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(Meghan) - Welcome to this episode of JING TV! Where we're going to talk about the perfect
piriformis.
(M) - Welcome to this episode of JING TV! I'm Meghan. (Rachel) - I'm Rachel, hiya. (M) - and we're excited to talk about the perfect
piriformis, can somebody have one? But in particular, actually piriformis syndrome.
(R) - Where is it? To start off. (M) - Where is it? You wanna talk about it's location?
(R) - Yeah, where is it? Meghan Mari (M) - So the piriformis, perfectly placed, is on the
anterior side of the sacrum and then it comes down to the greater trochanter in a nice diagonal
form and although in dissection the piriformis is actually not that big. (R) - No, because
you've seen it, haven't you? (M) - Yeah. (R) - When you did that dissection? (M) - Yeah.
(R) - It was much smaller than you thought? (M) - Much smaller and the actual lateral
element down to the greater trochanter was really tiny, but the trigger points, which
we'll talk about in a minute (R) - Yeah. (M) - can sometimes make it feel like it's as
big as a golf ball, like an absolutely massive muscle. (R) - It's quite interesting, because
when you did that dissection you said that 2 of the muscles that we get really good results
on clinically:- quadratus lumborum and piriformis (M) - yeah. (R) - were actually much smaller
than you thought, right, (M) - Yeah. (R) - same with the QL. (M) - Yeah, yeah, it's true actually,
much thinner. I'm also very aware of when we do dissections at the institute we often are
dealing with specimens, human beings who have given themselves to science, later in life,
and they may not have used those muscles a bit, as much. So it was (R) - They're older.
(M) - They're older. (R) - You were trying to say it really nicely. (M) - I was!
(R) - Anyway, back to the piriformis. (M) - But the quadratus femoris was MASSIVE! (R) - OK.
(M) - That was the big thing i really got, it was a big pillow. Anyway. (R) - Anyway,
we digress, back to the piriformis and it's perfectness. (M) - So it's perfectness. One
of the things that people can develop is piriformis syndrome and when they end up in the clinic
they say "I have sciatica" and we know first of all. A) Sciatica is not a condition, it's
not a pathology. (R) - It's a symptom, not a diagnosis. (M) - It's a symptom, not a diagnosis.
(R) - That's right, a good soundbite. (M) - That kind of pain pattern can be coming
from a herniated disc, it could be coming from trigger points in the QL, coming from
lots of things. (R) - SI joint syndrome. (M) - Right, so, (R) - yeah? (M) - you take over
and talk about why that might be coming from piriformis. (R) - One of the things about
the piriformis muscle is that it does pass very close to the sciatic nerve. Anatomical
variations mean that the nerve can go over the top, underneath or in some unfortunate
individuals (M) - So unfortunate. (R) - right through the middle. The sciatic nerve is really
long, I believe it's the longest nerve in the body and it's about the size, width of
my little finger and actually if you really train yourself and your palpation skills you
can actually learn to tune into this muscle, sorry this nerve at different levels.
(M) - It comes, parts of it come all the way down into the Achilles tendon, so you can get the
sense of the length of that pain that can happen if it's impinged. (R) - A very common
problem isn't it, numbness, tingling, pain in the buttocks and down the back of the leg.
As we said there can be various causes:- herniated disc; being comprised by the SI joint in some
cases; or in this case from a tight piriformis. Again we have had very good clinical results
from treating the piriformis (M) - Sure. (R) - although I do notice research wise some
people are actually questioning whether piriformis syndrome exists to the extent. Yeah it's true.
(M) - It's crazy! (R) - Research questions a lot of things. But we have found good results
in clinic from treating the piriformis. So 2 things. 1 you can get trigger points in
the muscle that cause it to be short and then it presses on the nerve and the other thing
is you can actually get trigger points in the muscle that cause a referral pattern down
the leg as well. (M) - That's the definition isn't it, of piriformis syndrome. (R) - Yeah.
(M) - That's something to be really clear about, what is piriformis syndrome. Although
I would say that it's very rare for people to come in and say "I have piriformis syndrome"
(R) - Oh yeah, no. (M) - They just say "I have sciatica" (R) - Yeah. (M) - So the techniques
that we tend to use. First of all, piriformis what's it's action? It's an external rotator
of the hip, one of the deep six. So trigger point work to it; also some really nice, chunky
fascial rolling, kinda really getting that whole entire area and kind of freeing it up;
doing lots of stretching work - to the clients tolerance and in particular we really like
soft tissue release, so soft tissue release (R) - Yeah. (M) - seems to make a really big
difference with the piriformis to free the sciatic nerve and I have to say, cos lots
of people ask us, can you tell the difference between if the piriformis is really tight
because of trigger points and impinging on the nerve OR it's actually not touching the
nerve or the nerve feels free enough and there are trigger points in the piriformis causing
the referred pain pattern and I would say generally, I can't. (R) - Yeah. (M) - I can't
tell the difference I'd have to treat both of that the same. (R) - Again with the Jing
protocol, it's a bit of a no brainer cos you're actually always treating all of the muscles
around the joint. Without a doubt we would say even if you're really sure it's only the
piriformis that's involved, there will be other muscles around the joint that will be
compromised. Always treat the erectors, the QL, all of the gluteal group including glute
medius and glute minimus which you can do side-lying and the psoas. We show you how
to do all that on the online course don't we? (M) - Obturator internus, obturator externus,
the gemellus twins. (R) - Yeah, we don't show you that on the online course. (M) - No, no
we don't, but it's important to give them a bit of love! (R) - Yeah. Always use a combination
of techniques, so not just trigger point. We recommend you use a combination of fascial
work; trigger point work; acupressure points, there's some great acupressure points for
piriformis (M) - There is. (R) - syndrome; stretching and teaching your clients some
stretches they can do themselves. Use all of that and you'll get great results.
(M) - Where can somebody find the online course Rachel? (R) - Oh yeah I keep forgetting to
do this bit, don't I, cos we've swapped. You can find, you can look at all this information
on our great online course which you can sign up for, we'd love to see you there on low
back, treating low back pain. You can follow us on Facebook or Twitter, which is my preferred
method @JingInstitute and you can also sign up to these video blogs on iTunes.