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Piriformis Static Manual Release

Piriformis Static Manual Release is a self-administered therapeutic exercise used to release the piriformis muscle and its surrounding tissues in the buttocks. The exercise involves applying sustained pressure with a foam roller, tennis ball, or other firm object to the piriformis muscle located outside the hip joint, just above the glutes. This technique can provide relief of piriformis pain, lower back pain, sciatica, gluteal pain, hip pain, and tension. It's

Transcript

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This is Brent of the Brookbush Institute and in
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...blank
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this video we're going over static
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manual release of the piriformis. Now, if
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you're watching this video, I'm assuming
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you're watching it for educational
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purposes and that you are a manual
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therapist, and in your state it
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specifies that manual release techniques
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are within your scope. Now, this probably
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goes for all athletic trainers, physical
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therapist, chiropractors, osteopaths,
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licensed massage therapists. You're all in
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the clear. However, personal trainers,
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probably not. Now, before I have a patient
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or a client on the table to do any
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release technique, any manual work, I'm
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going to be pretty sure from my
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assessments that that technique is
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necessary, especially when it comes to
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things like the piriformis or adductors,
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where we're getting into more sensitive
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areas. Obviously, if somebody came in for
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shoulder mobility issues or shoulder
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pain and you start palpating their
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backside, they're going to wonder what's
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up. Make sure you have a good working
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hypothesis before you're doing manual
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techniques. I'm going to have my friend,
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Brian, come out. He's going to help me
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demonstrate this technique. Now, all of
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these manual release techniques
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basically come down to locate the muscle,
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be able to palpate that muscle, and
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compress that muscle. You get bonus
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points if you know where the trigger
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points are, because those are your common
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points of tightness and having a general
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idea of where to place your hands will
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speed things up a little bit. I've
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done the due diligence of marking out
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some landmarks here that we need. I put
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this piece of tape over the posterior
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iliac spine, and then you can see it
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curves down here. Well, I hope you guys
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can see a little bit that it curves down
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here over the sacrum. If you can't, you'll
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get to see that in the close-up. And then
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here, we have the greater trochanter.
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The piriformis runs from anterior sacrum
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to greater trochanter. The last thing we
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need to consider, anatomically that is, is
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the fact that the piriformis is actually
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deeper than the glute max. So, we have to
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find a way of differentiating between
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glute max and piriformis fibers.
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My glute max fibers generally run this way,
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or vertical, whereas my piriformis is
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horizontal. So you guys should be able to
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notice that if you go this way, you can
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strum some glute max fibers. They're
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pretty thick. They're pretty broad-
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that's a big, thick muscle. Now, the
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piriformis fibers- if I go a little
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deeper and I go superior to inferior
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this way, then I start strumming. I have
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to get pretty deep though. You guys can
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tell if you go shallow and go superior
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to inferior, you don't get any- you don't
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feel fascicles, you don't feel strings of
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muscle fibers. Now, as far as finding the
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tense point, I'm going to go just below
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my iliac crest here. I'm going to go
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ahead and start around the sacrum. I
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happen to know that the piriformis
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trigger points are either generally very
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close to the sacrum, or right in the
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middle of the belly of the muscle. So if
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I take this nice, broad thumb this way,
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I can go from superior to inferior.
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I'm going to start by looking for really
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tight fascicles, because we're going to
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assume that even if it's a tight trigger
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point nodules, that they're still going to
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pull the fascicles they're attached to
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pretty tight. Once I found those tight
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fascicles, I'm going to go ahead and move
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maybe towards his greater trochanter if I
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feel like that's where the more of the
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tension is coming from. Once I find
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that nodule, I would then compress. Or if
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I feel like it's more towards the sacrum,
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I could move back all the way to his
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sacrum and see if pressing superior to
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inferior, a little medial to
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lateral there to find the most
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dense tissue until I find that trigger
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point, and then I could compress there. Now,
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I'm showing you guys all of this on this
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side so that you can see what I'm doing,
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but the truth of the matter is that from a
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technique standpoint, from a body
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position standpoint, I'm going to want to
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be on this side. I'm going to
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want to do the piriformis that
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is closer to me. I'm even going
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to show you guys a little bit of a trick
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here. If you have somebody in neutral
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position, their piriformis is actually
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not very
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tight. It's actually kind of in a
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neutral length, and if you just start
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pressing down, you might start playing
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that game of like trying to put your
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finger on top of a marble, or you may
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just press straight into mush. There's
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not a whole lot of feedback. So what I
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like to do, assuming that somebody has no
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knee issues, is go ahead and take them
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into knee flexion and then tuck their
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foot into my arm here, right in my elbow,
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on my armpit. And that way, as I'm
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palpating his piriformis, here, I can pull
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Brian into internal rotation, which is
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going to lengthen his piriformis and
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increase the tension a little bit, right
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so that now those fibers are pulled just
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a little taut. I'm not trying to stretch
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his piriformis this way, but I want
