I have been pondering over something for a while now and wanted to pick
your brains to see if I'm barking up the right tree with this one!?
Firstly, why do we always try to anti-spasm piriformis using the internal
rotation method? I think you will say that it's because that's how the
research has been done?!
The reason for asking is that I have a 19 year old client who is hyper
mobile at hip so when testing his hips with 4-sign assessment his left
knee drops to the couch, however right knee doesn't, therefore there is
asymmetry. He tried 4-sign anti-spasm for a week but it gave him more
problems so we stopped, his left hip, although very flexible is
dysfunctional (& he is in permanent external rotation with left leg-could
just be tight piriformis?) so I wonder if trying 4-sign using external
rotation (bringing the leg across the body and knee above 90degrees, then
trying to externally rotate) would work?
I have given him a piriformis stretch for now (leg across body and knee
high) & this is very tight for him)
He originally came to me as he had a LLD (left 5mm short) and had been
prescribed a heel wedge on left side for over a year but had developed
left shoulder pain. I taught him leg press anti-spasm and QL release and
he returned one week later with no shoulder pain, no heel wedge (he
chose to do this) and minimal LLD (love it!) I mention this as he has
clearly been shifted upwards on left side due to heel wedge and his hip
dysfunction on left is likely to be residual from the heel wedge?
All comments very welcome..... 😃
Great question and one that others may well have thought of too.
Piriformis anti-spasm exercise: yes we tend to use the 4-sign exercise as that is what the system kicked up as the most effective way of releasing the pelvic musculature. Â However that is not the only way it can or should be done. Â Each indiuvidual will present with different anomolies and if they have also have exessive lateral rotation in their hips then other methods of realeasing piriformis would make more sense. Â We teach on the courses the principles of the anti-spasm work and its OK to use those principles to create your own exercises based upon them. Â So for example you could release piriformis by doing 20/20 for the lateral rotators of the hip, as long as the hip joint is lower than 70 dgrees of hip flexion. You could also use the leg press technique as i think you said you were doing.Â
If someone has exessive lateral rotation, its often due to a joint issue rather than soft tissue. for example they may have a joint that is anatomically flawed in the form of a femoral retroversion (google that one - its a structural defomrmity of the neck of femur). Nothing to wory about, but it changes their natutal hip ranges.
Your suggestion for an alternative exercise is right in principle, but if you're trying to externally rotate the hip with it in flexion (if i'm understanding you correctly) that may not be the best way of hitting piriformis as its likely to be an internal rotator in that position. Â
Clearly the work your doing with this lad is working well, so you're right on the money with your prescription, hopefully these comments will help refine a little to help more....
Thanks Martin, always the answers seem obvious when you reply! Roll on March CPD day! I need a Martin Haines app, I type a question and a mini Martin responds! 😜
