Piriformis Syndrome: How do we deal with this athlete’s injury? The piriformis is a small stabilizing muscle that sits deep in the butt and plays a key role in the running movement, helping to externally rotate the hips, keep them flat and stabilize the pelvis. It extends from the lower part of the sacrum, where the base of the spine meets the pelvis, to the upper part of the femur.
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Repetitive activities, such as running, can overwhelm the piriformis – Photo: Istock Getty Images
The sciatic nerve passes directly through the piriformis muscle, and when the piriformis muscle contracts or spasms, it can sometimes compress the nerve, resulting in pain; That’s why we call it piriformis syndrome.
Unfortunately for runners and some athletes who use this muscle excessively and consistently, this injury has a common cause: Repetitive activities such as running can strain the muscle and compress or “inflame” the nerve, until it travels to the leg.
Piriformis syndrome can be difficult to diagnose because it’s easy to confuse with a herniated disc, sciatica, a proximal tendon bulge (also known as elevated tendinitis) or a lower back problem. Here are some of the main symptoms that can help you determine if the piriformis is the real cause of your gluteal pain:
- It hurts to sit: Those with piriformis syndrome do not always feel uncomfortable while running. Instead, they often find sitting, climbing stairs, and squatting painful. Pain while running, specifically or a feeling of excessive stretching when running on a hill or fast workouts, is usually a sign of a proximal hamstring strain.
- and sensitivePiriformis syndrome often causes the area to be painful. Applying pressure can cause discomfort or pain not only at the point of contact but also spreading to the leg.
- The pain is central to the buttocksPiriformis syndrome is usually felt in the middle of the buttock, as opposed to something like a proximal bulge of the hamstring, which usually causes non-radiating pain, located in the lower buttock, where the hamstrings connect to the pelvis.
The piriformis (red in the photo) is a small stabilizing muscle located deep in the gluteus maximus. – Photo: iStock / Eraxion
- Weak glutes are a significant contributor. If you sit constantly all day, whether at your desk or behind the wheel (in the epidemic I’ve seen many cases), the strength of your buttocks and hamstrings can decrease over time, due to atrophy and disuse.
- Pelvic misalignment due to other problems, such as a functional discrepancy in leg length or something as simple as incorrect sitting posture, may require the piriformis to work harder and contract or cramp.
- Ice and medication: You can apply ice and take anti-inflammatory medications (prescribed by your doctor) during acute phases when the area is sensitive to touch. But if the pain does not go away and lasts more than a few days, seek care from a sports medicine professional;
- Analgesic physiotherapy, acupuncture and shock waves: as primary pain relief measures. followed by muscle strengthening and rebalancing;
- It may be helpful to have your running form evaluated (biomechanically) and check for leg length differences and muscle strength imbalances;
- Orthotics may be advised if you have hyperpronation (inward movement of the foot when descending);
- In refractory cases, infiltrations and more invasive procedures may be indicated.
To prevent a recurrence of piriformis syndrome, you need to reduce the weakness of the piriformis muscle. Strength training is one of the best ways to do this.
Making sure your buttock muscles are strong is key to avoiding piriformis syndrome. We recommend exercises such as jump squats, weight squats, and plyometric exercises under the supervision of a physical trainer or physical therapist.
It’s also important to keep your pelvis in good shape. avoid running regularly on incline surfaces (or change the direction you run on the track to alternate sides), identify muscle imbalances that can cause you to favor one side of your body, and sit in a good posture (your head, shoulders, and hips should be aligned with your feet on the floor and distributed your weight equally on both hips).
To prevent muscle depression and atrophy, do not sit for long periods. If possible, alternate between sitting and standing while working; Otherwise, take hourly breaks. If you are traveling by plane, walk once every hour and, if possible, do the same when traveling by car.
And of course, you should always warm up well before the race. Dynamic exercises such as runs, one-legged jumps, and gentle stretches will wake up the glutes and help prevent piriformis syndrome.
* The information and opinions expressed in this text are the sole responsibility of the author, and do not necessarily correspond to the views of GE/I Mathematics.
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