Assess & Address: Piriformis Syndrome by Whitney Lowe

Pathology Assessment & Evaluation Treatment Massage Techniques

Massage techniques
Because the primary problem in piriformis syndrome is nerve entrapment by a soft-tissue structure, massage is highly effective. Myofascial trigger points in the piriformis muscle can be addressed with static compression techniques. This may be done with either a broad contact surface such as the back of the fist, or a small surface like the thumb, elbow or a pressure tool.

Since you may be applying compression to an area of nerve entrapment to address hypertonicity in the piriformis muscle, make sure that nothing you do exacerbates the problem. If the client reports a reproduction of the primary symptoms s/he has been feeling, then you know the pressure you are applying may be aggravating the nerve compression, and you should immediately cease pressure in that area. Communication with your client is imperative. If pressure on the piriformis aggravates the problem, you may shift toward either end of the piriformis muscle with direct pressure and still yield beneficial results while avoiding the primary site of nerve compression.

Longitudinal stripping methods along the length of the piriformis muscle will help to reduce tension. Stripping techniques may be done with the fingertips, knuckle, thumb, elbow or a pressure tool. An effective variation on the stripping technique is a pin-and-stretch method applied to the piriformis.

In this procedure the muscle will be put in a shortened position (lateral hip rotation) with the knee flexed to 90 degrees. The client will be asked to hold the hip in that position as the practitioner attempts to medially rotate the hip by pulling the leg into medial rotation. Once a level of moderate contraction has been established, the client will be instructed to slowly let go of the contraction. As the client does this, the practitioner will apply a longitudinal stripping technique to the piriformis. Compressing and stripping the muscle while it is under contraction magnifies the effect of the force applied to the muscle, which has a beneficial effect on getting at the deeper myofascial tissues. However, the same caution exists for this technique as for ones described above. If this method exacerbates the symptoms at all, it should not be performed. There is no benefit from further aggravating a nerve-compression syndrome.

Nerve-compression problems are quite prevalent in our society due to many occupational and biomechanical factors, such as prolonged sitting, repetitive motion and a general lack of mobility and flexibility. Since recent studies have indicated that sciatic-nerve irritation symptoms may not be strongly correlated with lumbar-disc pathology, it is important to look for other possible causes of these symptoms. Compression of nerve structures in the gluteal region by the piriformis muscle is a likely cause of these symptoms.

Massage is an excellent intervention for piriformis syndrome, as long as it is done correctly. It is in your best interest - and your client’s - to understand the pathologies related to nerve compression in order to be effective in addressing these common conditions.

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