Piriformis Syndrome – A Pain in the Butt
as published in the Onteora Runner's newsletter January 2007
During one of my long runs, the topic of conversation was “pains in the butt”. We discussed those pains in detail: relationships, family responsibilities and household chores, and quite literally that vague annoying pain that seems to originate in our rear ends and goes down the back of the leg. More often than not this pain occurs when we run and can be quite debilitating.
This “pain in the butt” is also known as piriformis syndrome. Some athletes experience deep pain in the gluteals; others a pain in the hamstrings or an elusive annoying discomfort down the back of the leg. It’s important to have a health practitioner rule out that these symptoms are caused by a herniated or bulging disk, sciatica or other musculoskeletal problems in this area. Since many of the symptoms experienced overlap with a variety of other problems, piriformis syndrome is known as a diagnosis of exclusion.
The sciatic nerve (the nerve that runs down the back of the leg) passes immediately below the piriformis. The piriformis muscle works in conjunction with four other deep gluteal muscles (superior & inferior gemeleus and internal & external obturator). Its function is to externally rotate the femur (thigh bone) in the hip and slightly extend and abduct the hip when the hip is flexed. Weak and/or tight musculature and biomechanical compensations contribute to piriformis syndrome.
Anatomical Contributors Include:
• Weak abductors
• Tight adductor muscles (inner thigh) and medial hamstrings
• Tight ITB (iliotibular band)
• Leg length discrepancy
• Foot pronation
Running Flaws/Biomechanical Contributors Include:
• Running on canted surfaces
- the leg on the “high side” of the road tends to pronate more.
- The adductors of the leg on the “high side” are under more tension during midfoot and toe-off.
- The external rotators and abductors are working harder to maintain stability during mid-stance.
• A long stride
• Running down hill fast or doing too many hills too often.
Stretches & Exercises:
Piriformis stretch: Lying on your back with both knees bent, rest your ankle of the leg that hurts over the knee of your unaffected leg. Grasp the thigh of your unaffected leg and pull that knee toward your chest. You will feel a stretch along your buttocks and possibly along the outside of your hip on the affected side. Hold this stretch for 20 to 30 seconds. Repeat 2 times.
Quadruped Extensions: This exercise is best performed with a friend watching you to make double check your form. Activate your lower abdominals by pulling your belly button up towards your back. Extend your right leg towards the wall behind you. Lift your leg up until it is parallel with the floor. Be careful not to twist your spine or buttock. Extend the opposite arm as shown. Hold 3-5 seconds. Lower and then repeat with opposite leg and arm. Do 5-7 sets.
These few tidbits should be of some benefit. Avoiding hills and canted roads should help alleviate some of the pain that you might be experiencing. Shortening your stride and reducing the amount of speedwork performed will also help. Also stretching appropriately and doing strengthening exercises will help keep you healthy and ready for the season to come.
Saturday, March 3, 2007
High Hamstring Tendinopathy
Running Injuries: High hamstring tendinopathy.
as published in the Onteora Runner's newsletter Decemeber 2006
It’s the beginning of the season for most of us and I’m sure many of us are looking ahead to improving our training; be faster; and go longer. Typically the winter months are used for active recovery and cross-training allowing the body and the mind to heal from the ardors of the past year. Some of us have incurred running injuries that were ignored during the season but are now needing to be addressed so that they don’t occur next year or prevent us from reaching our potential.
Common musculoskeletal injuries such as piriformis syndrome, plantar fascitis, and high hamstring tendinopathy affect a growing number of runners and triathletes. It’s been my experience that female runners tend to experience high hamstring tendinopathy more than men. Perhaps it’s hormonal. Perhaps it’s structural. Unfortunately research is limited.
High hamstring tendinopathy is an overuse injury most often seen in middle- and long-distance runners. High hamstring tendinopathy is quite literally “a pain in the ass”. As an exercise physiologist and coach, I’ve worked with many runners will typically complain of a deep buttock or upper hamstring pain brought on during acceleration and at faster speeds. Some will complain of sciatic and buttock pain while seated.
The Physician and Sportsmedicine, a peer reviewed journal, published an excellent article in their May 2005 issue. I’d like to share a few exercises that might be of benefit. The following information is from this article and is available on-line.
Hamstring Biomechanics During Running
During running, the hamstrings have three main functions. First, they decelerate the knee extension at the end of the forward swing of the gait cycle. This action helps provide dynamic stabilization to the weight-bearing knee. Second, at foot strike, the hamstrings elongate to facilitate hip extension, again stabilizing the leg for weight bearing. Third, the hamstrings assist the calf muscles in extending the knee during the takeoff phase of the running cycle.
