Issue link: https://www.massageandbodyworkdigital.com/i/1153082
72 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 client is supine with the hip joint flexed to 90 degrees, and the knee joint flexed. The therapist wraps his cephalad axilla (the axilla, or arm pit, closer to the client's head) around the client's knee. The therapist has a very stable position because both hands are on the table, both feet are well grounded on the floor, and both thighs are braced against the table. To perform the stretch, the therapist simply sinks downward by bending his lower extremity joints and dropping his body weight down on the client's distal thigh, bringing it into horizontal adduction to stretch the piriformis. As with the pushing method, it is important to keep the pelvis down on the table (Image 7A). If the client's pelvis does lift from the table, then the therapist simply adjusts the angle in which they drop down. In addition to having the advantage of using body weight to create the stretch, this protocol allows the therapist's hands to be free, if needed. Having the hands free can be extremely valuable to help relieve pinching pain the client often experiences in the proximal anterior thigh when a horizontal adduction stretch is performed. This pain is usually caused by compression of proximal hip flexor musculature that is tight, anywhere from the tensor fasciae latae laterally to the adductor longus medially. It can also be caused by bony impingement compression at the anterior aspect of the hip joint. Having the hands free allows the therapist to wrap their finger pads around the proximal anterior thigh and contact any tight hip flexor musculature that might be present; then, by leaning their body weight back, traction and open the region, thereby alleviating the pinching compression (Image 7B). Note: The therapist must combine leaning back to open the joint, with dropping down with body weight to stretch the piriformis. A little practice might be required to become proficient with this approach, but it is well worth it for the efficacy and comfort of this protocol. As with the supine horizontal pushing protocol, this stretch can be performed if the client has an unhealthy knee joint because the thigh is contacted directly instead of the client's leg. However, if any pressure is transmitted into the knee joint and discomfort does occur, then a variant position is to drape the client's leg around the therapist's trunk, allowing it to rest there and be supported (Image 7C). Note: For the female therapist, if either the position shown in Image 7A or 7C causes contact between the client's thigh and the therapist's breast tissue, this can be remedied by the therapist rotating her trunk away from the client. Supine position: Stretching the right-side piriformis by pushing the thigh into horizontal adduction at the hip joint. Permission Dr. Joe Muscolino. Supine position: Stretching the right-side piriformis by pulling the thigh into horizontal adduction at the hip joint. 7A: The therapist places both hands on the table to stabilize their position. 7B: Using the hands to open up the anterior hip joint region. 7C: Variant position to support the client's leg. 6 7A 7B 7C