Massage & Bodywork

September/October 2012

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technique CLASSROOM TO CLIENT | @WORK | ENERGY WORK | MYOFASCIAL TECHNIQUES Working with Sacrotuberous Ligaments By Til Luchau The sacrotuberous ligaments form a crucial structural crossroads in the human body. As mediators between the spine and legs, this pair of strong, broad ligaments bridges the upper and lower body; as stabilizers of the sacrum, they accommodate the left/right forces of foot-to-foot weight transfer; in efficient walking and running, these ligaments are key connective-tissue links in the chain of kinetic energy uptake, adding spring to each step.1 That is, they do these things when they're balanced and healthy. When they aren't, the sacrotuberous ligaments can play an equally significant role in many client complaints, including low-back pain,2 a condition that affects nearly 95 percent of all Americans at some point in their lives. While the sacrotuberous ligaments aren't involved in all back pain, a very large portion of low-back pain cases stem from issues related to these important ligaments, including: The sacrotuberous ligament (purple) is involved in conditions as varied as low-back pain, sciatica (the sciatic nerve is the large yellow structure lateral to the ligament), sacroiliac joint pain, hamstring syndrome, postural issues, and more. The falciform process (green) is indicated in peroneal pain and numbness, as the pudendal nerve can become entrapped here. Image courtesy Primal Pictures. Used by permission. 1 114 massage & bodywork september/october 2012 • Sacroiliac joint hypermobility, hypomobility, and pain. When one sacrotuberous ligament is tighter than the other, it can be associated with sacral rotation, side bending, or fixation. • Coccyx (tailbone) injuries and pain, since the sacrotuberous ligament attaches to and stabilizes the coccyx. • Sciatic pain (both axial and appendicular), including piriformis syndrome, since the sciatic nerve and piriformis are close neighbors. • Peroneal pain and numbness, as the pudendal or cutaneous nerves can become entrapped within the sacrotuberous ligament, or between it and the sacrospinous ligaments. • Painful sitting, hamstring tendinitis, or ischial bursitis. • Leg length differences, both anatomical and functional. • Spinal scoliosis or lordosis (swayback). • Pelvic torsions, upslip, and pubic symphysis irritation. • Slumped or twisted posture in sitting or standing, since the sacrotuberous ligaments are key determinants of sacral angle and segmental relationships all the way through the body. • Pelvic floor, prostate, and urogenital issues, because muscles and fascia of these structures attach to the sacrotuberous ligaments. In addition, many models of movement and fascial continuity describe the sacrotuberous ligament as a key structure. At its superior origin at the posterior superior iliac spine (Image 2), its fibers are continuous with the back's lumbar intermuscular aponeurosis.3 Inferiorly, its superficial

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