Issue link: https://www.massageandbodyworkdigital.com/i/1153082
Ta k e 5 a n d t r y t h e A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 71 The distal thigh can also be contacted to add to the lateral rotation force. As discussed earlier, when the thigh is flexed to 90 degrees, the piriformis becomes a medial rotator and is therefore stretched with lateral rotation. There are a number of ways the client can be contacted when performing this stretch (Images 5A–5C). Note: As with the prone stretch, because the leg is used as a lever to achieve the stretch, this protocol is precautioned against or contraindicated if the client has an unhealthy knee joint. Supine Position—Horizontal Adduction—Pushing Because the piriformis becomes a horizontal abductor when the thigh is first flexed to 90 degrees, it can be stretched with horizontal adduction—in other words, bringing the thigh across the front of the client's body. This protocol is usually performed by the therapist standing to the side of the client and pushing the thigh into horizontal adduction (Image 6). Stretching and Breathing Many breathing protocols are recommended when stretching the client, especially when neural inhibition techniques are used. However, there is one breathing guideline that is universally observed: the client should be exhaling when a stretch force is applied to the body. This is because stretching is best accomplished when the client is relaxed, and exhaling best facilitates client relaxation. Stretching the right-side piriformis with the client prone. It is important when performing this stretch that the client's pelvis remains on the table; otherwise, the stretch will move into the lumbar spine and be lost for the piriformis. Keeping the pelvis on the table is achieved by pushing across the table but also somewhat down toward the floor. An advantage to this stretching protocol is that the therapist can contact directly on the client's thigh instead of the (lower) leg. Therefore, this stretch can be performed even if the client has an unhealthy knee joint. Supine Position—Horizontal Adduction—Pulling Another way the supine client's piriformis can be stretched into horizontal adduction is for the therapist to stand on the opposite side of the table from the side of the piriformis being stretched and pull the client's thigh into horizontal adduction instead of pushing it. The advantage to this approach is that the therapist can use their body weight to create the stretch. Supine position: Stretching the right-side piriformis with lateral rotation of the thigh at the hip joint. The client's other lower extremity is used to contact the client's leg. The therapist directly contacts the client's leg. 4 5A 5B 5C