Issue link: https://www.massageandbodyworkdigital.com/i/530196
work on the posterior pelvis is almost always beneficial, especially when it's focused on relaxation of the piriformis in treatment of piriformis syndrome. The piriformis is the only rotator that attaches to the sacrum, so it is also important to address this muscle in any sacroiliac problem. • Let's not forget fascial connections that cross from the legs, go across the gluteal region, and travel up the back all the way to the skull. Leaving a hole in this sheet of fascial tissue is counterproductive to a client's balance. • Last, but not least, work on the gluteal region just plain feels great! Techniques for the Posterior Pelvis So, we understand that glute work is important. The good news is that working on the gluteal area isn't rocket science. Yes, there are many specific techniques for more advanced bodywork to remove sacral dysfunction and to balance the pelvis, but important therapeutic work can also be accomplished in a short time and as part of a primarily relaxation-based massage. Think of the different stresses put on the gluteals and rotators for such asymmetrical activities as skateboarding, tennis, golf, baseball, or even running in a counterclockwise direction around a track. As with many parts of the body, simply assessing tightness and working to achieve left-to-right balance is extremely effective. (Note: while it is beyond the scope of this article, once you balance the posterior pelvis, it is important to also create some front- to-back balance with the anterior pelvis, particularly the psoas, iliacus, abdominal muscles, and rectus femoris.) At Work—The Gluteus Maximus The gluteus maximus seems to have the rockstar status of Mick Jagger, while I call the equally important deeper gluteal muscles the Rodney ("I don't get no respect") Dangerfields of the posterior pelvis. It is important to also consider the depth of restrictions and be able to work deeply through the superficial gluteus maximus to address deeper tension in the rotators and gluteus medius, and, in turn, work through the gluteus medius to work on the gluteus minimus. Basic Swedish kneading strokes to the gluteus maximus are not only effective for easing tension and increasing circulation, but also feel great to the client even if you can only spend a minute or two applying them. For more detailed work, a precise focus of depth is crucial so you are not indiscriminately dissipating your energy into too many layers and working too hard. Visualize how the gluteus maximus must be free to slide over the deeper muscles as it lengthens and shortens when the femur moves from flexion to extension during running. Sink vertically through tissue until you feel the resistance of the deeper muscles. Then, apply force in all directions at But How Do I Talk About It? Maybe it's not the work itself that has you uncomfortable when addressing a client's gluteal muscles, but the conversation that goes with the work. Try these suggestions from three of ABMP's practitioners. Cindy Williams, LMT, ABMP Education Coordinator In the initial intake, I tell clients they can completely disrobe or leave their underwear on. I tell them I have better access to their gluteal muscles (related directly to low-back pain) if they completely disrobe, but it is whatever they are most comfortable with, and even with their underwear on, I can still work the glutes, or I can skip them altogether. I make it not a big deal, and then it doesn't become one. Kristin Coverly, LMT, ABMP Manager of Professional Development I stress the importance of the glutes: "These muscles are often tight, which can affect not only the gluteal area, but the low back and lower body. Because clients have varying levels of comfort receiving bodywork in this area, I wanted to talk about it with you beforehand so we can create a plan together. I can work this area over the sheet or directly on the skin like the rest of your session. What do you think?" Anne Williams, LMT, ABMP Director of Education For new clients with low-back pain I say: "Have you ever had your gluteal muscles massaged? If they are overly tight, they may be contributing to your low-back pain. Would you be willing to have these muscles massaged? I will only undrape one side of your buttocks at a time, or I can work through the drape. I'll be careful to maintain your modesty at all times. What do you think? What are your concerns?" Compiled by Karrie Osborn