Hi everyone, I’m Ian Harvey, massage therapist. This is my friend Christina. Today we’re going to be talking about thegluteal region. Some people have some trepidation about workingwith the butt, but this is an important area. Your gluteal region connects your legs toyour body, it affects your low back, it affects your abdomen, it affects pretty much everything,and yet a lot of the time we don’t even touch it as massage therapists. So let’s look at some easy ways of workingwith this area.
First, let’s talk about undraping. I like to come at the glutes from the topdown, and from the leg up. When I’m coming down from the back and theback is already undraped, maybe I’m working down this side of the body and I feel likeundraping the hip, I’ll restrain the drape at around L5 or the sacrum. And then I will fold over. And at this point, you could tuck into theside here but I usually don’t because I’ll be working a little under the drape here,which we’ll see in a second.
If I wanted access to the entire hipgluteregion, I would restrain the folded over drape right around the PSIS. So come around to the side a few inches, outto this lateral sacrum, restrain the drape there, and then fold over again, and thentuck at the inner thigh between the knee and the hip. To undrape from the leg, so let’s say thatyou have the leg undraped already, if I wanted to undrape this further, first I would restrainthe drape at this tuck at the inner thigh, and this will allow me to draw the drape mediallywithout the drape getting away from me, or
creating any sort of draft. From here I can work on most of the hip, Ican even work up into the low back if I were to leave this drape up. You can of course tuck around to the sideif you want to offer a little more security. When I’m draping this area, I make sure todo a lot of bunching of the fabric. I’ll bunch the fabric up, and then I’ll endwith a fold. The fold keeps the fabric in place, the bunchedup fabric prevents any sort of draft from happening, it creates a very nice thermalbarrier.
So, if I’m working in this area and her leg’smoving, her muscles are moving, there’s much less chance of this drape coming undone orsliding off. So let’s talk about some relevant landmarks. First, let’s find the SI joint. That’s the sacroiliac joint. You’ll find it if you palpate the ilium, thisbroad sheet of bone that forms the posteriorlateral part of the pelvis. And then come medial a bit, and you’re goingto hit this big roadblock.
This is the edge of the triangular sacrum. A lot of the trouble that can happen in thehips you’ll find right along this SI joint. People will report pain right here, and theymight report it as low back pain. So when people say they’ve got low back pain,ask them to point it out, they may just point out this ridge of bone here. This is a place where trigger points oftenhide, but if there’s any trigger point activity here, I want you to look at all of the thingsthat connect right there at that SI joint. We’ll talk about that more in a second.
Piriformis Syndrome versus Sciatica Animation
Piriformis syndrome is a neuromuscular conditionwhere the piriformis muscle one of the deep gluteal muscles presses on and compressesthe sciatic nerve causing pain, tingling and numbness in the buttock area and down thepath of sciatic nerve to the thigh and leg. Sciatic nerve runs UNDER the piriformis muscleand may be irritated when the muscle is too tight or shortened due to spasms. Piriformissyndrome is to be differentiated from sciatica which shows similar symptoms but has differentcauses. Diagnosis is commonly done by EXCLUSION ofsciatica. Because sciatica usually associates with compression of sciatic nerve roots bya herniated disc, sciatic symptoms in the
ABSENCE of spinal disc herniation are indicativeof piriformis syndrome. Causes and risk factors of piriformis syndromeinclude: Anatomical abnormality of the nervemusclerelation. Some people are more likely to get piriformis syndrome than others. Tightness or spasm of the piriformis muscle due to overuse injury. This commonly happensin sport activities that put pressure on the piriformis muscle such as bicycling, runningwithout proper stretching, or any activity that involves repeated movements of the legsperformed in sitting position. Treatment options include: Stretching exercises, massage, avoidance
of causative activities. Antiinflammatory drugs, muscle relaxants for relief of symptoms. Physical therapy that strengthens the gluteus maximus, gluteus medius, and biceps femorisis usually recommended to reduce strain on the piriformis muscle.