Issue link: https://www.massageandbodyworkdigital.com/i/78617
client of the reasons for working the ligaments. I'll often show my clients the anatomy involved,5 and I always The Sacrotuberous Ligament Technique. Once you have your client's permission, assess the boney space and tissue tone on either side of the sacrum and coccyx (Image 5). Use passive motion to release the ligament on the shorter and tighter side (Image 6). Images courtesy Advanced-Trainings. com. All used by permission. 5 explain why I think work here might be helpful by relating it to their particular symptoms. If you haven't already been trained in sacrotuberous ligament work, get familiar with the anatomy of the area by practicing palpation with a colleague or learning partner before attempting these techniques on a client. Once you have your client's 6 the body, the ligament on the shorter side will be tighter or harder if it is a contributor to the asymmetry, but softer if it is being slackened by the boney asymmetry (that is, if the asymmetry is due to other forces or structures and not the ligament itself ). Furthermore, if a ligament is tighter on the longer or wider side, it is most likely being stretched by the structural asymmetry, and the root cause lies elsewhere (for example, leg length, patterns of usage, etc.). Using these principles, you would then work more with the tighter or harder sacrotuberous ligament if it was on the side of the sacrum with less space between it and the ischial tuberosity (the shorter or narrower side), but work elsewhere in the body (such as the hamstrings or hip joint) when the tighter sacrotuberous ligament is on the longer side. If you suspect sacrotuberous ligament involvement in your client's symptoms, but don't perceive a length or tissue difference left and right, let your client's experience be your guide: work one side, and then have your client get up and walk or bend. Easier than before? You're on track. Not easier? Work the other side's sacrotuberous ligament, and recheck. Clients will frequently report less pain and greater ease when you work in this way to balance any left/ right differences you find in the sacrotuberous ligaments. SACROTUBEROUS LIGAMENT TECHNIQUE Because the sacrotuberous ligaments are in a personal, private part of the body, before working with them it is important to get your client's explicit consent and buy-in. Inform your permission to work these ligaments, stand at his or her side, and begin by making tactile contact somewhere other than the ligament itself (such as the knee or low back). In other words, ease into the area being worked. Checking in with your client all the while, reach across the body to find the opposite-side ischial tuberosity with one hand, and the posterior side of the coccyx with the other. The sacrotuberous ligament runs between these two landmarks, just anterior to the medial margin of the gluteus maximus. Palpate the sacrotuberous ligament on the lateral side of the upper gluteal cleft. Work on the opposite side of where you're standing, as this gives a better angle for your two thumbs to gently but firmly press into the ligament's inferomedial margin (Image 5). You aren't trying to feel the ligament through the gluteus; rather, you're feeling in front of the gluteus maximus. The ligament will feel ropy or hard on most people; remember, it is in front of the gluteal mound. Keep your two thumbs together in order to avoid straining them. Switch sides of the table and use this stable mono-thumb to compare the hardness and tension of the left and right ligaments. Also, compare the boney space and tissue quality on each side of the coccyx. The sacrotuberous ligaments and sacrospinous ligaments converge here, and each can contribute to coccyx pain or misalignment. 116 massage & bodywork september/october 2012