. If the piriformis muscle is compressing the nerve and that muscle is stretched, it will often increase neurological sensations. Lisa reported a slight increase in sharp pain and some paresthesia in the posterior thigh when this procedure was performed. This result, along with the findings from the other portions of the assessment, indicates there is some level of nerve compression. Sciatic nerve compression by the piriformis muscle would likely produce Lisa's gluteal and posterior thigh pain, but would not likely produce her lateral hip pain. She reported serious lateral hip pain and swelling immediately after falling on the stairs. That swelling subsided shortly after the injury, and she likely sustained an acute trauma to the trochanteric bursa, which caused the swelling. The trochanteric bursa is located over the greater trochanter and under the iliotibial band (Image 3, page 98). Complex cases often involve multiple issues, and commonly magnify underlying problems. For these types of conditions be sure to engage a comprehensive assessment protocol for a more thorough evaluation. academyofclinicalmassage.com Work directly with Whitney Lowe Providing high-quality, science-based training in advanced clinical massage for over 2 decades. Summer SPECIALS Engaging & interactive online courses Orthopedic Massage Certification Workshops, books, video Earn Free CEs Announcing Whitney Lowe's ACADEMY OF CLINICAL MASSAGE New Free sample course 2015 FALL Workshops: OR, AZ, MA, FL Stay up on clinical news & research with Lowe's free newsletter Visit us today! acmspecials.com "Lowe's program is the best I have taken in the last 30 years of CE." E. McCarron Free sample course