PERFORMANCE RUNNING EVERY DAY FITNESS REHAB Piriformis Syndrome Have you started to experience pain in your hip or down your leg while beginning or advancing your fitness program? This pain may be stemming from the piriformis muscle in your hip. This muscle can cause local buttock pain or pain down your leg if it is irritating your sciatic nerve. This condition is termed Piriformis Syndrome. One of the causes is overuse or sudden change in walking, running, or a lifting program. The best treatment for Piriformis Syndrome is stretching and strengthening of the hip musculature. Changes may also need to be made in your training regimen to take the stress off of this muscle, but good results can be achieved by implementing a good stretching and strengthening program. It is always a good idea to address any symptoms you might be having early on, the longer you wait the harder it is to resolve the problem. If you feel you may be experiencing Piriformis Syndrome or general gluteal pain the following article on everyday fitness and rehabilitation for Piriformis Syndrome may be valuable for you. Common Causes The piriformis muscle is a small muscle in the hip that runs from the sacrum to the outer hip bone. If the piriformis muscle becomes tight or cramps it can put pressure on the sciatic nerve, which passes underneath or through the piriformis muscle, depending on the individual’s anatomy. This can result in pain in the buttock or down the leg (sciatica). Typically this pain increases when the muscle contracts, when sitting for an extended time, or with direct pressure on the muscle. Shortening of the muscle and compression of the nerve is the most common cause of Piriformis Syndrome, but overuse of the gluteal and other muscles in the hip can also cause muscle spasms of the piriformis. Other factors in this syndrome include poor body mechanics and poor alignment of lower extremities (foot, ankle and knee) that contribute to gait problems. Stretching and Strengthening Stretching and strengthening are the best treatments for piriformis syndrome. This muscle rarely gets stretched, so a simple stretching routine can often work wonders. To stretch the right piriformis: lay on your back, bend your knees and cross your right leg over your left so your right ankle rests on your left knee in a figure four position. Bring your left leg towards your chest by bending at the hip. Reach through and grab your left thigh to help pull things towards your chest. Holding this stretch for a minimum of 30 seconds and repeating for 3 sets per day should be enough to get you started. If possible stretch the muscle while it is warmed up. www.therapeuticassociates.com/PerformanceRunning PERFORMANCE RUNNING EVERY DAY FITNESS REHAB Piriformis Syndrome: Continued It is also important to make sure you are flexible throughout your lower extremities to relieve some of the biomechanical stresses that may be placed on your hip musculature. Some of the important muscles to stretch would be the hamstrings, quadriceps, gastrocnemius and soleus muscles. Deep tissue foam rolling is also a very good option to reduce fibrotic patterns in these muscles that can lead to dysfunction. Making sure you are strong in the appropriate musculature to take the biomechanical strain off of your hip muscles is also very important. The best way to strengthen this musculature is by performing closed chain (feet on the ground) exercises concentrating on keeping the proper form. Some examples of these exercises are: squats, lunges, and step downs. When starting a strengthening program it is important to have someone assess your form so you do not stir up other issues. Staring with 2-3 sets of 10-15 repetitions of each strengthening exercises 3 times per week should be enough to get you started. Another thing that may need to be addressed with Piriformis Syndrome is your biomechanics. Sometimes proper footwear, inserts or orthotics can make a huge difference on the forces at your hip. Along these lines proper training is also important, as mentioned before, overuse is one of the major causes of this syndrome and getting guidance for proper training is a piece you do not want to leave out. Physical Therapists are trained to diagnose and treat your condition. I would encourage you to see your Physical Therapist if you think you are dealing with Piriformis Syndrome so the correct diagnoses can be applied and the correct treatment can be prescribed. www.therapeuticassociates.com/PerformanceRunning PERFORMANCE RUNNING EVERY DAY FITNESS REHAB Piriformis Syndrome: Continued Maintain good posture at all times: Sitting - Keep rear end to back of chair, do not cross legs, knees in alignment with hips. Standing - Keep weight evenly distributed on both feet. Sleeping - On back, with bolster under legs. On side, pillow between knees. Drink a lot of H2O to maintain good tissue health and reduce soreness. Stretching: Hamstring (Wall) Lying on the floor with right leg on wall, other leg through doorway, scoot buttocks toward wall until stretch is felt in back of thigh. As leg relaxes, scoot closer to wall. Hold 30-60 seconds. Repeat with left leg. Repeat 2 times per set. Do 1 set per session. Do 3-4 sessions per day. Stretching: Hamstring (Standing) Place right foot on stool. Slowly lean forward, keeping back straight, until stretch is felt in back of thigh. Hold 30-60 seconds. Repeat with left leg. Repeat 2 times per set. Do 1 set per session. Do 3-4 sessions per day. Piriformis (Supine) Cross legs, right on top. Gently pull knees toward chest until stretch is felt in buttock/hip of top leg. Hold 30-60 seconds. Repeat with left leg. Repeat 2-3 times per set. Do 1 set per session. Do 3-4 sessions per day. Drawing images used with permission by VHI www.therapeuticassociates.com/PerformanceRunning PERFORMANCE RUNNING EVERY DAY FITNESS REHAB Piriformis Syndrome: Continued Quadriceps Holding one foot with same-side hand, raise leg until stretch is felt. Hold 30 seconds. Repeat with other side. Repeat 2 times. Do 2-3 sessions per day. Gastroc Stretch Stand with right foot back, leg straight, forward leg bent. Keeping heel on floor, turned slightly out, lean into wall until stretch is felt in calf. Repeat with left leg. Hold 30 seconds. Repeat 2-3 times per set. Do 1 set per session. Do 2-3 sessions per day. Soleus Stretch Stand with right foot back, both knees bent. Keeping heel on floor, turned slightly out, lean into wall until stretch is felt in lower calf. Hold 30 seconds. Repeat with other leg. Repeat 2-3 times per set. Do 1 set per session. Do 2-3 sessions per day. Iliotibial Band Foam Rolling Weight on arms, roll hip over firm, full roller, moving body to floor. Feel stretch in outside of thigh and hip. Roll up and down outside of leg. Repeat both sides. Avoid twisting body. Repeat 15 times. Stretch left side. Do 1-2 sessions per day. Drawing images used with permission by VHI www.therapeuticassociates.com/PerformanceRunning PERFORMANCE RUNNING EVERY DAY FITNESS REHAB Piriformis Syndrome: Continued Closed chain exercises are the safest and most effective way to strengthen your lower extremities. Paying special attention to your form is of the utmost importance. Drink a lot of H2O, this will help with tissue help and tissue recovery. Forward Lunge Standing with feet shoulder width apart and stomach tight, step forward with right leg. Repeat with left leg. Do not let knees go over toes or cave in. Repeat 10-20 times per set. Do 2-3 sets per session. Do 3-4 sessions per week. Deep Squat Stand with feet shoulder width apart and squat deeply, head and chest up. Do not let knees go over toes or cave in. Repeat 10-20 times per set. Do 2-3 sets per session. Do 3-4 sessions per week. Medial Step-Down Stand with both feet on 8 inch step. Step down in the M direction with left foot facing forward, touching heel to the floor and return 10 times. Do not let knee cave in. Do 2-3 sets per session. Do 3-4 sessions per week. Drawing images used with permission by VHI www.therapeuticassociates.com/PerformanceRunning