resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
AAAOM – The Beginning of the End (Part II)
In 2012, the AAAOM board members met in Chicago for their annual meeting. The goal was to come to a consensus on a long list of issues the AAAOM needed to work on including a functional board and budget.
Leaving a Lasting Legacy: Donna Liewer
For the past 31 years, Donna Liewer has been on a personal mission "to comfort the afflicted and afflict the comfortable." In her role as executive director of the Federation of Chiropractic Licensing Boards, Liewer has accomplished that and much, much more.
AAAOM – Making Promises They Can't Keep
When the AAAOM first formed in 2007, their mission was clear: to support the profession through education, resources and legislative advocacy. The first years of the organization were filled with promise and hope.
News in Brief
Hamm Elected New President of the ACA; WFC / ACC 2014 Education Conference: Call for Papers; F4CP Recognizes Standard Process as $1 Million Supporter; Texas Chiro. College Begins Search for New President; League of Chiropractic Women Hosts Women's Success Summit.
Steven Rosenblatt: Birthing A Cross-Cultural Acupuncture Profession
The existence of a cross-cultural acupuncture profession in the United States, one that is legalized, licensed, supported by formalized, academic training and inclusive of non-Asian practitioners, is an important part of the medical landscape in this country and is responsible for improving the lives of hundreds of thousands of Americans.
Are You Guilty of Paternalism in Your Approach to Patient Care?
Einstein is purported to have said, "When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on a hot stove for a minute and it's longer than any hour. That's relativity." In some way, everything is relative to one's point of view.
The Healing Properties of Light: An Interview With Researcher Anna Cocliovo
This interview is with Anna Cocliovo, a light researcher and Acupuncturist in Arizona. During my own research in light, I came across the article she published for the American Journal of Acupuncture and sought her out as a result.
Flexion-Intolerant Lower Back Pain (Pt. 3): Mobilization & Soft-Tissue Treatment
What is the biggest challenge to the chiropractor in treating discogenic pain? You have to completely reframe the purpose of your manipulation. It is rarely about unlocking a stuck segment at the disc involvement level; it is not about putting a joint back in alignment.
Chiropractic Prevents ADHD? Research Shows...
Now that I have your attention, let me tell you what the latest study actually states. As you may have noticed, research over the past few years has begun to reveal that acetaminophen (the primary ingredient in Tylenol) is not as safe as once thought.
Resilience is the New Longevity
Sometimes we must enter a room through one door and not another, even though they both lead into the same space. I am talking now of the recent cachet with the concept of "resilience" regarding health, chronic pain and longevity.
Monoculture of the Mind: Part II
Cases are built within boundaries. Such bounds may be a program, event, activity or individuals. In this instance, a medical case has boundaries that include clinical interactions that are comprised of history, signs, symptoms, diagnoses, treatment plans and treatments.
Risk Factors for Heel Problems
Heel pain and gait disability are common occurrences in adults, often the result of thinning heel pads and a lifetime of exposure to heel-strike shock. One condition experienced by many people is plantar fasciitis.
Epigenetics: The Western Science Supporting Essence
Since the days of Darwin, western medicine has touted that our genes were set in stone, that our genetics were our destiny. We were told that the diseases that ran in our family were likely coming to us as well.
Successful Strategies in Integrating Acupuncture and Shiatsu in a Hospital Oncology Program
Colleagues from the Network of Researchers in Public Health in CAM recently published an article of interest to our Traditional Asian Medicine community.
One and Done: Keeping Patients From Vanishing After Just One Appointment
What happened to my 3:30 p.m. ROF? They may have rescheduled, but there are two common answers no one wants to hear: 1) "She called to cancel. I tried to get her to reschedule, but she refused." 2) "She no-showed.
Why DCs Need to Understand the Principles of "Inclusive Design"
In the past few columns, I've written about the negative effects of prolonged sitting at work. I've attempted to make the point that prolonged sitting (or prolonged standing) takes a toll on workers. Now let's discuss a related issue: the concept of "inclusive design."
Stress in the Modern Age: Impact on Homeostasis and What You Can Do (Part 1)
In 1926, Hans Selye first used the word stress in a biological context, referring to the nonspecific response of the body to any demand placed upon it.
Get That Shoulder to Move: Restoring Internal Rotation
How many times have you mobilized, performed ART, Graston, FAKTR and PIR, and stripped a patient's posterior capsule, yet on re-exam, discovered it was still blocked?
What is a Discipline in Medicine?
In my now prolonged dialogue with physicians, one question emerges with enough regularity to deserve mention and naming: what is a discipline?
Collaboration for a Cause
The Patient Protection and Affordable Care Act strongly encourages the formation of multidisciplinary practitioner teams called Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).
Green Tea Catechins Lower PSA, Other Biomarkers in Men With Localized Prostate Cancer
A 2006 study (Cancer Research) was the first human investigation to show that green tea catechins (GTC) are highly effective in reversing premalignant prostate lesions (high-grade prostate intra-epithelial neoplasia), an established precursor to prostate cancer.
March, 2008, Vol. 08, Issue 03
Treating Piriformis Syndrome
By Whitney Lowe, LMT
Sciatica is a term that describes radiating neurological pain that courses down the back side of the lower extremity. When the term is used, most people think of intervertebral disc pathology as the source of the problem. Lumbar disc pathology certainly can produce lower-extremity neurological pain, but other conditions can produce identical symptoms.
