Piriformis Syndrome

 

Anatomy:        watermarked piriformis

The Piriformis muscle originates on the anterior surface of the sacrum and inserts at the greater trochanter of the femur. It’s primary action is to laterally rotate the hip. When the hip is flexed, it abducts the hip.

 

 

 

Piriformis Syndrome:

While Sciatica is most commonly associated with herniated disk , similar symptoms can be a result of Piriformis Syndrome. There is some controversy surrounding the diagnosis of Piriformis Syndrome because “there is little evidence available regarding the best methods to diagnose and treat it” (Morgan, Does Piriformis Syndrome Exist?, 2013). In his article Unraveling the Complexities of Piriformis Syndrome, Whitney Lowe (2017) acknowledges the controversy surrounding PS but also writes, “there is strong evidence to suggest that not only does this condition exist, but it is often under-recognized as a cause of gluteal and lower extremity pain and dysfunction”. Assessment of Piriformis Syndrome is based on knowledge of anatomy, client history, and physical examination. The FAIR Test and Pace abduction test can help assess whether a client may have PS.

Sciatic Nerve: “Nerve roots exit the spinal cord” starting at L-4 through S-3 and merge with the sciatic nerve (Yeomans, Sciatic Nerve Anatomy, 2015). The largest and longest nerve in the body, the sciatic nerve passes through the hip region and deep to the piriformis muscle. For the majority of the population it exits inferior to the muscle before continuing down the leg and into the feet and toes. If the sciatic nerve is compressed or irritated, a person can experience motor and/or sensory impairment such as muscle weakness, numbness, tingling in the leg, foot, and/or toes (Yeomans, 2015).

Though Piriformis Syndrome usually involves compression of the sciatic nerve, other nerves that reside nearby can become compressed. The posterior femoral cutaneous nerve is a “sensory nerve supplying the posterior aspect of the thigh” (Lowe, 2017). A person with pain or other sensory sensations such as tingling, numbness that extends only to knee may have a compressed posterior femoral cutaneous nerve. It and three other nerves (sciatic, inferior gluteal, and pudendal) could become compressed between the ps and the sacrospinous ligament (Lowe, 2017). As the inferior gluteal nerve is a motor nerve for gluteus maximus, weakness with this muscle could be a symptom with nerve compression. It’s possible for the superior gluteal nerve to be compressed or trapped by a hypertonic piriformis muscle at the Greater Sciatic notch. A motor nerve,  compression is likely to result in weakness of the gluteus medius and gluteus minimus muscles (Lowe, 2017).

Sitting for long periods as well as overuse with activities such as running can cause the muscle to become hypertonic, causing motor or/and sensory impairment. Calcification in the muscle due to a blow or fall can contribute to Piriformis Syndrome (Lowe, 2017). According to the authors of Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach, ps is most commonly caused by macrotrauma: a one time traumatic event such as a fall or blow to the buttocks that can lead to inflammation or muscle spasm.

Treatment for Piriformis Syndrome can include stretching as well as massage using stripping techniques and static compression to treat myofascial trigger points.

Note that low back pain with numbness, shooting or radiating pain is cause to see a medical doctor for diagnosis before seeking any kind of treatment.


Stretches For Piriformis and Glutes
Get more from your stretch with mindfulness, intention, and breath

watermark sitting fig 4

 

Stretch 1:
Begin by lying supine on a mat. Cross one leg over the other to make a figure four. Bring yourself up so that your hands are on the floor, fingers pointing back behind you. Keep your back straight in order to feel the stretch. I like to feel as though my foot, ankle, lower leg is rotating towards me while my knee is easing back in the opposite direction.

