PIRIFORMIS Variations

Associated problems

MET (RI and PIR) positions and methods

B

• Lie face downwards.

• Your leg on the side to be treated (left in this example) should be bent at the knee and your lower leg allowed to fall outwards, rotating your upper leg internally (see Fig. 3.37B).

• When all the slack has been taken out (i.e. complete relaxation), your foot and lower leg should be moved slightly towards the upright, an inch (2.5 cm) or so, and held for 10–15 seconds before being released and allowed to fall outwards, again into rotation, for a further 30 seconds.

• Repeat this once more.

The contraction against gravity, when your lower leg is raised slightly, involves the piriformis itself and the subsequent increased stretch effect is therefore the result of PIR.

The hamstrings are semimembranosus, semitendinosus and biceps femoris and are type 1 (postural) muscles lying at the back of the thigh. They attach to the ischial tuberosity (‘sit-bone’) which gives them influence over the pelvis when either short or weak.

Pain in the leg and low back; pain in the buttock region. Pelvic problems (such as SI joint dysfunction).

See the following tests in Chapter 2: Shortness tests 3, 4, 8, 10, 13, 14A 32. HAMSTRINGS

Figure 3.37 A: Position of contraction for self-treatment of piriformis.

B: Position of stretch for piriformis when lying face down

Associated problems A

B

• Stand with the foot of the leg to be treated (left in this example) on a stool or bench, with your knee straight, heel resting on the stool.

• The bench provides the resistant counterpressure against which the isometric contraction is achieved.

• The isometric contraction develops as you lean your trunk forward and sense the tightness in the back of your left leg.

• Caution.Try to avoid tilting your pelvis as you introduce the forward lean, but attempt instead to keep your spine and pelvis and stable leg (the one on the floor) in line (see Fig. 3.38A).

• This should be held for 5–7 seconds.

• As you release, breathe in and out and as you exhale, the forward lean should be taken a small degree further, until the hamstrings feel comfortably stretched.

• Hold this stretch for 30 seconds and then ease your foot further forward on the bench a little and repeat the contraction and stretch once more.

• It is possible to target areas on the inner or outer aspect of the back of the thigh by carefully rotating your foot slightly inward or outward, before starting the process of contraction and stretch.

• Sit on the floor with both legs outstretched and lean forward as far as possible, from the hips, with your back rounded and neck flexed, to grasp your legs with both hands.

• Your current degree of spinal and hamstring flexibility will determine how far down your legs you can comfortably reach; it might be to the knee or beyond or even to the ankles or feet (if you reach this far you probably do not need to do the exercise!).

• Make sure your knees do not bend, so that the stretch can focus into the hamstrings (as well as the muscles of the back) (see Fig. 3.38B).

• Holding firmly with your hands, arms outstretched, introduce an isometric contraction by trying to sit up slightly against your own resistance (your hands provide the fixation, together with gravity).

B. Seated stretch (for spinal muscles as well as hamstrings)

Figure 3.38 A: Stretching the hamstrings using MET.

B: Position for stretching hamstring and erector spinae muscles MET (PIR) positions

and methods A. Standing stretch

A B

• After 5–7 seconds release the effort and, on an exhalation, slide your hands a little further down your legs, and grasp the legs at this new position.

• Hold the stretch for not less than 30 seconds (3–4 slow deep cycles of breathing).

• Repeat this process of an isometric contraction followed by increased stretch several times more, until you are no longer gaining length in the stretch.

This band of fascia and muscle runs from above the hip to below the knee on the outer aspect of the thigh. It is an important postural structure with influence over pelvic mechanics as well as hip and knee function.

Postural problems, recurrent low back and knee problems and pain in the hips, legs and buttocks. These tissues are involved in stabilizing the pelvis as well as in moving the leg outwards (abduction).

See the following tests in Chapter 2: Functional test 2; Shortness tests 16, 17

• Lie on your right side (in this example) on a table or bed, with your buttocks very close to the end.

• Your upper (left in this example) leg, which is to be treated, hangs down over the edge, while your lower (right) leg should be flexed at the knee and hip, and resting. Try to ensure that the lower leg is in line with the trunk, not forward of it.

• Lying relaxed with your upper leg hanging down in this way places stretch on tensor fascia lata and the iliotibial band (see Fig. 3.39).

• An isometric contraction is introduced against gravity by raising your leg some 1 or 2 inches (2.5–5 cm) and holding this for 10–15 seconds.

• As you release your leg it should be able to stretch further towards the floor, this position being held for not less than 30 seconds.

• As you release the leg to hang freely, be careful that you keep your right trunk on the bed/table, not allowing too much side bend to occur at the waist.

• It is possible to slightly modify the fibers being stretched by having your leg a little behind the line of your trunk rather than in line with it. Try not to let the leg come forward of the hip joint or the stretch will focus more into gluteus medius.

• Repeat the sequence once more and then treat the other side if needed.

33. ILIOTIBIAL BAND