Have you ever been in a relationship that caused you pain? One of those situations where the more you reflected on it, the more you tried to correct it, the more you contemplated the origin of its collapse or failure the worse you felt? Probably at some point we have all felt this chronic, persevering emotional pain that you thought might never disappear. The same can be true for physical pain. It seems when we have an injury, strain, or a particular region of our body that defaults to stress this area can "act out" often just by thinking about it. For many this pain develops, from the wise words of Forest Gump, in our buttocks!
The buttock pain often often originates in the muscle called the piriformis. The piriformis is a small muscle found deep in the hip, beneath the gluteus maximus that aides in externally rotating the hip joint (turning toes out). This muscle can be tight and overactive from sedentary lifestyles as well as from imbalanced training. Many of my friends are runners and cyclists which requires repetitive forward motion but neglects lateral and rotational elements. This causes tightness in the hip flexors and inner thighs and weakness in the abductors which are the glute medius and glute minimus. If the glutes are weak then this deep hip muscle, the piriformis, responds to work overtime and compensate for our weak glutes. As a result the piriformis becomes overactive, short and tight. Sometimes this problem is referred to as Piriformis Syndrome or a spasmodic piriformis.
In simple terms, there are two basic types of muscle: tonic and phasic. Tonic muscles are basically designed to work to maintain posture and much like outgoing, gregarious people tend to be "on" most of the time. For instance, a tonic muscle like the psoas, the major hip flexor, works constantly when we are standing. It is not unusual for the hip flexor to become short and tight and begin to dominate other muscles within its group, often called force couples. When the hip flexors begin to tighten the transvers abdominis (deep, low abs) tends to weaken in the partnership...they have lost their balanced relationship! Tonic muscles are easily facilitated, meaning they work even when they are not supposed to be working. In addition, as in the case of strengthening the glutes, even when the outgoing, affable piriformis has not been invited to the party, it will still try to crash and take over the evening or the exercise! If one person in a relationship starts to dominate, without giving the more quiet, passive, phasic participant a chance to respond the imbalance continues to increase. To shut down this rude imbalance we must stretch and relax the tightened muscle before we try to strengthen the weakened muscle.
I have seen it happen a lot in Pilates class. We arrive at the last minute anxious from work, kids, traffic and we want to get right to the exercises. We mentally, immediately send signals to grip, tighten, and stress. Thus your first exercise of the hundred you find yourself hanging by your tight hip flexors and tight low back while the weak abdominals are protruding and going along for the ride. As my wonderful Pilates mentor Dylann often says, "If you're not feeling it in your abs, you're missing the point!" Thus we will never get rid of a muscle imbalance if we do not stretch and relax the tightened muscles before strengthening the weakened muscles. In the case of Piriformis Syndrome, the sciatic nerve may be compressed or otherwise irritated by the tight, spastic piriformis causing pain, numbness and weakness that may extend from the buttocks all the way to the foot.
So what do we do to alleviate this chronic pain? In my case and experience it is best to proceed gently with the dominating piriformis. Because of its close association with the sciatic nerve, excessive stretching can irritate the nerve causing an increase in symptoms. Pilates will not cause Piriformis Syndrome, however poor technique and execution of the exercises can exacerbate it. The reason being, particularly in a group exercise class, we tend to "do" the exercise rather than truly to be "in" the exercise. Being "in" the exercise finds our core or phasic muscles awakening while simply "doing" the exercise often creates strain and discomfort as our tonic grippers try to join the party. Being "in" the exercise often tends to look like less work to the outside observer but when you as the participant connect from the inside-out you find the "work" earlier in the exercise. Working 1:1 with a trainer can minimize the tendency to stress and strain. Some strategies I have found useful:
1) Lay prone (on your stomach), legs less than hip width apart, turn the toes inward. Allow the low back and buttocks to relax...let the glutes spread...turn the low back off.
