Massage technique for release Piriformis Spasm

The piriformis  is a small, thick muscle that lies deep in the buttock region, underneath the gluteal muscles. It is one of the six muscles in the lateral rotator group. The piriformis muscle originates from the internal surface of sacrum, sacrotuberous ligament.It exits the pelvis through the greater sciatic foramen to insert into the greater trochanter of the femur.

This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle. It is thought that acute or chronic injury causes spasm of the muscle and irritates the sciatic nerve, resulting in sciatica.

Muscle test：

The patient lies on the unaffected side with the affected leg in 60° of hip flexion.  The knee should be bent and relaxed with the foot on the unaffected leg. One of the examiner’s hands should be placed on the hip to stabilize the joint.  The other hand should be placed on the patient’s knee to put pressure on it. The examiner should stabilize the pelvis and apply pressure downward on the knee, while rotating the hip internally. If the pain is in the buttocks with shooting pain down the posterior thigh, the piriformis is pinching the sciatic nerve.  If pain is just felt in the buttock with no shooting pain then the piriformis muscle is tight.       

Treatment:

1.    Trigger point treatment :

The piriformis has two trigger points:

1)    It lies on the edge of the sacrum, along the piriformis line.

2)    It lies a few inches to the inside of the greater trochanter landmark, along the piriformis line.

Find the trigger point of the piriformis, apply a deep pressure (ischaemic compression) with your elbow or thumb on this area, with a tolerable amount of pain and hold about one minute.

2.    Deep Transverse Frictions

Palpating the Piriformis: Draw an imaginary line from the posterior superior iliac spine (PSIS) to the tip of the coccyx. At 3 centimetres below the PSIS on this line, draw a second line to the great trochanter. The Piriformis muscle is found just beneath the second line.

Apply a deep transverse friction on the piriformis with your elbow or thumb.  Transverse frictions use an oscillating pressure applied across the direction of the tissue fibres.

3.    Pin and Stretch

The patient lies on their stomach and flexes their knee on the targeted leg to 90degrees. Afterwards, hold the heel of the targeted knee with one hand while the other hand is on the trigger point of their piriformis. Next, with the targeted leg, stretch sideways to its fully lengthened position and hold for 30 seconds.

With a pin and stretch massage, use finger pressure to pin the trigger point and then stretch the muscle away.

Home Stretching Exercise:

For the right side piriformis, lie on the back with both feet flat on the floor and both knees bent. Pull the right knee up to the chest, grasp the knee with the left hand and pull it towards the left shoulder. Hold the stretch for 30 seconds, then release.

Repeat three times.