& Address: Piriformis
by Whitney Lowe
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.
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.
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.
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
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.
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