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Copyright © Alastair McLoughlin 2015 Revised © Alastair McLoughlin 2019 and 2022
The right of Alastair McLoughlin to be identified as the original Designer, Developer and Author of the Work has been asserted by him in accordance with the Copyright, Design and Patents Act 1998.
All rights reserved. No part of this text may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover, or reprinted in any physical or electronic manner without the written consent of the author.
The ideas and concepts explored within this text are those of the author. For educational purposes only.
No diagnosis is being offered nor any cure promised by the application of this information.
Alastair McLoughlin cannot be held responsible for any injury arising from the application of this work by the practitioner to any third party however caused.
This work is not a substitute for medical attention. Please seek your physician’s advice if in doubt.
The AoB procedure is performed over the belly of the piriformis muscle, at a mid-way point between the edge of the sacrum and the greater trochanter of the femur.
INDICATIONS FOR USE
- Piriformis Syndrome / sciatic pain
- Pain in the middle of the buttock
- Tissue tension in the gluteal / hip area
- Sacrum feels restricted, tight or immobile
- Low back pain
CAUTIONS OR CONTRAINDICATIONS
Do NOT abduct the thigh (as shown) for clients with hip joint replacement or restricted and limited hip rotation due to arthosis, arthritis or similar degenerative hip complaints, or if abduction of the thigh elicits pain for the client.
Refer for medical diagnosis if you are unsure about any undiagnosed condition.
Position of the patient:
Client is laying prone on the treatment table.
Use of a face cradle is optional.
The AoB move can also be performed with the client laying on their side - which is often useful for the elderly or those who find laying prone too uncomfortable, such as a pregnant woman or a person with extreme and severe back pain.
Palpate the mid point of the glute and assess for tissue tension, discomfort or pain as shown in segment (a).
Assess both sides for comparison.
Treat the more affected (more tense or painful) side first.
The location of the AoB move is shown in segment (b) - approximately at the mid-point between edge of sacrum and outer trochanter of the femur.
The direction of the move is shown in segment (c)
Application of the AoB procedure - prone:
Usually BOTH piriformis muscles (left and right sides) are treated to achieve balance in the tension applied to the sacrum.
This is not applicable for the client who is laying on their side where only the affected piriformis is treated.
Treat the more affected side first.
Flex the knee on the affected side and allow the leg to fall laterally (outwardly) to the client’s comfort - as shown.
Putting the leg into this position adds a little tension to the piriformis to facilitate an easier and more positive release of the affected muscle.
You can perform the moves using either method as shown in the video demonstration - method (d) or method (e).
Perform the move on both sides in order to get a good balance of tissue tension between the two sides.
Application of the AoB procedure – side-laying:
This position is used:
- For the infirm or elderly person
- If the prone position is too painful (as in some cases of sciatica)
- Pregnant women
The client is laying on their side with one pillow under their head and another between their knees.
This helps to give greater comfort and relaxation to the client and the gluteal area.
This body position also stops the piriformis from being stretched.
The affected leg may need to be extended slightly to assist help relax the glute enough to facilitate a positive move across the piriformis.
If the hip is flexed too much the glute will be too tight to enable an effective release move.
There is no need to flex the knee and crank the leg for a client in this position.
Just make the move on the affected side - using both thumbs as demonstrated in the video - shown in segment (f).
TIP: After the move is completed pause for between two and five minutes to allow any pain to subside and to assist tissue relaxation around the area.
After the pause recheck the area for tissue tension.
If there is still tension you can repeat the move and wait another two to five minutes.
Additional AoB moves for sciatic pain:
When Piriformis Syndrome or sciatic pain continues to refer pain through the length of the nerve (g) you may have to apply additional release moves in the affected areas (h).
You will need to palpate the areas of tissue tension and be guided by the areas of pain as reported by your client.
These AoB release moves are very small, as you are working on the nerve itself.
Allow a little more rest time after the releases down the leg to give the tissues opportunity to relax and release their grip on the nerve.
Help the client to a seated position:
Pause and check the client experiences no dizziness or light-headedness. (i)
Ask them to stand - placing BOTH feet on the floor at the same time to allow even weight-bearing into both hips to occur.
If the client is dizzy or light headed then wait for a minute or two to allow that feeling to clear itself.
Only then may the client step down from the couch placing BOTH feet on the floor at the same time to allow even weight-bearing into both hips to occur.
If the client continues to be dizzy (j) after waiting two minutes then lay them in a foetal position, cover them with a blanket and wait for the dizziness to pass.
Return them to a seated position and check any dizziness has subsided.
Then ask them to stand - placing BOTH feet on the floor at the same time to allow even weight-bearing into both hips to occur.
The client may need to sit for a few moments before dressing and leaving your office.
How it works:
The piriformis originates from the anterior (front) part of the sacrum, the part of the spine in the gluteal region, and from the superior margin of the greater sciatic notch (as well as the sacroiliac joint capsule and the sacrotuberous ligament).
It exits the pelvis through the greater sciatic foramen to insert on the greater trochanter of the femur.
Its tendon often joins with the tendons of the superior gemellus, inferior gemellus, and obturator internus muscles prior to insertion.
Piriformis syndrome occurs when the piriformis irritates the sciatic nerve, which comes into the gluteal region beneath the muscle, causing pain in the buttocks and referred pain along the sciatic nerve.
Seventeen percent of the population has their sciatic nerve located through the piriformis muscle.
This subgroup of the population is predisposed to developing sciatica.
The gluteals (including the piriformis) can be aggravated by sitting on a hard surface or by sitting on a wallet or cell phone carried in the back trouser or jeans pocket when driving, for example.
The AoB movements we perform trigger a release of the piriformis, minimising the pressure on the sciatic nerve and thus releasing the symptoms of sciatica.
Advise the client to not sit on hard surfaces.
Do not place hard objects, such as a phone or wallet, in their back pocket.
Relaxation of the tissue is often felt quickly with a second or even third session of this work being sometimes necessary to clear the problem.