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68 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 9 The piriformis is functionally important as a lateral rotator at the hip joint and for its role in stabilizing the sacroiliac joint. It is also functionally important for its relationship to the sciatic nerve (Image 1; see The Piriformis and Piriformis Syndrome, page 69). Because the piriformis has multiple roles, it is valuable for therapists to have expertise and comfort working with it. One major manual therapy treatment approach when working on the piriformis is stretching. This article explores the many ways the piriformis can be stretched, comparing and contrasting the relative benefits of each method. WHAT IS STRETCHING? Stretching is essentially a simple mechanical process. It is a manual/movement therapy aimed at making a soft tissue longer. This occurs via a fundamental characteristic of soft tissue known as creep, which states a soft tissue will deform (change shape) in response to a sustained force placed upon it. In the case of stretching, the deformation/ change is for the tissue to become longer. When musculature is stretched, in addition to the mechanical effect of lengthening, we also have a neurologic effect in which the baseline tone of the musculature is decreased, relaxing the musculature and allowing it to be even more effectively lengthened. Lengthening and relaxing myofascial tissue allows greater range of motion at the joints crossed and, therefore, more ease with movement of the body. HOW IS STRETCHING ACCOMPLISHED? Knowing how to stretch a muscle, or any soft tissue, is extremely simple and can be figured out instead of memorized. Approaching how to figure out the stretch of a muscle can be done in two ways. One method is to visualize moving the attachments of the muscle away from each other. The second method is to move the client's body passively into the opposite joint actions of the joint actions of the target muscle. After all, a joint action is the concentric shortening function of the muscle, so to stretch/lengthen this muscle is to do the opposite of its action(s). For example, if a muscle is a lateral (external) rotator of the hip joint, then bringing the hip joint into medial (internal) rotation would lengthen it. If instead the muscle is a medial rotator of the hip joint, then we would lengthen it by laterally rotating the hip joint. The piriformis attaches from the internal surface of the sacrum to the greater trochanter of the femur (Image 2). Therefore, to stretch it, all we need to do is visualize the attachments of the muscle and then move the client's body such that the femoral attachment of the muscle moves away from the sacral attachment. Alternatively, we can explore stretching the piriformis from the point of view of doing the opposite of its joint actions. However, this can be a bit complicated because the line of pull of the piriformis, and therefore its joint actions, can change when the position of the hip joint changes. Anatomic Position When the hip joint is in neutral anatomic position, the line of pull of the piriformis crosses posterior to the hip joint (Image 3A, page 70). Therefore, it is a lateral rotator of the thigh at the hip joint and is stretched by medially rotating the thigh at the hip joint. By Joseph E. Muscolino, DC S T R E T C H I N G T H E P I R I F O R M I S

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