Stretch 2: 
Lay supine on the floor, legs stretched out. Bend one leg and bring it up in a flexed position. Take the opposite hand and place it on the knee of the flexed, raised leg and draw your leg straight across to the opposite side. Imagine the face of a clock underneath you with the number 6 in the direction toward your pelvis and the 12 toward your head. If you are stretching the right leg, you would be moving towards the number 3. Left leg would be towards the number 9. Your shoulders stay on the floor. As you move across, your hip can leave the floor and follow the movement. Come back to center. Draw your leg across and up towards the opposite shoulder. Your shoulders and hips stay on the floor. Come back to center. If you have the flexibility and it feels like a ‘good’ stretch, change hands so that the same hand clasps your knee and the opposite hand clasps around the lower leg or ankle. Take this stretch in the direction towards your head (12 o’clock). Explore the stretch and find out what works best for you.
Stop the stretch if you feel any pain, numbness or burning type sensations.

References

 

 

 

 

 

 

Three Stretches for Latissimus Dorsi & Teres Major

Overview/ Anatomy:

Teres Major is often referred to as the Lats ‘little helper’. Synergists, Latissimus Dorsi and Teres Major work together to perform the same actions of the glenohumeral joint (shoulder): Extension, Adduction, and Medial (inward) Rotation.

The Latissimus Dorsi is the largest muscle of the back, and it’s main function is movement of the upper limb. It originates in the mid back thoracic region ; the thoracolumbar fascia, and iliac crest (hip bone). It inserts into the humerus (bone of the upper arm).

Teres Major lays between the Lats and Teres Minor on the lateral (outside) border of the scapula (shoulder blade).

Some of the Movements of the Shoulder are:

  • Flexion: From a position of arms down at the sides of the body, the arms move forward and upward toward the head.
  • Extension: The return from flexion – arms lower down toward the sides of your body. *Lats and Teres Major extend the shoulder (glenohumeral joint).
  • Abduction: with the arms down at the sides of the body, the arms move in a upward direction out to the sides of the body.
  • Adduction: the return from abduction – arms that start out to the sides of the body lower down towards the body. *Lats and Teres Major adduct the shoulder (glenohumeral joint).

Latissimus and Teres Major also medially rotate the shoulder.

A few activities that use the Latissimus Dorsi (and to a lesser extent Teres Major) are: Swimming, rowing, and climbing rope.


Stretches For Latissimus Dorsi and Teres Major
Get more from your stretch with Mindfulness, Intention, and Breath 

 

Standing Hands Clasped Over Head:
Stand with your feet parallel about hip width apart. Clasp your hands and place them above your head with palms facing the ceiling. Drop your pelvis, tail bone straight down toward the floor. Chest, shoulders open. Ears ease back in line with your shoulders.

Feel the bottoms of your feet like a tripod. Feel the balls of the big toes, little toes, and heels on the floor.

Breathe and think about stretching your elbows straight and reaching your palms toward the ceiling. Increase the stretch by bending side.

Variation 2: Cross one hand over wrist to guide yourself into more of a stretch.

 

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Sitting Side Stretch:
While this side stretch targets Quadratus Lumborum, it also stretches the lats and teres along the outer border of the scapula and back. Sit cross legged on a mat. Drop your shoulders down and feel that the two shoulders are level. Open chest and shoulders. Head draws back so the ears are in line with the shoulders.

If you feel discomfort sitting cross legged (perhaps your knees are high as opposed to closer to the floor; therefore forcing you to lean back) you can place 1 or 2 folded blankets underneath your sit bones. Your feet will of course need to be off the folded blankets as you want your sit bones to be higher.

Bending to the side, bring one arm over the head and the other at your side on the floor, palm down. Breath and feel the length along the outer border of your scapula and sides of back. You can increase the stretch by placing the forearm on the floor. Look down towards the floor or straight forward as you bend side then slowly turn your gaze to look up (refer to the image above). Breathe.

Having straightened up to the beginning position, keep the arm above your head for a few more deep breaths. Enjoy the feeling of length from your seat on the floor to your finger tips — then lower the arm and begin the side bend to the other side.