2) Run on flat surfaces. Hills are great for making the glutes work overtime but often this is exactly what triggers the piriformis to dominate. Sprinting is great for awakening the glutes but aim for longer strides and flatter surfaces. Small shuffling steps, as often seen in the sport of tennis, don't kick in the glutes and instead keep the piriformis overactive. Balance this movement pattern with "bounding," long strides to encourage range of motion of the hip joint.
3) Lie supine (on your back) and find a neutral pelvis. Imagine a clock sitting on the pelvis with 12:00 at the belly button, 6:00 near the tailbone, 3:00 left hip and 9:00 right hip. Roll a heavy imaginary marble between 12 and 6 . This motion is quite straightforward....pelvic rock. Now try laterally rolling the marble between 3:00 and 9:00. Try to focus on the abdominals doing the movement rather than the hip or low back. I have found this motion to be much more challenging in the case of a tight piriformis and low back. The tendency is to over-recruit and hike the hip toward the shoulder rather than glide the hip up and down. When you reach the right hip toward the ceiling the left hip presses down and vice versa. This is instrumental in firing the internal oblique that tends to weaken (it is passive and phasic) if we don't relax the piriformis and low back. If we can get the internal oblique leading us into rotation the pelvis will stay more level decreasing risk for back injury and giving us greater power in rotation from our deep core.
4) Foam rollers are beneficial tools for soft-tissue massage. I call it the "poor man's massage." Use caution however when using the roller on hyper sensitive spots. 20-30 seconds of a sustained hold or slow rolling should be adequate for the piriformis. If the pressure reproduces symptoms but the symptoms resolve after the massage then the roller may be helpful in reducing the muscle spasms and tightness. If however the symptoms of tingling, numbness weakness persist or are exacerbated then the region may be too inflamed to benefit at this point. In that case I have found ibuprofen, rest and ice works well to reduce the inflammation.
5) I had a client and fellow runner tell me recently that after running assessments, shoe orthotics, physical therapy consults she found the greatest resolution in her hip pain was a small change in her running technique...she widened her stance. Basically, she intentionally turned on her glute medius and minimus to balance the pull of the tight inner thighs or adductors. Rather than running on a balance beam give yourself some space and distance. Once you get the abductors firing the piriformis realizes it's efforts are not necessary to run on a flat surface...it can relax! Lateral motions with resistance bands or sidelying leg lifts and "clam-shell" exercises also help to strengthen this region.
The buttock pain often often originates in the muscle called the piriformis. The piriformis is a small muscle found deep in the hip, beneath the gluteus maximus that aides in externally rotating the hip joint (turning toes out). This muscle can be tight and overactive from sedentary lifestyles as well as from imbalanced training. Many of my friends are runners and cyclists which requires repetitive forward motion but neglects lateral and rotational elements. This causes tightness in the hip flexors and inner thighs and weakness in the abductors which are the glute medius and glute minimus. If the glutes are weak then this deep hip muscle, the piriformis, responds to work overtime and compensate for our weak glutes. As a result the piriformis becomes overactive, short and tight. Sometimes this problem is referred to as Piriformis Syndrome or a spasmodic piriformis.
In simple terms, there are two basic types of muscle: tonic and phasic. Tonic muscles are basically designed to work to maintain posture and much like outgoing, gregarious people tend to be "on" most of the time. For instance, a tonic muscle like the psoas, the major hip flexor, works constantly when we are standing. It is not unusual for the hip flexor to become short and tight and begin to dominate other muscles within its group, often called force couples. When the hip flexors begin to tighten the transvers abdominis (deep, low abs) tends to weaken in the partnership...they have lost their balanced relationship! Tonic muscles are easily facilitated, meaning they work even when they are not supposed to be working. In addition, as in the case of strengthening the glutes, even when the outgoing, affable piriformis has not been invited to the party, it will still try to crash and take over the evening or the exercise! If one person in a relationship starts to dominate, without giving the more quiet, passive, phasic participant a chance to respond the imbalance continues to increase. To shut down this rude imbalance we must stretch and relax the tightened muscle before we try to strengthen the weakened muscle.
