resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
Climbing the Ladder of Opportunity (Part 1)
President Obama spoke of building "ladders of opportunity" in his State of the Union and Inauguration addresses.
An Introduction to Evidence-Based Clinical Practice - Again
One of your patients is in for treatment and catches you off guard by asking you a question about a news article she recently read. It seems that a new intervention for back pain was found to reduce the rate of serious side effects by 50 percent.
News in Brief
Parker Announces Executive Director of Parker Professional; Athletic TIPS Program Getting Financial Support; ANJC Award Recipients Named.
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
Look, Listen and Learn to Code
Study of the Current Procedural Terminology (CPT) Evaluation and Management (E&M) coding system can leave a doctor of chiropractic a bit confused. The description of the five new-patient and five established-patient examination codes takes up several pages in most coding books. The degree of detail and charts used to describe the codes can be overwhelming.
Putting Public Health Into Action: Thinking Globally, Acting Locally
The Chiropractic Health Care section of the American Public Health Association (APHA) met at the 141st APHA Annual Meeting and Exposition in Boston late last year, and it was another triumph for chiropractic and its public health advocates.
New Knee, New Pain (Part 2)
The patient presented to the chiropractic clinic with symptoms of genu varum and pain on the medial aspect of the tibiofemoral joint.
Acupuncture Ambassadors: A Chat with Leader Anthony M. Giovanniello, MSAc,LAc
When you first meet Anthony Giovanniello, you realize he's a humble practitioner, yet is bursting with a type of dedication that you can't help but be overwhelmingly inspired by.
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
Ask and You May Receive
A friend of my mother has had a problem with her ears for almost 20 years. Whenever the wind blows, it sends shooting pain through her jaw. She has seen any number of medical specialists over that time, but with no relief.
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
Preserving the Natural Resources and Culture of Chinese Herbal Medicine
As the world experiences unprecedented population growth and ever-increasing ecological pressures, the topic of preserving Chinese medicine's natural resources has attracted steadily increasing attention from practitioners.
The Urinary Bladder Official
The Bladder Official is known as the Official Who Controls the Storage of Water. In Western medical terms, this organ collects the urine excreted by the kidneys.
We Get Letters & E-Mail
Let's Restore Integrity to Health Care – Starting With Us; MDs Offer More – So Can We.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
Increased Breast Cancer Risk: Another Implication of High Cholesterol
In addition to being a known risk factor for heart and cardiovascular disease, recent studies have highlighted the link between high cholesterol and increased risk of breast cancer. Breast cancer is the second most common malignancy in women after skin cancer.
Why Stretching Doesn't Work
Like most chiropractors, a good part of my day is spent working with sedentary office workers who spend eight to 12 hours a day glued to a desk chair in front of a computer.
The Many Faces of Cervical Compression
When evaluating the neck, there are any number of orthopedic tests to be considered.
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
Betraying Patients and the Profession
Imagine flying from New York to Paris on a jumbo 747. Your thoughts are on your vacation and experiencing the City of Lights. Midway over the Atlantic Ocean, you overhear the flight attendants talking in muffled voices.
Common Disorders of the Temporomandibular Joint
The evaluation and management of craniofacial pain is a complex endeavor, which often encompasses the presence of temporomandibular joint disorders.
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
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.
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