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Back to Training Tips Table of
Contents
Piriformis
Syndrome
A Real Pain in the Butt
by
Dr. Tim Maggs
If
you’ve ever felt pain in the hip, pain in the center of the butt, or pain
down the back of the leg, you likely are suffering, at least partially, with
piriformis syndrome. The piriformis is a muscle which runs from your sacrum
(mid-line base of spine) to the outer hip bone (trochanter). This muscle truly
works overtime on anyone who runs at all. The muscles in and around the
gluteal region help with three areas: 1) rotation of the hip and leg, 2)
balance while one foot is off the ground, and 3) stability for the pelvic
region. Needless to say, all of these characteristics are needed by runners.
Conclusion—the piriformis muscle is pretty important for all of us.
Injuries
to the Piriformis
This
muscle is a prime candidate for repetitive motion injury (RMI). RMI occurs
when a muscle is asked to perform beyond its level of capability, not given
enough time to recover, and asked to perform again. The typical response from
a muscle in this situation is to tighten, which is a defensive response. This
tightness, however, manifests itself in several ways to a runner.
The
first symptom suggesting piriformis syndrome would be pain in and around the
outer hip bone. The tightness of the muscle produces increased tension between
the tendon and the bone which produces either direct discomfort and pain or an
increased tension in the joint, producing a bursitis. A bursitis is an
inflammation of the fluid filled sac in a joint caused by an elevation of
stress and tension within that joint.
The
second symptom suggesting piriformis syndrome would be pain directly in the
center of the buttocks. Although this is not as common as the other two
symptoms, this pain can be elicited with direct compression over the belly of
the buttocks area. A tight muscle is a sore muscle upon compression due to a
reduced blood flow to that muscle.
The
third symptom suggesting piriformis syndrome is a sciatic
neuralgia, or pain from the buttocks down the back of the leg and sometimes
into different portions of the lower leg. The sciatic nerve runs right through
the belly of the piriformis muscle and if the piriformis muscle contracts from
being overused, the sciatic nerve now becomes strangled, producing pain,
tingling, and numbness.
Simple
Physiology
Any muscle repetitively used needs to have an opportunity to recover. This recovery can either be on Nature’s clock, or can be facilitated and sped up with proper knowledge and treatment. Since the muscle is tightening due to overuse, continued use will only make it worse. This injured muscle needs to relax and have increased blood flow to it for more rapid healing. The tightness also reduces the normal blood flow going to the muscle, reducing the speed with which the muscle can recover. To encourage fresh, oxygen-rich blood to the muscle is the most powerful means of getting the muscle to begin to relax and function normally. Multiple massages per day to this area are greatly encouraged.
The
next step in this “recovery” process is to use a tennis ball under the butt
and hip area. While sitting on the
floor, roll away from the side of involvement and place a tennis ball just
inside the outer hip bone under the butt area. As you begin to allow your weight
onto the tennis ball, note areas of increased pain and soreness. Trigger points
will tend to accumulate in a repetitively used muscle, and until these toxins
are manually broken up and eliminated, the muscle will have an artificial
ceiling with regard to flexibility potential and recovery potential. So, if
it’s sore and hurts while you are sitting on it, you’re doing a good job.
Let the ball work under each spot for fifteen to twenty seconds before moving it
to another area. Once you’ve been on the ball for four to five minutes, put
the ankle of the involved leg over the knee of the noninvolved leg (crossing
your legs). Now place the tennis
ball just inside the outer hip bone again and work the tendon of the piriformis
muscle. While this pain is typically excruciating and takes some time to
effectively reduce, the benefits here are huge. Be patient, be consistent, and
good things will happen.
Additional
Treatments
Due
to the fact that the sciatic neuralgia and the hip bursitis or tendonitis are
both inflammatory in nature, ice, or cryotherapy, over the involved area fifteen
to twenty minutes at a time will be beneficial. This should be done multiple
times per day.
Stretching
of the hip muscles should not be done until the acute pain is gone. Then, begin
with gentle stretching, such as the cross-legged stretch, while pulling up on
the knee. The muscle should have increased flexibility before an active return
to running.
Finally,
I always discourage the use of pharmaceutical anti-inflammatories. Not only do
they greatly aggravate the intestines, they suggest an artificial wellness that
can lead to bigger problems. Proteolytic enzymes, such as bromelain, are both
natural and extremely beneficial with no side effects. For more information,
visit your health food store or check out Rehab Plus on our website.
For further information, Dr. Maggs can be reached at (518) 869-1884, his Web site: www.RunningDr.com or via e-mail at RunningDr@aol.com.
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