My ass is killing me- let’s work on your priformis
‘Hey running man, Any experience with piriformis syndrome? I’m dealing with a nasty case of it and I’m missing running big time.’
First off, I’m sorry to hear you’re suffering.
‘Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the hip/ buttocks and along the path of the sciatic nerve descending the lower thigh and into the leg.’
I just wrote that without even looking at a textbook. Impressive, eh?
Kidding. That’s from wikipedia.
In sum, your ass is killing you. Or your thigh. Let’s look at some very simple fixes to get back in action.
Remember I am not a Doctor. I’m just a guy who has made every mistake in the book and learned what worked in his own recovery.
What I recommend below is safe and may get you out of pain (it has for me). If pain persists it’s always smart to see your Doc.
I have not had piriformis syndrome but if I did these are the steps I would take to get better quickly.
1- Read my article on R.I.C.E. Rest, Ice, Compression and Elevation. This is the start of any journey of recovery. I would stress the Rest aspect.
2- Activate your glute muscles: In some cases of piriformis syndrome the glute muscles are not firing optimally. The piriformis and glutes are synergist muscles, they help to put your hip in extension (extend your leg behind you). If the glutes are not functioning properly then the piriformis will be overtasked with movement work it is not designed to handle. This is called synergistic dominance.
Imagine you and a co-worker do similar work. They go on vacation and you have to not only do your work but you have to pick up their workload too.
For a couple days you’re fine with it.
After a week you’ll start to bitch about it.
If you don’t bitch you deserve a raise.
The pain in your butt can be the overworked piriformis bitching about too much work.
So why do our glutes get inhibited?
Glutes often get inhibited because we are seated so much. The glutes are inactive when seated, so our brain loses the desire to fire them properly.
Your brain has a move it or lose it mentality. If you spend no time moving a muscle your brain forgets about it.
Lie down on your stomach, bend the knee on the unaffected side and lift the thigh as high as you can. Take a picture or have a look at how high it comes. Bring it back down. Now lie flat, bend the knee on the affected side, lift it as high as you can. I will bet you $20 your affected glute didn’t lift nearly as high. The lack of muscular recruitment is contributing to your injury.
So what to do: Bridges, assisted bridges, single leg bridges, bird dogs, and progressed bird dogs. These will activate your glute muscles.
2A- Release your hip flexors: Why aren’t your glutes firing properly? You may (probably?) have tight hip flexors. I’ve been training clients for 15 years and can count the number of clients with fair to good hip flexor mobility on one hand. Hip flexors are tight because we ALL sit so much and sitting puts our hips in a shortened position making them tight. They will remain that way unless we ask them to open up.
The hip flexors will release if you do the bridges, single leg bridges and bird dogs as well. Or maybe you release them with isometric glute flexes throughout the day.
3- LAX Roll- Here’s the progression for foam rolling.
Start with a soft foam roller.
Progress to a harder one.
Progress to a PVC pipe.
Then to a tennis ball.
Finally to lax ball.
You want to sit that ball right into your glutes, right onto your piriformis and hunt around for your “points of interest” (aka the spots that really sing when you put some pressure on them). Repeat for your hip flexors.
I’ve filmed videos of how I would roll out both your piriformis and your hip flexors. Check them out.
What’s your prediction for foam rolling sore glutes and hips, former heavyweight champion Clubber Lang?
4- Stretch
A quick word on stretching. I recommend you stretch after you’ve warmed up (you’re warm and sweating) or at the END of your workout. Stretching before a workout or run has been proven to decrease neuromuscular recruitment of your muscles. So jog for 5 minutes, then stretch. Or mobilize before hand (active stretch) and then do your sit and reach stretches after your workout is done.
Some stretches I like for the piriformis (with video):
Figure 4 stretch– A versatile stretch in that you can do it from your back, from a seat, or even standing. Try :60 each side during a warm up or after your run.
Half pigeon– simultaneously a hip flexor and hip stretch. A great place to lie for a few minutes after you finish your run. I’d recommend :60+ on each side after a run.
Twisted triangle– An intense dig into the hip. :60+ each side after a run.
Standing Hip stretch– this is a stretch that people with IT band tightness like very much. This and figure 4 you can easily break out in the middle of a run. Feeling tight, run to the side of the road and sit in this stretch for :30+ aside after your run.
5- Nerve glides- The sciatic nerve runs alongside or through your piriformis. If you’re getting a stabbing pain that extends down from your glute and into your hamstrings then something is likely pressing on the sciatic nerve. The shooting pain is a message from the nerve telling you to cool it.
So you’ve foam rolled, you’ve activated glutes and released your hip flexors and you’re still in pain. Let’s glide the nerve a little bit. Maybe it became impinged and just needs a little nudge to get to a more comfortable spot.
There are 2 types of nerve glides:
Tensioning sequences- the proximal and distal ends of the nerve are separated (mildly) and then released. Basically you lengthen the nerve, floss it around and then release.
Slacking sequences- the proximal and distal ends of the nerve are unloaded to decrease threat. Do this when you think the nerve is stretched too long. Just shorten it and let it hang.
Nerve glides deserve their own blog. I’m on it.
In the meantime here’s some glides that may help with piriformis syndrome.
A common theme I’d like to underline: Your body loves subtlety.
Don’t hit it with the grand gesture, but give it some small daily affirmations. Little things mean a lot.
Less is more. While performing these HOLD BACK.
Don’t tense beyond a 3/10. If you go to hard your body will not respond.
Common Peroneal Nerve Glide
To review here is a summary of the tension – slacking sequence (parentheses)
plantar flexion – (dorsiflexion)
ankle inversion – (ankle eversion)
toe flexion – (knee flexion)
straight leg raise
hip adduction – (hip abduction)
hip internal rotation – (hip external rotation)
spinal lateral flexion
spinal flexion – (spinal extension)Test out your muscles after each sequence and see if you feel stronger, more flexible, pain free.
Tibial Nerve Glide
To review here is a summary of the tension – slacking sequence (parentheses)
dorsiflexion – (plantar flexion)
ankle eversion – (ankle inversion)
toe extension
straight leg raise – (knee flexion)
hip adduction – (hip abduction)
hip internal rotation – (hip external rotation)
spinal lateral flexion – (spinal extension)
spinal flexion
Test out your muscles after each sequence and see if you feel stronger, more flexible, pain free.
Sural Nerve Glide
To review here’s a summary of the tension – slacking sequence (parenthese)
dorsiflexion – (plantar flexion)
ankle inversion – (ankle eversion)
straight leg raise – (knee flexion)
hip adduction – (hip abduction)
hip internal rotation – (hip external rotation)
spinal lateral flexion – (spinal extension)
spinal flexion
Test out your muscles after each sequence and see if you feel stronger, more flexible, pain free.
