Question:
Hi Everyone,
Just want a little advice please if you dont mind :)
I have a client who i have known for a number of years personally (my best friends mum) and she has been in terrible pain for the last couple of months and has been diagnosed with Sciatica. She called me asking for a massage to relieve her pain so after getting all the boxes ticked with her GP I did her a treatment a week and half ago. I did quite a bit of research before hand about sciatica so i could confidently treat her and i did adapt the treatment so she was comfortable and had plenty of cushions and I did a lot of work on the hips and glutes and she felt great relief afterwards and called me to rebook this Saturday. So I have been reacherching a little more and have found information on Piriformis Synrome which causes Sciatic Pain, she has no pain in the spine just all the way down her legs to the toes and this seems to fit her description of the pain more than the Sciatica. i have printed off the info and I would ever try to diagnose someone as it is not my job but do you think I should give it her to take to our local GP as she is there every week trying to get sorted out or keep my thoughts to myself?? (Our local GP is not the best I moved my family due to there poor standards) as I think if she has been mis-diagnosed she could get sorted and off for some Physical Therapy instead of being doped up on tablets (18 per day) and depressed as she cannot leave the house.
Also if you have any tips for me to add to my massage to help that would be great.
Thanks
Coop
tis a tricky one, as therapist we should not diagnose nor scaremonger our clients. You could do some work on her piriformis muscle.. and giver her exercieses to stretch this out... often tghteness comes with the sciatica.
Then she can mention to her dr that her piriformis has been unusually tight, would this be in line with her symptoms???!!!!
That way you are not mis diagnosing...
Look at Trigger Points for the Piriformis release, if you are not familiar with these, maybe just apply pressure - firm but not painful, to the origin and insertion points of the muscle.. the pain will hurt initially but lessen.. the client should feel this...
Also, maybe some vibration work and kneading over the muscle will help.
Hope this is helpful and not arrogant!
love and light,
I totally agree that we're not allowed to diagnose... I'm not sure whata GP can do to help with piriformis syndrome; it's so often misdiagnosed. Anyway, there are some sport therapy muscle tests that can be done to be sure that it is the piriformis that's the problem (deduction rather than diagnosis!!)...
The piriformis muscle, as I'm sure you know, does lateral rotation at the hip. It is very deep inside the pelvis, so you can't really get to it to do any massage-like/trigger pointingwork on it. You can test this by doing both Lateral and Medial Rotation at the hip tests - one to check the strength of the muscle, the other to test its stretchiness... Lateral:get you client to lie on their front, with the offending leg bent up at the knee so the foot is up in the air. Then get them to slowly drop their foot over towards their other leg (keeping the knee bent and thigh in the same position, so it's just rolling - this is lateral rotation at the hip). If this hurts them in the hip, there could be weakness in the piriformis muscle. Compare left and right legs, to see what's normal Range of Movement for them. Repeat this going the other way (so the leg flops out, keeping the leg bent), then compare left and right.(This is medial rotation). If the range of movement is different to the other leg, chances are, the piriformis is tight. Then, while they are still medially rotating (I know it's weird cause the foot islateral, but this is medial rotation at the hip)place your hand around their ankle, hold their leg at the end of their range of movement and ask them to gently resist your pressure. If this is different from their other leg, chances are their piriformis is an area you might consider working on. Really difficult to explain with out demonstrating or drawing a picture! Hope I haven't offended any sports therapists colleagues with a bad explanation!![&:]
Assuming the tests are positive (ie. there is a problem with the piriformis) you could refer them to a sports therapist, who could do Muscle Energy Technique stretches (METs) to the piriformis by getting them to lie on their back on the couch, then with with knee bent and hip flexed, pushing their knee across to the opposite shoulder. This gives the piriformis a really good stretch, then using either METs or PNF techniques, you can stretch this further.
The other thing the sports therapist will likely do is advise on some exercises for the piriformis. These will strengthen and stretch the hip rotators and they can do the knee to opposite shoulder thing themselves, and another good one is sitting on a dining chair, with knees and hips at 90 degrees, then move the ankle out to the side, whilst keeping the knee in the same flexed position and the hip in the same flexed position. Swinging out and in will be a really good exercise for the piriformis.
Bowen could help them too, as it is possibly a wonky pelvis or jaw that's causing the problem, and I would also get them to think about doingyoga!
Hope that's helped.