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Chair Stretch:
Begin by kneeling on a mat in front of a chair. Place your hands shoulder width apart on the chair’s seat. Lower your torso and head below shoulder level as pictured above. Feel the length in your back, along the lateral (outside) border of your scapula (shoulder blade),  and out through your fingertips (they of course are still placed on the chair). Following a few or more breaths you can take your hands off the chair and lower all the way down to child’s pose. An exercise ball can be used in place of a chair as seen in the photograph.

 

Safe Stretching:

  1. Don’t stretch to the point of pain. If lessening the intensity of the stretch still causes pain, stop.
  2. Stretch with consistency – as a daily routine or every other day.
  3. Gradually increase the intensity of the stretch over a period of time.
  4. Stretch slowly. Don’t bounce. Breathe

Body Alignment: Mindful alignment makes for more effective stretching. It also helps in injury prevention. A few alignment reminders:

  1. When standing, think of your foot as a tripod. The ball of the big toe, the ball of the small toe, and the heel form a tripod. Distribute your weight equally among these three points. Feel the weight on your left and right foot equally. As you put your intention on this you may notice that you have a tendency to favor one side over the other.
  2. When standing, feel your pelvis, tailbone drop straight down toward the floor (or chair if sitting).
  3. Many of us allow our shoulders to round and our head to jut forward from it’s gravitational center. Think about opening your chest and shoulders and easing your ears back in line with your shoulders.

 

Suggested External Links:
Why Is Breathing Important During Stretching?:
https://healthyliving.azcentral.com/breathing-important-during-stretching-9443.html

Latissimus Dorsi Muscle – Attachments, Action & Innervation:
https://www.getbodysmart.com/arm-muscles/latissimus-dorsi-muscle

 

 

 

Circulatory & Deep Tissue Massage

“What style of massage do you do?”, is a question a number of my new clients tend to ask. My massage sessions are eclectic in that they integrate various modalities depending on a client’s needs. My education at IPSB college introduced me to a wide variety of Western and Eastern modalities. I eventually chose to focus my practice around the Western modalities Circulatory, Deep Tissue, and Trigger Point.

Circulatory (or Swedish) is a style of massage that has a number of therapeutic benefits. Circulatory helps to release tension and stress in the body. The release of tight, constricted muscles eases pain while bringing nutrient rich blood into the muscle tissue. In his text Orthopedic Massage Whitney Lowe writes, “One of the most significant effects of massage is the encouragement of blood flow in smaller capillaries that are restricted due to muscle tightness” (Lowe, 2009). A release of tension in the body is often accompanied with a feeling of release emotionally or/and mentally (stress reduction) as well as increased clarity and energy. It has been suggested that this modality aids the lymphatic system by helping to clear out metabolic waste. A variety of strokes are used. A few of these strokes are: Effleurage (long gliding strokes that move in the direction toward the heart are incorporated throughout a massage session), Compression, Petrissage (grasping and kneading), and Tapotement (percussion strokes). These strokes can be done with light, medium, or firm pressure.

Deep Tissue uses techniques to address the deeper layered muscles. The work is slow so that the therapist’s tool (thumb, palm, soft fist, elbow) can melt into the muscle tissue; slowly gliding along the direction of the muscle fiber as tension in the muscle tissue melts and dissolves. Effleurage is a massage stroke most commonly associated with Circulatory or Swedish massage, but in Deep Tissue work, deep effleurage strokes can be most effective in easing out tension and helping to move tissue fluid.

Neuromuscular Therapy focuses on relief of pain that can be brought on by postural distortion, biomechanical dystunction, Ischemia, and Trigger Points. Trigger Points develop in Ischemic muscle tissue and refer pain to other areas of the body. My sessions incorporate bone cleaning (cross fiber) and Trigger Point with Circulatory massage.

Reference:

Lowe, Whitney (2009). Orthopedic Massage: Theory and Technique. Mosby Elsevier.

Osborne – Sheets, Carole (1997). Deep Tissue Sculpting: A technical and Artistic Manual for Therapeutic Bodywork Practitioners. Poway, California: Body Therapy Associates.