How to Get Rid of That Pain in Your Butt

By

Dr. Clay Hyght

DC, CSCS, CISSN

No, of course this is not an article about how to knock off your nagging wife or lazy husband. Instead, this article is about Piriformis syndrome: What is it? What causes it? How can you get rid of it? ust !cause most "eo"le ha#e ne#er heard of it doesn$t mean that this im"ortant "roblem isn$t affecting thousands of athletes e#ery single day. What i it! Piriformis syndrome is what we nerdy doctor ty"es call an entra"ment neuro"athy. In laymen$s terms, that means that a muscle dee" in the gluteal area %the "iriformis& is tight and'or inflamed which decreases the conduction or flow of the largest ner#e in the body %the sciatic&, which lies nearby. Pain can be in or around the "iriformis muscle, or along the distribution of the sciatic ner#e, generally in the back of the thigh, but "ossibly all the way down into the foot. (hooting "ain along the sciatic ner#e distribution is called sciatica. %Please note, that$s "ronounced sigh)*+)ika, don$t re#ealed to e#eryone within earshot that you ha#e no idea what you$re talking about and say -my ski)atik ner#e....&. Pain can also be referred u" into the lower back region. /nfortunately, this condition is often misdiagnosed as a disk herniation. 0octors tend to assume that sciatica 1 disk herniation. 2ff you go to get an 34I. (ince 567 of the adult "o"ulation has a disk herniation, they may find one. Now it$s off to surgery to cut that thing out. (adly, this does ha""en, and the condition may resol#e for a little while due to the rest after the surgery. 8ut it$ll be back. +he moral of this story is to get a second and third o"inion, and try to see someone who has e9tensi#e knowledge in conser#ati#e care and has no #ested interest in surgery. +o get an idea whether or not you may ha#e "iriformis syndrome, in addition to the "ain "atterns mentioned abo#e, you would :uite "ossibly ha#e "ain walking u"hill or u" stairs, along with "ain after "rolonged "eriods of sitting. +he stretches mentioned below may also e9acerbate the sym"toms. In many cases, contraction against resistance would also make the sym"toms worse. "nato#y $ Where% It "t! ;et$s take a ste" back and look at the anatomy of the "iriformis muscle. +he origin of the muscle is the anterior "ortion of the sacrum. <or the record, the sacrum is a large wedge) sha"ed bone that forms the base of the s"ine and lies between the two hi" %co9al& bones, forming the "el#ic girdle. +he "iriformis muscle then goes through the greater sciatic

foramen before it blends into its tendon and inserts onto the to" of the greater trochanter. =ou can feel the greater trochanter a few inches below your belt line %unless you$re a member of the -hi" ho" generation and go around rockin$ the ultra baggy "ants style& on the sides of your u""er thigh. 3any lay "eo"le often call the greater trochanters hi" bones. +y"ically, the sciatic ner#e e9its the greater sciatic foramen behind the "iriformis muscle. 8ut, as you well know, there are e9ce"tions to e#ery rule. In about >57 of the "o"ulation, the sciatic ner#e %es"ecially the common "eroneal branch of it& will go through the "iriformis muscle. If you are a forward thinker and thought that those within that >57 would be much more likely to ha#e "iriformis syndrome, gi#e yourself a gold star, genius, you are correct. 4egardless, an affected %tight and'or inflamed& "iriformis can e#entually lead to sciatica. Bio#e&hani& $ What% It Do! +he function of the "iriformis is to abduct and laterally or e9ternally rotate the femur. *bduction of the thigh means to mo#e the leg out to the side away from the body. ;ateral %a.k.a. e9ternal& rotation means to rotate the hi" such that your toes are "ointed out to the side instead of forward. 'tiology $ Who Get It! *ccording to most references, women tend to get "iriformis syndrome about si9 times more often than men. *lthough most "eo"le don$t "ro"ose a mechanism, I$m fairly certain than it has to do with the anatomic #ariation of the female "el#is as com"ared to that of a male. ;ikewise, women tend to ha#e a greater ? angle, which means that their legs angle in more, thus seemingly "utting the "iriformis is a slightly stretched "osition. 2n a somewhat similar note, some ha#e suggested that coitus %a.k.a. -knocking boots.& can aggra#ate "iriformis syndrome due to the abduction and e9ternal rotation of the hi" @oints by the female in the standard -missionary. "osition. Hmm....? +herefore, in women who suffer from "iriformis syndrome, maybe co"ulating in the "rone or canine "ositions would be better choices to a#oid e9acerbating the condition. *s for athletes, it seems that runners, cyclists, and weightlifters most commonly ac:uire the condition. *nother hazard is sitting for "rolonged "eriods with the hi"s abducted and e9ternally rotated. +his can occur at one$s desk, but it is also #ery common while dri#ing for long "eriods of time. Treat#ent $ How to Go (Bout )i*in% It.