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those fibers pulled a little taut, so that
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when I go to press on that trigger point
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it doesn't do this to me. Alright, so I'll
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pull down. Once again, broad strokes. I'm
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going to go superior to inferior to find
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those fascicles, and then I'm going
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to go either proximally towards his
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sacrum, or distally towards his greater
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trochanter until I find the most tender
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point. I'm going to use this hand as my
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dummy thumb in this case. I'm
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going to go ahead and put the other hand
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to apply pressure. I'm going to try to
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straighten out my arms to get as much
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tension as I need here, and then I'm just
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going to lean in with my body weight
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until I feel that point where the tissue
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density really starts ramping up. I don't
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want to go all the way to the tissue end
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point. I don't want to go all the way to
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an end feel. I don't want so much pain
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that I actually get the muscle
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contracting under my fingers. Then I'll never
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get a release. But if I go right up to
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the point where I feel that increase in
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tissue density, and I lean until I feel a
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release underneath my fingers, that is a
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decrease in tissue density, or Brian
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tells me. You still feeling that? Alright,
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he's still feeling that. I'm going to
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hold for a few more seconds. If he
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says that
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he no longer feels the soreness, he
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no longer feels the uncomfortableness,
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the discomfort, then we can go ahead and
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move on. It's starting to let go, right? Yes, it's a lot looser now.
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Your piriformis was pretty
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jacked up. Alright, next up we'll do
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our close-up recap, guys, but I hope from
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this position you guys can see my
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body position. Manual therapists, you
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always have to be thinking about you
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first, and I know that sounds crazy. But
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notice once I had him in position, my
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arms were straight, I pulled him into
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as much internal rotation as I needed,
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and all I'm using is body weight.
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Specifically, this hand is pressing over
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this hand which is totally relaxed, so
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that I'm not wearing out joints. I'm not
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putting myself in a compromised position.
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Okay, guys, here's our close-up recap. You
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can see I've marked out the posterior
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ilium. I've marked out the sacrum, here, it's
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where this tape turns down. And then I've
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marked out the greater trochanter. We
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know his piriformis goes from anterior
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sacrum to greater trochanter, deep to
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those vertical glute fibers. To add
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tension to his piriformis so that I'm
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not playing the "try to put my finger
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down on a marble," or I'm not just pushing
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into mush because all of these muscles
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are relaxed in this position, I can add
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tension by pulling Brian into internal
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rotation here. So, I'm going to tuck his
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foot up in my arm. I'm going to strum
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superior to inferior to find those
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horizontal fibers. Once I find the
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tightest fascicles- it helps to know that
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most of your trigger points are going to
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be located either closer to the sacrum or
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in the middle of the belly of the muscle-
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so once I find those tightest fascicles, I'm
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going to move in one direction or the
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other until I find a nodule or acute
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point of increased tissue density. I'm
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then going to apply pressure by letting
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this hand relax and placing the other
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hand over top, straightening out my arms
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and leaning in.
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I'm then going to hold that until I feel a
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release or I can do the other protocol,
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which would be five seconds on, two
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seconds off, five seconds on, two seconds
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off. I think I've mentioned in previous
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videos that I do tend to gear towards
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the the static hold, and usually 30 seconds
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to 2 minutes does the trick. I hope you
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guys enjoyed this video. I hope you add
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static piriformis manual release to your
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repertoire and use it when necessary.
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Let's talk a second about what
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assessments would lead me to believe
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that the piriformis needs to be released.
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If we're talking about the overhead
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squat assessment, we're talking about
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knees bow out, an inadequate forward lean,
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a posterior pelvic tilt, or an
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asymmetrical weight shift, that would be
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the piriformis opposite the side of the
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shift. If we're looking at goniometry,
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we're looking at either a lack of
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internal rotation in prone, or if we're
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doing those supine tests, piriformis will
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actually cause a reduction in range of
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motion in either direction. That has to
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do with that weird action of the
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piriformis where if you get closer and
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closer to 90 degrees, it starts to become
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more and more of an internal rotator
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rather than external rotator. If you don't
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know what I'm talking about, look up the
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piriformis article in www.brentbrookbush.com
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and you guys will see. You could
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possibly consider something like the
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FABER test or the hip impingement test,
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which are both special tests for the hip,
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as also indications that this may be
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tight. From a pathology perspective,
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although I don't like to go from
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pathology to technique, if somebody had
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gotten diagnosed with piriformis
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syndrome or a sciatica, I would also
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definitely put this technique in my
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repertoire just to see if we could get
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any abatement from symptoms. Now, mind
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your scope, mind your technique as far as
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your body position, and, of course, stay
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specific to your assessments. I look
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forward to hearing your
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comments. Please leave your comments
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below. If you have any questions, if you
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think I left anything out, please let me
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know. I'll talk with you guys soon.