Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
I just got finished with a ...
resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.