I just wrote that without looking at a textbook. Impressive, eh?
Kidding. That’s from wikipedia.
My ass is killing me
If you have piriformis syndrome then, in sum, your ass is killing you. Or your thigh. Let’s look at some very simple fixes to get you 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.
Have you tried RICE?
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.
Synergistic Dominance
In some cases of piriformis syndrome the glute muscles aren’t firing optimally. The piriformis and glutes are synergistic in hip extension (i.e. extending your leg behind you). If the glutes aren’t functioning properly the piriformis is overtasked. 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.
Why did the glutes shut down?
Glutes often get inhibited because we are seated so much. The glutes are inactive when seated, so our brain loses the desire to fire. This is explained in this article from the Somatic Movement Center:
“Our nervous system likes to be as efficient as possible, because making fast decisions helps us
survive. When our nervous system notices that we keep repeating the same movement or
posture, it begins to make that movement or posture automatic... sensory motor amnesia describes the negative effects of developing muscle memory; the state in which we have lost sensation and voluntary control of a movement or posture
because it has become so deeply learned.”
In plain english: sitting is bad for glute engagement, and we’ve become experts at sitting.
What to do?
Let’s teach the glutes how to move again. These exercises will engage your glutes and may help you achieve better hip extension:
An added benefit is your hip flexors will release from doing bridges, single leg bridges and bird dogs as well. Or maybe you release them with isometric glute flexes throughout the day.
Soft Tissue Work
Why aren’t your glutes firing properly? You probably have tight hip flexors. Hip flexors are tight because we sit so much (again with the sitting). Sitting puts our hips in a shortened position and, as shown above, the brain does it’s thing. They’ll remain tight unless we ask them to open up by foam rolling.
Roll on a Lax Ball
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.
What’s your prediction for foam rolling sore glutes and hips, former heavyweight champion Clubber Lang?
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 beforehand (active stretch); then do your sit and reach stretches after you finish.
Some stretches I like for the piriformis:
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.
Nerve Glides
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.
In the meantime here’s some glides that may help with piriformis syndrome.
A common theme I’d like to underline: Less is more. While performing these HOLD BACK. Don’t tense beyond a 3/10. If you go too hard your body will not respond well.
Common Peroneal Nerve Glide/Slack
Sciatic nerve glide/slack
That’s enough for one day
I could go on recommending potential treatments but you’ve got some good, actionable info here.
Remember you’re not doomed to be in pain forever. If one false move can get you into pain then one can certainly get you out.
You’ve got to keep searching… that can be a pain in the ass.
However, that always beats a literal pain in the ass.