A client of mine had bi-lateral piriformis release surgery about six years ago. This procedure involves cutting the muscle proximal by the origin so as to "release" the pressure on the sciatic nerve due to muscle spasm. Unfortunately, the healing process involves the piriformis simply scarring down. Hence, both sides are uneven in terms of strength and innervation. As a result, her gait is deviated. The left leg moves properly; however, the right leg moves like a half-moon and tends to rotate inward with supernation of the right foot. I would like to know how I can properly train her for running while correcting this deviation. I am skilled in both corrective stretching and core training (as per NASM). What stretches and/or exercises would be appropriate to improve the kinetic chain?
NASM advise that your client should consult with a soft tissue therapist to remove (break up) the inelastic tissue that has formed. Hopefully with soft tissue techniques (i.e., soft tissue release, active tissue release, myo-practic techniques), your client will regain the necessary extensibility to fully benefit from the corrective exercises necessary to regain control of the lower extremity.
If no therapist is present, refer to article(s) on Myofascial Release Techniques and concentrate on holding the tender areas until discomfort reduces by 75 percent. This self soft tissue technique should be a large part of the corrective process and needs to precede CST/NST (core and balance) exercises. In addition, all strength (IST) exercises should be done on one leg to retrain kinetic chain structural integrity.