Issue link: https://www.massageandbodyworkdigital.com/i/72343
MYOFASCIAL TECHNIQUES The Rotator Technique: use static pressure on the piriformis attachments on the greater trochanter, combined with femur rotation. Images courtesy Advanced-Trainings.com. clinically useful information, since it is questionable whether variations in the piriformis/sciatic nerve arrangement, even if they were known, would change one's hands-on therapeutic approach. In other words, whatever the anatomy, the most practical strategy is usually to do some work and see how the symptoms respond, then adjust your approach accordingly. Piriformis entrapment doesn't occur without reason or cause, however. Some of the other structural and functional factors that may trigger piriformis-related sciatic pain include: • Internal rotation of the hip or leg, since during gait, the piriformis may contract to counteract tendencies toward internal rotation. Internal hip rotation, in turn, can be related to ankle pronation or myofascial imbalances (e.g., tightness of the anterior fascia lata, medial hamstrings, or posterior adductors). • Sacral position and movement restrictions (since the piriformis acts on the sacrum), such as will be seen when there are sacroiliac joint issues, leg length differences, or ilia mobility imbalances. Whatever the cause of piriformis entrapment, the Rotator Technique is an efficient and effective way to assess and release any local impingement related to the piriformis, as well as the other external rotators (such as quadratus femoris) that can have bearing on sciatic nerve health. To perform the technique, start with your client prone and the knee of the affected leg flexed. Use the lower leg to slowly roll the femur into internal and external rotation (Images 2 and 3). With the soft fist of your other hand, gently apply firm, static pressure to various aspects of the greater trochanter, which is the distal attachment of the piriformis and other rotators. Use both hands: with the hand moving your client's leg, feel through the client's structure for the resistance of your static hand on the rotators. Once you feel a change in the tissue's resilience, release your pressure, move your soft fist to another location, and slowly roll the femur again, feeling for restrictions in the new location. Be thorough: use this technique throughout the buttock and rotator region, but avoid direct pressure on the sciatic nerve itself. (The nerve runs midway between the trochanter and lateral edge of the sacrum, and pressure on it will be felt by your client as a tenderness or electric sensation.) Rather than indiscriminately mashing the nerve and tissues here, imagine freeing the nerve by releasing any hypertoned or adhered structures that surround it. 112 massage & bodywork november/december 2011 As its name suggests, the superior gluteal nerve is in the superior portion of this gluteal region (visible superior to the piriformis in Image 1 on page 110). Although considerably smaller than the sciatic nerve, it can be a source of sciatic-like pain in the upper buttock and low back. If your client experiences pain here, you can use the Rotator Technique to release the tissues around this nerve as well. BICEPS FEMORIS/ADDUCTOR MAGNUS TECHNIQUE Distal to the rotators, the sciatic nerve can be impinged or tethered within the structures of the posterior thigh, particularly where it lies within the thick connective tissue of the intermuscular septum between the biceps femoris and adductor magnus (Image 4). We can adapt the Rotator Technique to help differentiate these powerful leg structures from one another, and in doing so, provide more freedom for the nerve. Begin with the biceps femoris, which is the most lateral of the hamstrings. As in the Rotator Technique, use gentle medial rotation of the femur with one hand, while the soft fist of your other hand rolls the biceps laterally off the underlying femur and adductor magnus (Image 5). At the extreme of the allowed motion, pause, wait, and feel for tissue release.