Glutes and the Deep Hip Rotator
Today we are going to talk about a very important topic, how and why the Gluteus Maximus, Medius and the Piriformis are SO IMPORTANT to treat. When these muscles are tense they can cause you a world of pain. Such as:
Lower back pain
Sciatic pain & symptoms
Pain climbing stairs/hills
Pain when pressure is applied to the hip
Posterior inclination of the pelvis (i.e. "farmer's butt")
Pain resulting from a sudden twisting motion
I like to group these three muscles together, especially if my client is already on the table. For lower back pain it is often caused by tension in the glut. med. and max. When these muscles are tense it pulls down on your lower back, therefore causing pain. Another symptom that is often paired with LBP is sciatic pain/symptoms, in that case I work on the Piriformis; the Piriformis is a deep hip-rotator in which the sciatic nerve runs. When the Piriformis is tight it can trap the nerve and cause a shooting pain down the outside of the leg. As a therapist is getting to the Piriformis he/she has to go through the first layers of muscle which are the glutes. So, by working the Piriformis, we’re knocking out 2 problems with 1 stone in helping the lower back feel better, and relieving sciatic pain.
Even if my client does not have sciatic pain I still work the Piriformis for LBP because the it is the only muscle that attaches to the sacrum. All the other deep hip rotators attach to the Ischium (the curved bone forming the base of each half of the pelvis).
Work slowly and tell your therapist if the pain and I mean, ANY kind of pain, good pain, bad pain gets above a 4 (scale 0-10). We want to help our clients but certainly not send them through the ringer.
(For LMT, NMT use only)
I'd like to offer peer advice to fellow therapist on how to work these muscles:
Glutes - Myofascial release, petrissage, compressions, muscle stripping, hold trigger points. Work the attachment points of each Glute from Ilium to Ischium.
Piriformis- Hold trigger points, this is my favorite technique for treating this particular muscle. By using my thumbs or fingertips to hold the pressure. This is probably the easiest way to treat the muscle, however it is very hard on the therapist's hands. Muscle stripping is also efficient.
And we all know that there are those who won’t speak up so in that case pay attention to body language! If their tightening their muscles or moving around on the table then lighten up with the pressure! This is a good rule of thumb to go by if you do not want your client to be in pain for days after after their session.