In many cases, es"ecially if they are not chronic in nature, stretching alone %I don$t mean you ha#e to be by yourself when you stretch& will often re#erse the sym"toms. +he goal of stretching is to return the "iriformis back to its normal resting length and tension. +here are a number of good "iriformis stretches. I$ll describe a cou"le that you can do without the aid of a "artner, although, as with other things in life, it$s often better to ha#e a "artner. 3y fa#orite "iriformis self)stretch is as follows: sit on the edge of a chair, couch, bed, etc. that "uts your hi" at about A6 degrees of fle9ion when your feet are on the floor. +o stretch the right "iriformis, "lace your right ankle on the left side of your left knee. Bras" the right side of your right knee with your left hand and reinforce with your right hand. Now "ull your right knee toward your left shoulder. *nother common stretch is to lie on your back with your knees and hi"s fle9ed and feet on the ground. <rom that "oint you essentially finish the stretch in the same manner as the one abo#e ) cross your leg and "ull your knee to your o""osite shoulder. Brief Tangent I don$t want to confuse you, but I must address another stretch that many feel does not stretch the "iriformis. It, howe#er, is su""orted in at least one "iece of literature. I.*. Ca"and@i states that the function of the "iriformis in#erts abo#e D6 degrees of hi" fle9ion. +his means that the "iriformis would, at that "oint, be a medial or internal rotator of the hi" while still maintaining its function as an abductor. If this is the case, then the final ste" of the abo#e stretches would essentially be incorrect. Instead of "ulling the knee toward the contralateral shoulder, one would need to "ush the knee away from the body to e9ternally rotate the hi" and stretch the "iriformis. +hat ha""ens to be a stretch that some "eo"le "rescribe as a "iriformis stretch. *lthough Ca"and@i$s work is incredible and recognized around the world, I$m going to humbly disagree. I, along with many other doctors, ha#e successfully treated "iriformis "roblems with stretches that fle9 and internally rotate the hi". Who knows, maybe I$m @ust really lucky, or maybe it was the *cti#e 4elease and "eriodic ultrasound that cured the "iriformis "roblems. I$ll maintain an o"en mind. 2ne must kee" in mind that Ca"and@i also says that the gastrocnemius does not aid in knee fle9ion to any significant degree. I #ehemently disagree with that. +ry doing lying leg curls with your foot dorsifle9ed %toes "ulled toward your shin, which lengthens the calf& and with your feet "lantarfle9ed %toes "ointed away, which shortens the calf&. I belie#e you$ll notice the same thing e#eryone else does, you can do less with your feet "lantarfle9ed because the gastrocs are shortened and can$t hel" as much with the knee fle9ion. If Ca"and@i were correct, then it wouldn$t matter either way.

3y "oint is not to downgrade Ca"and@i %who is :uite a biomechanical genius&, but to "oint out that no one knows e#erything. (o kee" an o"en mind. 'nd Tangent In general, hold the stretch "osition for fi#e to ten seconds initially, but work your way u" to holding it for one minute. 4e"eat at least three times "er day. If your "iriformis is in acute s"asm, I recommend stretching it once "er waking hour. 8e careful not to o#erdo the intensity of any stretch. 0oing so can do more harm than good by actually tearing tight muscle fibers. 4emember, when trying to "ermanently increase the length and 423 of a muscle by causing "lastic deformation, the ideal method is to a""ly low intensity but long duration stretches ) sorry High Intensity fanatics. 8esides stretching, there a cou"le of thera"ies that can greatly assist in treating "iriformis syndrome. /ltrasound can be used to "ro#ide an anti)inflammatory effect to a swollen "iriformis. It can also be used to essentially heat u" scar tissue that may ha#e formed within the muscle. * :ualified doctor or thera"ist would administer the ultrasound in an a""ro"riate manner. It$s not a treatment you should do yourself, as it could cause some fairly serious damage if used im"ro"erly. =ou don$t @ust turn it on and rub the ultrasound head o#er your gel) coated butt. 0ee" tissue massage can also be in#aluable in treating "iriformis syndrome. In my o"inion, the best and most s"ecific techni:ue is *cti#e 4elease. It$s a #ery "recise techni:ue that$s used to remo#e any adhesions that might ha#e formed within the "iriformis or between it and the sciatic ner#e. * generic dee" tissue massage can hel" if the clinician knows the anatomy of the dee" gluteal muscles #ery well. *s much as you may en@oy it, ha#ing a bu9om blonde massage thera"ist with little to no knowledge of anatomy sim"ly rub your butt isn$t going to do a whole lot for alle#iating your "iriformis syndrome. Con&lu ion I ho"e you feel enlightened now that you ha#e a basic understanding of "iriformis syndrome. *s some old guy once said, -an ounce of "re#ention is worth a "ound of cure.. If he were still around, he$d tell you to stretch your "iriformis %and other muscles& on a regular basis. 0on$t wait until you feel "ain. !+ill ne9t time ) I$m 0r. <eelgood, I mean 0r Elay. ))

*long with being a 0octor of Ehiro"ractic and Eertified (trength and Eonditioning ("ecialist, 0r. Elay Hyght is also a national)le#el bodybuilding com"etitor and fitness model that writes for #arious fitness "ublications. <or more great health and fitness information, log on to www.0rElay.com. F G66H . Elayton Hyght. *ll 4ights 4eser#ed.