|Body Region:||Gluteal Muscles|
|Conditions Associated with TPs:||Sciatica, Low back pain, leg pain|
|General Symptoms:||Most common is upper leg pain in the back of the leg. Numbness, tingling and other nerve symptoms can be found as well.|
|Common Causal Activities:||Since the muscles are used for standing and positioning, extended activity in these can lead to the TPs. Trauma is often a causative factor. Trauma to the back, legs and even feet will cause a person to stand and walk differently due to the pain or discomfort. This will cause the Gluteal muscles to work differently than normal and develop TPs.|
|Self Care:||Using tennis ball therapy is one of the easiest and best methods. A hooked tool is effective.|
|Therapist Care:||The massive Gluteal muscles mostly fall in the region between the sacrum and the lateral part of the upper leg (femur) bone. It is a deep muscle and best treated with a double thumb post. The best technique is to start in the center with the fingers flat on the sacrum. As you look for and treat the TPs move in a spiral outward until the entire deep area is covered. Leave you fingers in place and only move your thumbs. This will anchor your hands in place, give you leverage and maintain control of the therapy. Trying to do the opposite side Gluteals doesn't work. Your line of drive is not specifically downward into a prone (face down) patient. It is actually toward the center spindle or post of the body. As such trying to lean over the patient and pull your hands back into the Gluteals is bad on your own body. Walk around. It's much better for you.|
|Special Notes:||Since the Sciatic Nerve is a mingling of most of the nerves exiting the low back region and going to the legs and feet, it starts out as a fairly large cable of nerves (think a phone cable). It's passing through a powerful and often used muscle can lead to irritation of the nerves in the bundle. Any pain in the legs should consider TPs as a part of their condition.|
There are three basic techniques used in the Gluteal muscle region, the double thumb post, the elbow, and the clenched fist. The first two are done with the patient face down, while the third is done with the patient face up.
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The double thumb post is started with the fingers spread out and placed on the Sacrum and Iliac Crest. This gives an anchor to the hands as treatment is performed. Start with the thumbs in the center of the muscle mass. As you scan for TPs, having the patient tell you when one is found, move the thumb tips in an outward spiral, moving about 1/2" to 1" at a time, until the entire mass is covered.
In treating the TPs, by locking your elbows, you can use gravity and your body weight to apply pressure. This saves your own body from excessive work.
If you choose to sit on a chair or exam stool, you can use the elbow technique. When using the elbow, place the thumb of the treating arm in the opposite armpit (Axilla) for a strong triangle support, guide the elbow with the other hand, and simply lean into the elbow.
The picture to the right shows a patient using the clenched fist on their own Gluteal muscles. The key is to make a fist, then relax it so that there is no upward elevation of the first knuckle. Next place it under the Gluteal region with the patient slightly rolled away from the treating region. This is easily done by elevating the knee with the foot flat on the table and allowing the knee to drop to the contralateral (opposite) side. Once in position, have the patient roll back onto the fist. Now clench the fist tight and elevate the first knuckle into the muscle region resting on top of it.