Muscle Mondays

What a Pain the Butt - Piriformis and Piriformis Syndrome



The piriformis is a small muscle in the gluteal region - small, yes, but can be plagued with a number of issues causing pain and discomfort - it is literally a pain in the butt.

The piriformis attaches at the anterior sacrum, running diagonally to the greater trochanter, a location near the top of the femur. It is deep the gluteus maximus - or, you know, the butt muscle. Given it’s width at the sacrum, and narrowing as it runs to the femur, it can have the appearance of a pear, hence its name. In Latin, “piriformis” more or less means “pear-shaped.” 

The primary reason it can cause a number of issues is its location in relation to the sciatic nerve. The sciatic nerve is the longest nerve in the human body. It begins in the lower back, and runs down through the pelvic structure, down the back of the leg. On its way, it passes underneath the piriformis. In some people, the nerve actually passes through the muscle. 

This means when the piriformis is tight, it can compress the nerve, causing radiating pain and numbness down the back of the leg. You’ve probably heard of Sciatica. Sciatica is an impingement of the nerve in the lower back, usually by a herniated disc. When the nerve is compressed by the piriformis, it is known as Piriformis Syndrome, also sometimes called “false Sciatica.” This condition can be exacerbated by such things as sitting for long periods of time, especially with a wallet in the back pants pocket that further compresses the nerve.

Because of the muscle's attachments at the anterior portion of the sacrum, and the greater trochanter near the posterior aspect of the femur, tight piriformis muscles of varying degrees on either side of the body can pull the sacroiliac joint out of alignment, causing further pain and imbalance.

How Massage Can Help Piriformis Syndrome

Firstly, there are a few tests that can be done prior to massage work to assess and determine whether the client is experiencing a compression of the sciatic nerve in the lower back, or at the piriformis. This involves running the client through a series of stretches and positions in order to briefly recreate symptoms felt in the client’s day-to-day life. 

Once it’s determined the issue is at the piriformis (more on Sciatica and treatment for it in a later post), massage can help loosen the muscle and return it to its proper length, relieving pressure on the sciatic nerve. This process may be uncomfortable during the session itself, but bring great relief after. Massage should also be applied to the surrounding gluteal area, hamstrings and calves, to relieve any lingering nerve pain. Self-care stretches and corrective exercises done between sessions can maintain effects of massage work.


Muscle Mondays - The Rotator Cuff

We often refer to the rotator cuff structure as one muscle, but it is actually comprised of four muscles:



- Supraspinatus

- Infraspinatus

- Teres Minor

- Subscapularis

Together, they work to stabilize the shoulder, and hold the head of the humerus inside the fossa (a small indentation) of the scapula. The head of the humerus adjoining with the scapula is known as a “ball and socket” joint, which allows for the most range of motion out of all the types of joints there are in the body. But this also means the joint is more susceptible to injury.

Rotator cuff injuries are common for people who have occupations or play sports that include repetitive motion in the shoulder, particularly overhead. Office and desk workers are also prone to injuries and pain due to rounding and slumping of the shoulders. A rotator cuff injury will result in a dull ache in the shoulder, perhaps made worse by sleeping on it. In some cases, the rotator cuff can be injured in a single accident, sometimes resulting in a tear in one or more of the tendons or muscles. In that case, immediate medical care is needed to treat the injury.

How Massage Can Treat Rotator Cuff Injuries:

Rotator cuff injuries can lead to limited range of motion in the shoulder, impingement of nerves and other structures in the area, and in some cases, strains and tears. Massage can help alleviate the pain, and also help stretch and elongate muscles. Posture analysis and self-care exercises can also be provided to reduce risk of future re-injury or aggravation.