Name: Piriformis Static Manual Release
Uploaded: 2023-04-26T01:00:03.000Z
Duration: 11 min 20 s

English captions

https://stream.mux.com/F2U4M3HfBoccSTuCZhngNM1bK7gMUSE77LXiCHQ52yg.m3u8

Learn the proper technique for piriformis static manual release (a.k.a. soft tissue mobilization, ischemic compression, trigger point release) in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based course provides detailed guidance on assessment, positioning, tissue differentiation, and pressure application to address piriformis trigger points, reduce hip, sacroiliac joint and lower back pain, and restore optimal function of the lumbopelvic hip complex (LPHC). Ideal for clinicians and movement professionals, including physical therapy students, massage therapists, athletic trainers, and chiropractors, seeking to enhance their manual therapy skills for rehabilitation, performance, and pain management.

Manual Release Techniques Overview

Anatomy of the Piriformis Muscle

Locating Trigger Points in the Piriformis

Applying Pressure for Release

Techniques for Adding Tension

Assessment Criteria for Piriformis Release

Final Thoughts and Scope of Practice

Piriformis Static Manual Release

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

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 originates on the sacrum and inserts into the greater trochanter, coursing horizontally deep to the upper portion of the 

Start with your patient or partner in prone.

Locate the sacrum and greater trochanter and imagine a line between these two points.

Start by identifying the fibers of the superficial 

 which have a vertical fiber orientation; take a moment to identify the individual fascicles and fiber orientation by strumming medial to lateral, just deep to the skin.

Then, along the line between the sacrum and greater trochanter, depress through the 

 fibers, strumming inferior to superior or superior to inferior, attempting to identify horizontally oriented fibers. It may not be possible to feel individual fascicles depending on the thickness of overlying tissues; however, the horizontally oriented, somewhat tube-shaped 

 are horizontally oriented muscles, just inferior to the 

The sciatic nerve may be compressed during this technique. Although manual compression is unlikely to irritate or damage this nerve, if tingling, numbness, or burning is felt, adjust your hand position. The sciatic nerve is about "pinky-width", a small adjustment in any direction should allow you to pin trigger points, taut bands, and dense nodules without continued compression of this nerve.

 are in the middle of the muscle belly, and close to the origin of the muscle near the sacrum.

Start with the patient in prone, standing on the affected side adjacent to the patient's knee

Along the line between the sacrum and greater trochanter, depress through the 

 fibers using a thumb over thumb hand position

Strum inferior to superior or superior to inferior, attempting to identify horizontally oriented fibers and taut bands.

Note: It may not be possible to feel individual fascicles depending on the thickness of overlying tissues; however, the horizontally oriented, somewhat tube-shaped 

 and dense areas, should be identifiable.

Once a taut band is located and/or dense nodule is located consistent pressure is applied.

The practitioner may control the amount of tension in the muscle by controlling the amount of internal and external rotation of the femur with the lower leg "tucked" under the arm.

Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

 can be palpated and release; they are horizontally oriented muscles, just inferior to the 

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