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Piriformis and the pain it can be

Is your Piriformis really to blame for your pain?

Piriformis syndrome is painful, and definitely annoying, but I do feel sorry for the piriformis muscle being singled out so severely. 

Imagine you’re sitting on a bus that you have to get every day… and someone smells really bad. It’s making the entire bus stink. 

You have no way of knowing who the person is. Everyone looks relatively normal. So, your options are:

  •          Move around until the smell gets less intense, learning to live with a low-level smell
  •          Sit there and do nothing, hope the person that smells gets off (although their smell may linger for a while)
  •          Avoid the bus altogether

Or, the best, most long term, more effective option:

  •         Campaign to get everyone on the bus interested and aware of personally hygiene, making it the BEST SMELLING BUS THIS SIDE OF THE MILKY WAY!!!!!!

Once you get a good look at the whole bus, the person you thought was the smeller might not be OR there could have been more than one smeller!!! 😱

And that’s how you should deal with the Piriformis muscle! Buy it perfume!

… wait… I mean, treat it as one part of a whole system! Not just mask symptoms, try to ignore it, or avoid the things you like to do altogether.
Ok fine, the metaphor is a bit tenuous, but I have to at least try.

Basically, I want you to start thinking of your body as a unit; a series of interconnected pieces which don’t (can’t) work in isolation. You simply cannot blame one muscle for a bad stink in your body – even if it seems to be close to the site of pain.
This is often the case when people experience pain in the glutes / down the leg. Yes, the Piriformis might ultimately be the one compressing the sciatic nerve, but it isn’t doing it all by itself because it randomly got tight independently of the rest of your muscles. For a real cause, and therefore real solution, you must consider the entire bus (yeah that’s right, I’m sticking with the metaphor).

As we’re talking about the Piriformis, we’ll limit our roll call to the rear of the bus:

The Glute Group:
Gluteus Maximus, Gluteus Medius, Gluteus Minimus and Tensor Fasciae

The Iliopsoas Group:
Iliacus and Psoas Major

The Adductor Group:
The Adductor Brevis, Adductor Longus, Adductor Magnus, Pectineus and Gracilis

The Lateral Rotator Group:
The Externus, Internus Obturators, The Piriformis, Superior & Inferior Gemelli and Quadratus Femoris

The Hamstring Group:
The Semimembranosus, Semitendinosus and Biceps Femoris

The Quadriceps Group:
The Vastus intermedius, Vastus medialis, Vastus lateralis and Rectus femoris. We’ll also pop the Sartorius in here too.

(Is anyone else imagining like an 80’s style gangster dance battle with all these muscles in suits, clicking, just about to commence? Just me?! Okay fine)
Out of 20+ muscles, the piriformis is only ONE. And a small one at that.

Yes, maybe it may be part of a problem, but there are many things you can do to calm and prevent pain simply by making these muscles work together harmoniously… rather than digging a lacrosse ball into your bum. In a lot of cases, one muscle starts to cause pain because other muscles are tight, weak, or not being used in the right way.
Pain is just your body talking to you, and you should really listen when it does.

And while this information is all well and good, what are we meant to do when pain strikes? How do we treat it and prevent it from happening again?

In my complete hip conundrum blog I talk about the importance of moving your hips through all elements of extension, flexion, lateral movement and rotation, both internally and externally. Most people with piriformis syndrome only latch onto two things: external rotation (usually using the pigeon stretch) and glute med activation through abduction (usually with clamshells) and that’s it!

Using these exercises, more often than not, you will get temporary relief. But it is just that – temporary. It’s like constantly banging your head on the same doorframe every day, so you put padding on your head. Yes, it’ll help, but the real solution would be to learn how to duck when you walk under it (better than the bus analogy? No? Ok I’ll stop now..).

By only addressing these two movements and ignoring the rest you’ll just fall into the cycle of treating symptoms, going back to the same movement you were doing before, triggering another flare up, treating symptoms, etc. I’ve met people stuck like this for years! 

So much emphasis goes towards treating symptoms, no one ever stops to address the cause: the movement (or lack of).

Luckily, there’s one exercise that hits hip movement so completely that it should feature if every single one of your lower body warmups.

All you do is: 
  • Stand on one leg,
  • Lift your knee,
  • Open your hip,
  • Internally rotate it,
  • Extend your hip
  • Then reverse it so that you externally rotate too
… Sounds a bit weird when you write it down, so here’s a video:

Doing this drill a few times daily (e.g. while the kettle’s boiling) will dramatically enhance your overall hip mobility & function. The best thing about it is that everyone can do it, you might not get very high or get much rotation at first, but that’s ok! Using the ideas from the Simplistic Mobility Method, you simply want to get better at it over time and bring both sides into balance - you will then reap the benefits, even if it is a big challenge for you at first.

If your hips feel like they are grinding or if you experience sharp pain, then reduce your range and reps. You’ll know the difference between good pain and bad pain.

If you are currently experiencing hip/glute/back pain (or it’s a regular occurrence), I’d recommend doing this 3-5 times per side first thing in the morning, again before training, after training and finally last thing at night before bed. However, don’t let this put you off – even just doing the morning set is better than not doing it at all! Over time as you feel the drill getting easier and your hips getting more mobile, you won’t need to do it every day. The good movement will become part of your normal hip function.

I’ve found dedicating time to complete movement drills like Hip CARs is way more effective than doing long ass programs with high rep sets of resistance band directions, pigeon stretches and clamshell exercises. If you just move your hip how your hip wants to move, your body won’t develop erroneous tightness or weakness.
Unfortunately, so often you see the advice given is to just rest – to sit and get weaker, waiting for the pain to go away. That won’t ever happen. You might become more used to it, it might turn into a constant dull ache rather than a sharp pain, but it won’t just go away by itself if your body doesn’t move well. Getting your muscles to work better might be a little painful or challenging right now, but over time, building strength will get rid of your body’s need to be on the defensive.
When I had a serious back injury, I used to wake myself up every few hours in the night to actively move my hips, because I found the more I did, the less intense my pain became. Yes, it was truly painful at the start but overtime the movement began to make a real change – it became normal for me to not be in pain. Mentally it’s probably one of the hardest experiences I’ve ever had. That was in my mid-twenties, now in my 30’s I’m more mobile and feel better than I ever had in my entire life.
You must take your own body under your own management, not just blame external factors or use a diagnosis like a crutch.
Even though today we’re talking about Piriformis, hopefully you can see that this concept applies to every injury/pain/niggle you have. Your body is made up of complex systems that work in multiple ways, making sure to understand those is the key. Blaming one thing is rarely helpful, instead focus on something you can control: HOW YOU MOVE.

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