Piriformis Static Manual Release

Differentiation

1. The piriformis originates on the sacrum and inserts into the greater trochanter, coursing horizontally deep to the upper portion of the gluteus maximus .
2. Start with your patient or partner in prone.
3. Locate the sacrum and greater trochanter and imagine a line between these two points.
4. Start by identifying the fibers of the superficial gluteus maximus 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.
5. Then, along the line between the sacrum and greater trochanter, depress through the gluteus maximus 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 piriformis should be identifiable.
6. Note, the deep rotators are horizontally oriented muscles, just inferior to the piriformis .

Potentially Sensitive Tissues

• 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.

Trigger Points

• Common trigger points for the piriformis are in the middle of the muscle belly, and close to the origin of the muscle near the sacrum.

Release Technique - in Prone

1. Start with the patient in prone, standing on the affected side adjacent to the patient's knee
2. Locate the sacrum and greater trochanter and imagine a line between these two points.
3. Along the line between the sacrum and greater trochanter, depress through the gluteus maximus fibers using a thumb over thumb hand position
4. 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 piriformis and dense areas, should be identifiable.
5. Once a taut band is located and/or dense nodule is located consistent pressure is applied.
6. 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.
7. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).
   1. Note, the deep rotators can be palpated and release; they are horizontally oriented muscles, just inferior to the piriformis .