Home » Therapy Notes – Sacrotuberous Ligament

Therapy Notes – Sacrotuberous Ligament

The sacrotuberous ligament can be difficult to treat from many perspectives. It is physically hard to reach. It is part of the pelvic floor and therefore a delicate area to work. It is a tough bundle of connective tissue and can be rough on the hands, especially the medial aspect.

They have a pelvic problem, but it is seldom discovered during the interview.  This problem usually requires a good deal of additional assessment and the therapists often struggle with finding this one. Sacrotuberous imbalance is noted when the therapist compares the ischial tuberosity to the sacrum from side to side, or on palpation of the lateral sacrum.

Once this has been properly assessed and found, it’s onset may be connected to an accident or chronic hip problem that occurred years ago. This seldom presents as an acute issue. Acute issues usually present with acute pain from the surrounding myofascial structures. More often, this presents as a lingering pattern that is left after other hip, thigh, and low back problems have been addressed. I often resolve this by balancing the pelvis and may need to do additional work along the lateral sacrum.

This is easily confused with many other trigger point referral patterns. The pain at the top of the thigh is similar to the referrals of piriformis and gluteus maximus. In fact, this is very similar to the referral of the trigger point in the lower gluteus maximus. The calf pain is similar to the referrals of gastrocnemius, soleus, tibialis anterior and gluteus minimus. The heel pain is similar to the patterns of soleus, quadratus plantae and tibialis posterior.

Pelvic Ligaments

Anatomy Review?

So, the first step is pelvic balancing. Pelvic balancing also provides longer-lasting results than solely using direct treatment of the ligament.

Each therapist has their own method of pelvic balancing. I prefer craniostructural work with SOT blocking but also use METs, strain-counterstrain, and some NMT techniques.

This protocol starts in the middle of the sacrum and treats the sacroiliac ligament and overlaying multifidi that hold tension on the medial border sacrotuberous ligament.

This protocol deals with loosening the entire sacrotuberous ligament, including the medial aspect.

This NMT protocol for gluteals helps to relieve tension in attachments to the sacrotuberous ligament.

It is a common follow-up protocol after treatment of the sacrotuberous ligament.

This NMT protocol for piriformis and deep hip rotators helps to relieve tension in attachments to the sacrotuberous ligament.

It is a common follow-up protocol after treatment of the sacrotuberous ligament.

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