I have seen it happen a lot in Pilates class. We arrive at the last minute anxious from work, kids, traffic and we want to get right to the exercises. We mentally, immediately send signals to grip, tighten, and stress. Thus your first exercise of the hundred you find yourself hanging by your tight hip flexors and tight low back while the weak abdominals are protruding and going along for the ride. As my wonderful Pilates mentor Dylann often says, "If you're not feeling it in your abs, you're missing the point!" Thus we will never get rid of a muscle imbalance if we do not stretch and relax the tightened muscles before strengthening the weakened muscles. In the case of Piriformis Syndrome, the sciatic nerve may be compressed or otherwise irritated by the tight, spastic piriformis causing pain, numbness and weakness that may extend from the buttocks all the way to the foot.
So what do we do to alleviate this chronic pain? In my case and experience it is best to proceed gently with the dominating piriformis. Because of its close association with the sciatic nerve, excessive stretching can irritate the nerve causing an increase in symptoms. Pilates will not cause Piriformis Syndrome, however poor technique and execution of the exercises can exacerbate it. The reason being, particularly in a group exercise class, we tend to "do" the exercise rather than truly to be "in" the exercise. Being "in" the exercise finds our core or phasic muscles awakening while simply "doing" the exercise often creates strain and discomfort as our tonic grippers try to join the party. Being "in" the exercise often tends to look like less work to the outside observer but when you as the participant connect from the inside-out you find the "work" earlier in the exercise. Working 1:1 with a trainer can minimize the tendency to stress and strain. Some strategies I have found useful:
1) Lay prone (on your stomach), legs less than hip width apart, turn the toes inward. Allow the low back and buttocks to relax...let the glutes spread...turn the low back off.
2) Run on flat surfaces. Hills are great for making the glutes work overtime but often this is exactly what triggers the piriformis to dominate. Sprinting is great for awakening the glutes but aim for longer strides and flatter surfaces. Small shuffling steps, as often seen in the sport of tennis, don't kick in the glutes and instead keep the piriformis overactive. Balance this movement pattern with "bounding," long strides to encourage range of motion of the hip joint.
3) Lie supine (on your back) and find a neutral pelvis. Imagine a clock sitting on the pelvis with 12:00 at the belly button, 6:00 near the tailbone, 3:00 left hip and 9:00 right hip. Roll a heavy imaginary marble between 12 and 6 . This motion is quite straightforward....pelvic rock. Now try laterally rolling the marble between 3:00 and 9:00. Try to focus on the abdominals doing the movement rather than the hip or low back. I have found this motion to be much more challenging in the case of a tight piriformis and low back. The tendency is to over-recruit and hike the hip toward the shoulder rather than glide the hip up and down. When you reach the right hip toward the ceiling the left hip presses down and vice versa. This is instrumental in firing the internal oblique that tends to weaken (it is passive and phasic) if we don't relax the piriformis and low back. If we can get the internal oblique leading us into rotation the pelvis will stay more level decreasing risk for back injury and giving us greater power in rotation from our deep core.
4) Foam rollers are beneficial tools for soft-tissue massage. I call it the "poor man's massage." Use caution however when using the roller on hyper sensitive spots. 20-30 seconds of a sustained hold or slow rolling should be adequate for the piriformis. If the pressure reproduces symptoms but the symptoms resolve after the massage then the roller may be helpful in reducing the muscle spasms and tightness. If however the symptoms of tingling, numbness weakness persist or are exacerbated then the region may be too inflamed to benefit at this point. In that case I have found ibuprofen, rest and ice works well to reduce the inflammation.
5) I had a client and fellow runner tell me recently that after running assessments, shoe orthotics, physical therapy consults she found the greatest resolution in her hip pain was a small change in her running technique...she widened her stance. Basically, she intentionally turned on her glute medius and minimus to balance the pull of the tight inner thighs or adductors. Rather than running on a balance beam give yourself some space and distance. Once you get the abductors firing the piriformis realizes it's efforts are not necessary to run on a flat surface...it can relax! Lateral motions with resistance bands or sidelying leg lifts and "clam-shell" exercises also help to strengthen this region.
