Piriformis Suggestions

Jim, this one’s for you! I found a bunch of postings on priformis on the USA Triathlon coaching group. I’ve pasted the original question someone posed and some answers. I hope you get your answers next week working with Eric, he is great! Let me know how it goes.

Diane

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Subject: [USATCoaches] Piriformis issues
From: “jason.tricoach” <jason@start-

tri.com>
Date: Fri, June 13, 2008 11:51 am
To: USATCoaches@yahoogroups.com

I’ve been suffering from some deep pain in the hips that I tend to notice the most when I get
off the bike and start running. It’s more of a dull ache than sharp pain but seems to limit the
length of my stride. One of my clients also has ’similar’ conditions. I’m not ready to call it
sciatica and have opted for the often mis-diagnosed piriformis syndrome.

I’ve been doing some specific stretching for a few weeks now but have had limited relief. In
this month’s Runner’s World there’s an article on the syndrome and a suggestion that some
strength training might help.
I’ve therefore embarked on a piriformis strength training routine but it’s rather limited to one
exercise.. the cross-over stretch with a weight on the knee. Would be interested if anyone
can suggest any others.
I’ve justified this approach by deciding that my training is too linear / planar and I’ve
neglected rotational movements that you don’t tend to do when running, cycling or
swimming. I’ll update on progress but would be interested in the group’s experience /
suggestions with regard to Piriformis issues.

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A couple other things to consider…
Have you ruled out that this may be coming from your back and not the piriformis?  Lumbar disc injury can refer to exactly that area.  Does prolonged sitting bother it, or is it only when you run off the bike?  When did it start?  Can you recall an incident that may have set it off? What is your bike position?  Is your back flexed (rounded forward) or straighter?  Is the piriformis in fact tight (have you assessed the muscle length compared with the unaffected side?)  Assessing piriformis length is essentially looking at how far you can bring your knee up and accross your body while externally rotating your hip (kind of hard to do on yourself, though)
I bring this up, because as a PT student, I did mistakenly initially diagnose a patient as piriformis syndrome when it turned out to be lumbar disc referral.  One of the big things to consider, is that if it is the disc, you will want to back down the running for a while.
If you aren’t finding relief with stretching and strengthening geared towards the piriformis, get checked out by a PT or orthopedist.
Regardless of what is going on, you almost can’t go wrong with a good core strengthening/stabiliziing program and working on the hip abductors. And an appropriate stretching program. These are things all of us should be including in our training to help protect against injury and maintain optimal biomechanics.
Just my thoughts,
good luck
Sara Gilliland, SPT, CSCS
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And then there is the issue of the Psoas that gets shorter and tighter as we age and spend more time sitting behind a desk, in car, etc.

I found that doing Pain Free e-cises (supine groin stretch), and core strength (with some extra attention on the hamstrings) has gotten rid of my piriformis, etc issues. And of course I have a great Chiropractor who does some great trigger point release stuff for the Psoas specifically (something she learned from a Rolfer (sp?)).

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I would also have your running gait evaluated.
And, as you mentioned, doing strength exercises in different planes of motion other then sagital (frontal and transverse).

Jessica Laufenberg, MA,CSCS
Exercise Physiologist, USAT Level 1 Coach
USAT Midwest Board Member