Massage Today
March, 2012, Vol. 12, Issue 03

A New Method for Dealing with Hip Rotators

By Shari Auth, MA, Lac., LMT, NCBTMB

Remember "Piece Goods Often Go On Quilts" or as my anatomy teacher taught us, "Pirformis and the Go-Go Queens?" Both are memorization tools for recalling the names of the six deep lateral rotators of the hip.

The first letter of both phrases corresponds to the first letter of one of the rotators (i.e. piriformis, gemellus superior, obtuator internus, etc.) Left-brain knowledge crammed in during massage school all to be forgotten later, with the exception of the fashionable piriformis. We may have forgotten the names, but in clinical practice, hip rotators are hard to forget. Tight hip rotators contribute to lumbago, sciatica, turn-out in the legs and feet, and just plain old hip pain in people who travel, sit or clench too much.

Clients hip rotators can be contracted and short for a long time before prompting them to see a massage therapist. For the average person, yogis and dancers aside, this is one of those hard-to-reach, hard-to-stretch and overall unconscious places.

Forearm Massage

Hip Rotators Image 1 The Auth Method is a system of massage that makes the health and well-being of the practitioner's body the priority, without sacrificing results. The method was developed with the belief that with the right tools, technique and body mechanics, performing massage can be effortless. In the Auth Method, the forearms are the preferred massage tool for the majority of massage work for a few reasons. The forearms are more durable massage tools than the hands, fingers or thumbs, so you can work longer on your clients with less wear and tear on your body. When it comes to hip rotators, this durability provides a strong tool for getting into the deep muscles of the pelvis. Let's face it, the hands, fingers and thumbs are no match for the large muscles of the hips.

Massaging the hip rotators with the fingers or thumbs can be pokey and uncomfortable for the client. When using the forearms, you have a broad surface area of contact, so the sensation is smooth and not pokey. This broad contact is ideal for working larger muscles groups because you can massage more of your clients in less time. Finally, the forearms are perfect for leaning into. I recommend using body weight instead of muscular force when massaging. Using muscular force is exhausting and runs the risk of working too deep. By using body weight, you'll naturally sink to the first layer of tight tissue; as that layer releases, you'll sink to the next layer of tight tissue. Work patiently, layer by layer, to create a deep tissue massage experience that is painless for your client and effortless for you.

Hip Rotators Image 2 Stretch and Release

Placing a muscle in a stretched position while performing massage is a wonderful tool for a massage therapist, because it intensifies the massage without further taxing the massage therapist. Extra effort by the therapist isn't needed for the recipient to receive deeper work. This comes in handy when you're working on a large or muscular client. Taking a muscle off the stretch softens the muscle and allows the practitioner to sink deeper into the muscle. Alternating between putting a muscle on and off the stretch while massaging is an effective technique for releasing a muscle. It incorporates all the benefits of stretching with massage, coupled with the benefits of taking a muscle off the stretch.

First Things First: Warming Up the Hip

Hip Rotators Image 3 Because the hip rotators are deep to the gluteus maximus, it is necessary to first massage the gluteus maximus. After the gluteus maximus has released, it is easier to contact and work with the deep rotators. With your client in prone position, undrape their hip. Tuck the drape securely under either leg. The drape should cover the client's midline. Effleurage the hip and leg, sufficiently spreading oil throughout. Stand alongside the table at the level of your client's anterior superior iliac spine facing down the table toward their feet. Spread your legs a legs-length apart with either leg in front. If the leg closest to the table is in front, try leaning your hip against the table for comfort. Rest your forearm closest to your client just below the iliac crest with your elbow skimming the lateral border of the sacrum. Be mindful to use your upper forearm versus your middle of lower forearm. Using the upper forearm provides you with more leverage.

Rest your other hand on your client's leg. (Image 1) Gradually lean your body weight onto your forearm and sink into your client's hip muscles. The massage table should be low enough that you can comfortably drop your body weight onto your client and high enough that your back is straight. Glide down your client's hips, tracing the border of the sacrum with the edge of your forearm and ending the stroke at the ischial tuberosity. Keep your forearm parallel with the massage table so you have a broad base of contact, this will ensure that your massage stroke isn't too pokey. (Image 2) Repeat the stroke as needed to warm up the hip and release the gluteus maximus.

Deep Hip Rotators

Hip Rotators Image 4 To massage the hip rotators with a stretch, pick up your client's ankle and bend their knee to 90 degrees. (Image 3) Repeat the same hip stroke with the knee bent; when you reach the vicinity of the rotators, about halfway down the sacrum, move their ankle and lower leg laterally. (Image 4) This will put the hip rotators on a stretch. You will feel the rotators become taut as they are being stretched. This taut quality will increase the intensity of the massage for your client, so be mindful not to overstretch or apply too much body weight onto the area. You may only have to move the ankle a couple of inches until the rotators have an adequate stretch — proceed slowly. By massaging the hip rotators in the stretched position, you are able to release tight hip rotators as well as lengthen short hip rotators.

Slowly bring the ankle back so it's hovering over the knee, releasing the stretch in the rotators, softening the tissue and allowing you to sink in deeper on the rotators. Repeat this stretch and release over the entire region of the rotators, increasing the stretch as necessary, moving slow and steady. This is a deep and often tight area for our clients. Encourage your clients to breath into their hips during this work. This will relax them and promote circulation in the area.

Releasing tight rotators can reduce turn-out in the legs, changing the alignment through your client's lower body. I have noticed that my clients are more grounded, centered and relaxed after receiving deep bodywork in the hips. Check in with your own body when massaging. Be conscious of keeping your shoulders relaxed, back straight and legs active. Remember, this is your time, too. At the end of the massage, if our clients are more relaxed but we are more tense, we have only succeeded in transferring tension rather than reducing it. Massage, even in deep areas of the body, can and should be easy on your body.

Shari Auth, MA, Lac., LMT, NCBTMB, is a licensed massage therapist and acupuncturist, and is certified in the Rolf method of structural integra-tion. She is the creator of the Auth Method and has a full-time practice in New York City. Auth teaches continuing education workshops and has a DVD, Auth Method of Therapeutic Massage: A Guide to Using the Forearms. For more information, visit www.authmethod.com or www.shariauth.com.