Treatment Options and Rehabilitation:
After an initial evaluation and diagnosis by a health care professional, several treatment options are available for relieving high hamstring pain, preventing its recurrence, and getting the athlete back into running.
Treatment typically includes:
• Pain control. Ice works wonders.
• Pelvic alignment if necessary. I would recommend a sports chiropractor who has experience working with athletes.
• Soft-tissue mobilization. Breaking up adhesions or scar tissue will help realign muscle fibers. I would recommend a health care professional who specializes in deep tissue massage, myofascial release or muscle energy techniques.
• Progressive hamstring flexibility. An appropriate stretching regime for both legs to ensure a balanced structure.
• Core-strengthening program. I’ve included snapshots of two very effective exercises. These are not as easy as they look and should be performed with someone supervising them. It’s quite easy to think that you’re aligned when doing them, but that’s not usually the case. One side will typically be weaker than the other and there will be a tendency to compensate and use other muscles which might lead to injury.
Prone plank with hip extension.
Keeping your head level with the floor, support your body weight on your forearms (elbows bent at 90°) and toes. Maintain a neutral spine while maintaining position. Each leg is lifted and held for 5 secs. Repeat 5-10 times per side alternating legs.
Bridge on ball with ball curl.
Lay on the floor with your feet on a stability ball. Hips are raised until the knees, hips and shoulders are in a straight line. It’s important to keep your back in a neutral mid-range position. The bridge position is maintained as you push the ball forward and back. The goal is to be able to do this with both legs and then progress to single leg. Repeat 10 times.
as published in the Onteora Runner's newsletter Decemeber 2006
It’s the beginning of the season for most of us and I’m sure many of us are looking ahead to improving our training; be faster; and go longer. Typically the winter months are used for active recovery and cross-training allowing the body and the mind to heal from the ardors of the past year. Some of us have incurred running injuries that were ignored during the season but are now needing to be addressed so that they don’t occur next year or prevent us from reaching our potential.
Common musculoskeletal injuries such as piriformis syndrome, plantar fascitis, and high hamstring tendinopathy affect a growing number of runners and triathletes. It’s been my experience that female runners tend to experience high hamstring tendinopathy more than men. Perhaps it’s hormonal. Perhaps it’s structural. Unfortunately research is limited.
High hamstring tendinopathy is an overuse injury most often seen in middle- and long-distance runners. High hamstring tendinopathy is quite literally “a pain in the ass”. As an exercise physiologist and coach, I’ve worked with many runners will typically complain of a deep buttock or upper hamstring pain brought on during acceleration and at faster speeds. Some will complain of sciatic and buttock pain while seated.
The Physician and Sportsmedicine, a peer reviewed journal, published an excellent article in their May 2005 issue. I’d like to share a few exercises that might be of benefit. The following information is from this article and is available on-line.
Hamstring Biomechanics During Running
During running, the hamstrings have three main functions. First, they decelerate the knee extension at the end of the forward swing of the gait cycle. This action helps provide dynamic stabilization to the weight-bearing knee. Second, at foot strike, the hamstrings elongate to facilitate hip extension, again stabilizing the leg for weight bearing. Third, the hamstrings assist the calf muscles in extending the knee during the takeoff phase of the running cycle.
Treatment Options and Rehabilitation:
After an initial evaluation and diagnosis by a health care professional, several treatment options are available for relieving high hamstring pain, preventing its recurrence, and getting the athlete back into running.
Treatment typically includes:
• Pain control. Ice works wonders.
• Pelvic alignment if necessary. I would recommend a sports chiropractor who has experience working with athletes.
• Soft-tissue mobilization. Breaking up adhesions or scar tissue will help realign muscle fibers. I would recommend a health care professional who specializes in deep tissue massage, myofascial release or muscle energy techniques.
• Progressive hamstring flexibility. An appropriate stretching regime for both legs to ensure a balanced structure.
• Core-strengthening program. I’ve included snapshots of two very effective exercises. These are not as easy as they look and should be performed with someone supervising them. It’s quite easy to think that you’re aligned when doing them, but that’s not usually the case. One side will typically be weaker than the other and there will be a tendency to compensate and use other muscles which might lead to injury.
Prone plank with hip extension.
Keeping your head level with the floor, support your body weight on your forearms (elbows bent at 90°) and toes. Maintain a neutral spine while maintaining position. Each leg is lifted and held for 5 secs. Repeat 5-10 times per side alternating legs.
Bridge on ball with ball curl.
Lay on the floor with your feet on a stability ball. Hips are raised until the knees, hips and shoulders are in a straight line. It’s important to keep your back in a neutral mid-range position. The bridge position is maintained as you push the ball forward and back. The goal is to be able to do this with both legs and then progress to single leg. Repeat 10 times.
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