Problem: The client complained deep pain in his right buttock, a numbness in his lower leg and pain whilst walking.
Assessment: After undertaking an examination I observed the following:
- On palpation of the buttocks where the sciatic nerve crosses the piriformis muscle, the muscle was too tight and pain occurred.
- Pain and discomfort occurred in the buttock area whilst placing the hip into an external hip rotation and abduction.
- When raising the leg 25 degrees, the sacrotuberous ligament and piriformis muscle became taut because of its attachment to the ischial tuberosity and the hamstrings.
- Back – tension across the lower back and in the left buttock needed releasing.
- Hamstrings - the muscles in both legs showed tightness with small adhesions.
- Knees – some scar tissue on the ligaments around the Patella (knee cap).
- Shins/ankles - on palpation I felt the tight Achilles and calf muscles were causing the pain and discomfort and scar tissue on the medial tibia inside of both legs at 4 - 6” from the ankles.
Treatment: The following course of treatment was then undertaken:
- Soft tissue pressure massage was applied to the Pririformis muscle.
- Deep tissue massage was applied to the muscles to release muscle tightness and remove adhesions.
- Soft tissue massage was applied across the shins and knee ligaments to remove the adhesions.
- Sports massage was applied to the Hamstrings and Quadriceps.
Results: After the 1st treatment the client felt he had more movement on walking with less pain.
After 2nd and 3rd treatments, the pain and discomfort in his buttock and back was hardly noticeable and the sensation in his lower leg was slowly improving. His calf muscle needed a lot of deep tissue massage to release the tension and simple stretching exercises were given.
After 4th and 5th treatment, he had no pain or discomfort in his buttock on activity. His sensation in his lower leg was increasing with every visit. He was advised to try a short run.
On the 6th treatment, he reported the run went well, no pain in his buttock or back, the sensation in his leg is recovering slowly. Continued stretching and exercises advised for prevention.