6) The pigeon pose in yoga is frequently recommended to stretch the piriformis and relieve tightness in the hip. In addition, the figure 4 stretch is also designed to improve hip range of motion and stretch the piriformis.
7) Avoid surfing the web and writing lengthy blogs. Sciatic pain gets worse during activities like prolonged sitting that cause the piriformis muscle to press against the sciatic nerve.
I found the article below to be particularly helpful for a more thorough understanding of Piriformis Syndrome. As always, consult a physical therapist or doctor when you have pain. We are so fortunate in the Milwaukee area to have free sports injury assessments provided by Aurora Rehabilitation. This service can help identify the problem and often results in a simple home program of strengthening and stretching to relieve the muscle imbalance.
I have included an excerpt from Brent Anderson, PhD, P.T. and President of Polestar Pilates, and his assessment of sciatic pain and treatment.
http://pilates.about.com/od/pilatesforeverybody/a/Pilates-Exercises-Sciatica.htm
Protecting the Sciatic Nerve in Exercise
Anderson: Sciatica is a nerve injury. With a sciatic injury you want to be careful not to irritate the nerve more than it already is. Consider that the nervous system is continuous through your whole body from the crown of head to the toes and fingertips. Anywhere we move the body we are in essence moving the nervous system. So what you want is gentle movement without over-stretching the nerve.
I caution people about the idea of over-recruiting muscles. For example, if you are doing Pilates from a more classical perspective where you are tucking your bottom a little bit and squeezing the hip extensors (glutes), it could be inappropriate for somebody with sciatica. That would increase the pressure on the sciatic nerve and decrease the space around the nerve. You want to work in a more neutral spine. We often use the phrase: As much as necessary, as little as possible.
If the sciatica is coming from a herniated disc, then we have to take all the disc precautions. Disc precautions include not going into unnecessary flexion, and sometimes extension. Avoid overusing the buttocks and the piriformis muscles. Avoid putting the nerve on stretch. Avoid too much flexion [forward bending] in the lumbar spine which could irritate the nerve if there is a disc lesion. Again, work from a neutral spine, get things to move and relax, and get the core strong. You can do a lot of Pilates and still remove stressors on the sciatic nerve.
Thank you for reading!
I found the article below to be particularly helpful for a more thorough understanding of Piriformis Syndrome. As always, consult a physical therapist or doctor when you have pain. We are so fortunate in the Milwaukee area to have free sports injury assessments provided by Aurora Rehabilitation. This service can help identify the problem and often results in a simple home program of strengthening and stretching to relieve the muscle imbalance.
I have included an excerpt from Brent Anderson, PhD, P.T. and President of Polestar Pilates, and his assessment of sciatic pain and treatment.
http://pilates.about.com/od/pilatesforeverybody/a/Pilates-Exercises-Sciatica.htm
Protecting the Sciatic Nerve in Exercise
Anderson: Sciatica is a nerve injury. With a sciatic injury you want to be careful not to irritate the nerve more than it already is. Consider that the nervous system is continuous through your whole body from the crown of head to the toes and fingertips. Anywhere we move the body we are in essence moving the nervous system. So what you want is gentle movement without over-stretching the nerve.
I caution people about the idea of over-recruiting muscles. For example, if you are doing Pilates from a more classical perspective where you are tucking your bottom a little bit and squeezing the hip extensors (glutes), it could be inappropriate for somebody with sciatica. That would increase the pressure on the sciatic nerve and decrease the space around the nerve. You want to work in a more neutral spine. We often use the phrase: As much as necessary, as little as possible.
If the sciatica is coming from a herniated disc, then we have to take all the disc precautions. Disc precautions include not going into unnecessary flexion, and sometimes extension. Avoid overusing the buttocks and the piriformis muscles. Avoid putting the nerve on stretch. Avoid too much flexion [forward bending] in the lumbar spine which could irritate the nerve if there is a disc lesion. Again, work from a neutral spine, get things to move and relax, and get the core strong. You can do a lot of Pilates and still remove stressors on the sciatic nerve.
Thank you for reading!
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