The sciatic nerve, formed by nerve roots from the lumbar and sacral plexuses, is the largest nerve in the body. It passes through a number of small spaces as it makes its way from the lumbopelvic region down the lower extremity. Along the way there are several sites at which sciatic nerve compression can occur. Nerve compression in any of these locations can produce symptoms identical to those of a herniated lumbar disc.
In the gluteal region, the piriformis muscle can compress the sciatic nerve, creating a condition known as piriformis syndrome. The sciatic nerve derives from the L4-S2 nerve roots and courses anterior to the sacrum, before passing inferior to the piriformis muscle (Figure 1). Tendinous bands at the edge of the muscle can compress the nerve. It also can be compressed between the piriformis and the sacrospinous ligament. Even a low level of pressure applied to the nerve for a long period of time can create symptoms.1
Other nerves in this region also are susceptible to compression and are variations of piriformis syndrome. The superior gluteal nerve can be squeezed between the piriformis and the greater sciatic notch (Figure 1). The superior gluteal nerve is primarily a motor nerve that supplies the gluteus medius, gluteus minimus and tensor fasciae latae. Nerve compression produces weakness in the abductors of the hip, but radiating pain down the posterior leg does not occur, as the nerve is confined to the gluteal region. If neurological symptoms are confined to the posterior thigh and do not extend below the knee, compression of the posterior femoral cutaneous nerve could be the reason. The posterior femoral cutaneous nerve lies adjacent to the sciatic nerve and also can be compressed by the piriformis muscle.2
Certain anatomical variations play a role in piriformis syndrome. The sciatic nerve is composed of two divisions: the peroneal and tibial. Usually, they are bound together along the length of the nerve, but in some cases they divide as they pass the piriformis muscle (Figure 2). Sometimes one division goes through the muscle while the other goes below it. In other cases, one division goes above the piriformis while the other goes below. In a small percentage of the population, both divisions go directly through the piriformis muscle.3 It is easy to see how some of these anatomical variations cause increased neurological symptoms.
Piriformis syndrome routinely occurs from external pressure such as sitting on a wallet. In rare cases it results from a direct blow to the buttock area.4 As a result of trauma, adhesions can develop between the piriformis muscle, the sciatic nerve and the roof of the greater sciatic notch.
Myofascial trigger points in the piriformis or other gluteal muscles can create hypertonicity and lead directly to nerve compression. Trigger points in the gluteus minimus are known to reproduce symptoms identical to sciatica and could be confused with piriformis syndrome.3 Sacroiliac joint dysfunction also can perpetuate trigger points in the piriformis muscle and increase the likelihood of nerve compression.5
The most important factor in designing a treatment strategy for any soft-tissue disorder is to understand the nature of the problem and make sure the physiological effects of the treatment approach fit appropriately. The primary problem in this condition is nerve entrapment by a soft-tissue structure. Therefore, the goal of treatment is to reduce compressive force on the affected nerve(s). The piriformis muscle is the cause of the nerve entrapment, so treatment strategies emphasize reducing piriformis tightness.
After applying superficial effleurage and other general warming techniques to reduce tension in the gluteal muscles, treatment of the piriformis can begin. Keep in mind that this region can be very tender, so approach treatment with presence and compassionate pressure. Myofascial trigger points in the piriformis muscle are treated with static compression techniques. Apply pressure to the region and hold it for 8-10 seconds until you feel some degree of tissue relaxation under your treatment hand. Static pressure can begin with a broad contact surface such as the back of the fist to gain initial muscle relaxation. After warming up and relaxing the muscles with broad applications of pressure, use a small contact surface such as the thumb, elbow or pressure tool for specific trigger-point treatment.
Use caution when applying pressure to this region because you don't want to further compress the region of nerve entrapment. The muscles may be tender, but pressure on the piriformis region should not reproduce or aggravate the neurological symptoms. If pressure on the piriformis region aggravates neurological symptoms in the gluteal region or down the lower extremity, you need to reduce pressure and/or move to a different location.
Longitudinal stripping methods along the length of the piriformis muscle also help reduce tension. Stripping techniques are performed with the fingertips, knuckle, thumb, elbow, or pressure tool. The stripping motion can be performed from the sacrum toward the trochanter or from the trochanter toward the sacrum.
In some cases, you want to avoid putting direct pressure on the region of nerve entrapment. Muscle energy technique (MET) stretching is a great option in this case. To perform an MET treatment for the piriformis, begin with the client in a prone position. Bring the lower extremity into lateral rotation to shorten the piriformis. Instruct the client to hold the leg in that position as you attempt to pull the foot in a lateral direction (medially rotating the hip). Tell the client to slowly release the contraction. As the contraction is released, pull the foot farther laterally, which stretches (Figure 3).
Piriformis compression of nerves in the gluteal region is likely a cause of lower-extremity sciatic nerve symptoms. If piriformis syndrome is accurately identified as the cause of the symptoms, massage is a valuable treatment strategy as long as it is performed correctly.
Click here for more information about Whitney Lowe, LMT.
comments powered by Disqus