Just want a little advice please if you dont mind :)
I have a client who i have known for a number of years personally (my best friends mum) and she has been in terrible pain for the last couple of months and has been diagnosed with Sciatica. She called me asking for a massage to relieve her pain so after getting all the boxes ticked with her GP I did her a treatment a week and half ago. I did quite a bit of research before hand about sciatica so i could confidently treat her and i did adapt the treatment so she was comfortable and had plenty of cushions and I did a lot of work on the hips and glutes and she felt great relief afterwards and called me to rebook this Saturday. So I have been reacherching a little more and have found information on Piriformis Synrome which causes Sciatic Pain, she has no pain in the spine just all the way down her legs to the toes and this seems to fit her description of the pain more than the Sciatica. i have printed off the info and I would ever try to diagnose someone as it is not my job but do you think I should give it her to take to our local GP as she is there every week trying to get sorted out or keep my thoughts to myself?? (Our local GP is not the best I moved my family due to there poor standards) as I think if she has been mis-diagnosed she could get sorted and off for some Physical Therapy instead of being doped up on tablets (18 per day) and depressed as she cannot leave the house.
Also if you have any tips for me to add to my massage to help that would be great.
Thanks
Coop
Answers:
tis a tricky one, as therapist we should not diagnose nor scaremonger our clients. You could do some work on her piriformis muscle.. and giver her exercieses to stretch this out... often tghteness comes with the sciatica.
Then she can mention to her dr that her piriformis has been unusually tight, would this be in line with her symptoms???!!!!
That way you are not mis diagnosing...
Look at Trigger Points for the Piriformis release, if you are not familiar with these, maybe just apply pressure - firm but not painful, to the origin and insertion points of the muscle.. the pain will hurt initially but lessen.. the client should feel this...
Also, maybe some vibration work and kneading over the muscle will help.
Hope this is helpful and not arrogant!
love and light,
Answers:
I totally agree that we're not allowed to diagnose... I'm not sure whata GP can do to help with piriformis syndrome; it's so often misdiagnosed. Anyway, there are some sport therapy muscle tests that can be done to be sure that it is the piriformis that's the problem (deduction rather than diagnosis!!)...
The piriformis muscle, as I'm sure you know, does lateral rotation at the hip. It is very deep inside the pelvis, so you can't really get to it to do any massage-like/trigger pointingwork on it. You can test this by doing both Lateral and Medial Rotation at the hip tests - one to check the strength of the muscle, the other to test its stretchiness... Lateral:get you client to lie on their front, with the offending leg bent up at the knee so the foot is up in the air. Then get them to slowly drop their foot over towards their other leg (keeping the knee bent and thigh in the same position, so it's just rolling - this is lateral rotation at the hip). If this hurts them in the hip, there could be weakness in the piriformis muscle. Compare left and right legs, to see what's normal Range of Movement for them. Repeat this going the other way (so the leg flops out, keeping the leg bent), then compare left and right.(This is medial rotation). If the range of movement is different to the other leg, chances are, the piriformis is tight. Then, while they are still medially rotating (I know it's weird cause the foot islateral, but this is medial rotation at the hip)place your hand around their ankle, hold their leg at the end of their range of movement and ask them to gently resist your pressure. If this is different from their other leg, chances are their piriformis is an area you might consider working on. Really difficult to explain with out demonstrating or drawing a picture! Hope I haven't offended any sports therapists colleagues with a bad explanation!![&:]
Assuming the tests are positive (ie. there is a problem with the piriformis) you could refer them to a sports therapist, who could do Muscle Energy Technique stretches (METs) to the piriformis by getting them to lie on their back on the couch, then with with knee bent and hip flexed, pushing their knee across to the opposite shoulder. This gives the piriformis a really good stretch, then using either METs or PNF techniques, you can stretch this further.
The other thing the sports therapist will likely do is advise on some exercises for the piriformis. These will strengthen and stretch the hip rotators and they can do the knee to opposite shoulder thing themselves, and another good one is sitting on a dining chair, with knees and hips at 90 degrees, then move the ankle out to the side, whilst keeping the knee in the same flexed position and the hip in the same flexed position. Swinging out and in will be a really good exercise for the piriformis.
Bowen could help them too, as it is possibly a wonky pelvis or jaw that's causing the problem, and I would also get them to think about doingyoga!
Hope that's helped.
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