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26 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 3 Most of us who've done bodywork for a while have at some point during a session elicited a jump reflex or yelp as an elbow or sharp fingertips accidentally landed on a client's nerve. Normally, we reposition our contact point to avoid the sensitive area, but not always. During my first couple years in practice, I thought the client's pain reflex might be a sign that I'd discovered the problematic area. Finally, I began to suspect that my attempts at "chasing the pain" may have been chasing off some of my clients. Here, I'll discuss the top three nerves that have given me the most trouble and demonstrate myoskeletal techniques for avoiding these sensitive areas. SCIATIC NERVE The bulky sciatic nerve isn't the only neural structure traversing through the greater sciatic notch, but it's the one I've probably aggravated the most, especially when treating clients with piriformis syndrome (Image 1). A misplaced elbow with the client prone can easily trigger pain and may even bruise the nerve if forcefully or repetitively compressed against the ischial spine. Random poking on the nerve can trigger sharp, radiating pain and, in some cases, numbness and accompanying gait alterations. I finally discovered I could avoid bullying the sciatic nerve by treating the client in a sidelying position. The first step in this routine is to f lex the client's knees and trunk to 90 degrees. In this posture, the piriformis changes from an external to internal hip rotator (and abductor) due to its insertion on the superior border of the greater trochanter. The therapeutic benefit of this f lexed position is that it tautens the piriformis muscle, allowing greater forearm KEY POINTS • The myoskeletal techniques outlined here can help avoid unintentionally colliding with your clients' nerves and eliciting the dreaded jump reflex. • Three nerves that have caused the author trouble over the years include the sciatic nerve, cervical root nerves, and the superior cluneal nerve. TECHNIQUE By Erik Dalton, PhD MYOSKELETAL ALIGNMENT TECHNIQUES 1 While treating piriformis tightness, a misplaced elbow can bruise the sciatic nerve as it traverses the sciatic notch. Do You Get on Your Clients' Nerves? Steer Clear of Sensitive Areas contact and more precise assessment for tightness and spasm. In Image 2, my ulna bone pressure is focused on the piriformis tendinous insertion at the greater trochanter. I begin by allowing my soft forearm to slowly sink into the tendon. Once I feel I have a good tissue hook, I ask the client to begin a slow and rhythmic pelvic rocking motion. By hooking and dragging the piriformis tendon inferiorly as the client's hip attempts to move superiorly, I can trigger a Golgi tendon organ release, causing the muscle to loosen its grip on the sciatic nerve. CERVICAL NERVE ROOTS For years, my go-to routine for addressing anterior scalene tightness in clients presenting with thoracic outlet syndrome was to get them supine and use my fingers to wade through the anterior neck, palpating for tightness at the muscle's origin at the transverse processes (C2-C6) or insertion at the first rib. Even with years of practice, my fingertips would sometimes stray to a nearby nerve root and cause discomfort. One day, while teaching a class in Costa Rica, I was helping a participant whose partner was in a sidelying position and it suddenly occurred to me that I might have better and safer scalene access by Sciatic nerve Piriformis

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