SOS

[Maya]

Hi. I'm having an Oral Practical exam today, and I need help on how to stretch the Piriformis while in prone. I have only 10-minutes to perform a treatment so finding a trigger point in the gluts will eat into my time as I have to turn my client to supine to stretch the muscle. Thanks

 

[Proud New Momma]

SOS

Something like this might help?

Piriformis Stretch:
http://www.youtube.com/watch?v=lfP0QssgdXs

 

[GMJ]

SOS

@maestra: thanks but i was hoping it would show a passive stretch on prone (due to time constraints). im wondering though if i should just do an internal rotation (going opposite of what pirifomis does) until my "client" feels a stretch and then hold it for 30 secs...? im asking this in the context of finding a trigger point in the piriformis as opposed to the gluteal region, which is what im trying to avoid because it will mean turning her on supine and i wont have a lot of time, e.g. pillow, drape, etc. i hope im not confusing you. my classmates and i have a practice "stem" that says client walks in complaining of pain in the left gluts that radiates down to the posterior leg (Client has been diagnosed with gout ). QLs and Piriformis have the same TrP referral pattern but stretching QLs mean redraping client, taking pillow out, etc. again, im trying to minimize that so i can have more time to do my treatment.

 

[dreamer]

SOS

Try undraping up to the knee, lifting the ankle up, then rotating the leg internally while the knee is flexed. You'll be pulling their ankle toward you (assuming you're standing at the side of the table) kind of reminiscent of a slot machine. If you're looking for TrPts, turn so you are facing their feet and put your forearm in the muscles just medial to the greater trochanter of the femur and feel around as you rotate the leg back and forth. This will give both a stretch and some mild work on the muscle attachment within just a matter of 30 secs to a minute.

 

[Matej]

SOS

@Taoist: that's exactly what i did : I got a "client" with gout (R foot) and pain in the gluts radiating down the posterior leg (talk about my piriformis moment right there! lol ). I decided to start on prone, and as I turned my client, I banged the Right Toe (lost points there - I should have had my client slide down the table until his feet was off it before turning him), and then as I had him on prone, the table got exposed so my client's face was right on the vinyl (lost points there too). Anyway so I scored with my "amazing" (according to my examiner)fascial techniques and location of TrP in the Piriformis muscle, but ran out of time so I barely squeaked by with 11points out of 25. I didn't have time to stretch the piriformis as I had to leave the heat on for a bit (not real tx time but just to show I know the protocol for Trp tx), and while it was there I decided to work on the hamstrings and the gastrocs, and was planning to finish the treatment with my client on supine, and do MLD to flush out the metabolites associated with gout. Of course the timer went off, and I slunk away with my miserable score. Anyway, so thats about it as far as my midterms OP went.... My Finals OP should be interesting I'll definitely keep you posted. but hey, THANKS SO MUCH! and to you as well, MAESTRA. I truly appreciate your taking the time to respond to my SOS.

 

[Gee G]

SOS

You can do some basic stretching of the external rotators when prone, but it's pretty near impossible to isolate piriformis and effectively stretch it in that position. Also, the piriformis is an external rotator in some positions, but an internal rotator in others.

I think you did well to start with the techniques you described, based on your current level of knowledge. If you really study how to stretch your clients later, you may think of this session and imagine different ways you might have handled this client's complaint. Remember that graduating from massage school is the very beginning and that you will still have loads to learn... so don't stop studying after you graduate!!

 

[John-Musca]

SOS

@Jason: you are absolutely right about how nearly impossible it is to isolate the Piriformis, but I gotta try Thanks you by the way for your encouraging words. I appreciate it.

 

[iluv2tradestks]

SOS update

Just an update; for my finals OP my "client" was 41 yrs old complaining of hip pain (R), tested positive for Ober's and Thomas, and was also diagnised as hypertensive. He was on NSAIDS prior to treatment.

I started by informing client that I already washed my hands, elevated client into semi-reclined position, pillowed under the leg, did DDB, rockings/shockings/compressions, while putting heat on quads. I asked if client was ok if I undraped her right leg, as soon as I got consent I took off the heat, did fascial/ skin rolling on quads until +ve hperemia, GSM and segued into mm stripping (using short segmental retrograde strokes due to hypertension condition of client). I chose quads for my Trp site (easier to stretch!) with a lowered pain scale due to NSAIDS intake prior to tx, heat on Trp site, did passive ROM of hip, knee and ankle then worked on peroneals and soleus, took heat off, stretched quads (asked client to slightly flex the other leg while I bring her affected leg over the table to stretch it).

I forgot what Obers test was for, which was the primary tx goal - tx for IT band contracture, so I failed. I felt frustrated because I should know these special tests by heart and yet I don't, thus the failing mark. I wished my intructor was more straightforward, like putting IT band contracture on the stem, but I guess he was also testing my kowledge of Special tests at the same time, so there. ... I had back-to-back OP, and my second one was easier: fibromyalgia with supraspinatus tendinitis and kyphotic posture. Fm was just secondary, so I turned client on prone with rolled towels on shoulders for the hyperkyphosis, heat on upper traps, fascial techs on upper back, worked on Supraspinatus Tendinitis, rhomboids (GSsm, rhythmic mobs then strengthened) for the kyphosis, TrP on Levator Scap, heat and stretch, turned client on supine with a rolled towel along spine, worked on pecs (fascial, gsm, stretched), scm, scalenes, and the timer went off. I barely passed when my 2 scores were added up.
I feel so frustrated. Do I need to study some more? Practice some more? My written tests are ok - I get 90s easily, but OPs kill me. I dont know what to do.

 

[Sarezh]

SOS

Study some more. Practice some more. Learn from your mistakes and accept the fact that you will always have to keep doing so. Never put your references away, and return to them frequently, especially when reviewing a session to consider how it went. Discuss cases with classmates and professionals (especially if you can find a good mentor) to get outside insights.

Tests are easy. Reality is hard. Persist and you will succeed.