Hi guys. I injured my right piriformis whilst doing squats about 18 months ago. I received physiotherapy for it, which helped, but every so often, the muscle seems to spasm and becomes inflamed. I also do a lot of gymnastics and martial arts, so it’s more noticeable after I’ve done a set of backflips or bridges. I thought that by doing more hamstring work, I’d be able to correct this, but I’m starting to suspect that it might be the surrounding muscles might be the weaker ones. Any insight would be appreciated.
I believe the muscle you are talking about is the Piriformis, not pinaformis. Not to be picky at all, just so you know.
I frequently suffer from a tight piriformis, and have pulled it a couple times. Lying flat on my back with my feet flat on the floor, and alternating heat and cold help a little.
Stretching frequently also helps; in fact, stretching nightly is the best way for me to ensure that I’m not going to be dangerously tight the next morning. You said you had some physiotherapy, so I assume you were shown some good stretches for the piriformis (and for the hip flexors?). My advice is to spend a few minutes daily–just a few–stretching that part of the body. Maybe, like with sprained ankles, you are now more prone to injuring that area; therefore, you need to be proactive about it.
Good luck.
Tim
I think you mean the piriformis. By doing more hamstring work maybe productive or counter productive depending on your hamstring to quad ratio of your leg. Most people tend to be more quad dominant if this is the case for you then you are on the right track. I didn’t hear you say anything about stretching. As a martial artist I am sure you do plenty of stretching but you may need to add a few more in there to help out your pelvic area. Most likely you have a lot of scar tissue in that muscle that is blocking the flow of blood. An intense massage technique known as ART (active release technique) will definitly help reduce inflamation. It needs to be done to different areas of your glutes and IT Band. Check your flexibility of your hip flexors also. They maybe too tight and also will need to be stretched. Stretch after every leg work out. Good luck
I don’t remember details of how it started, but I had piriformis trouble a few months back. A chiropractor adjusted my sacroiliac joint (probably the opposite one, but don’t quote me on this) and haven’t had any trouble since. So you might visit a chiropractor if you know a good one.
Scott
You might look into some further soft-tissue therapy such as ART and seek some individualized strengthing/stretching recomendations from a knowledgeable professional.
If it continues to bother you it might be wise to consult with a specialist.
Hi and thanks for the reply. Sorry about the mistype- I didn’t bother checking before submitting! I do stretch 5-6 times a week in addtion to what I do at gymnastics; however, I don’t normally include glute/hip flexor stretching as I was under the impression they would be involved when stretching for front and side splits. Does anyone know what the the ideal strength ratio should be for hamstrings to quads? It was suggested that it might also be a contributing factor.
Those ratios are ridiculously outdated. They’re based on numbers from machines with no functional carryover to any athletic movements, and don’t take into account the effects of limb length, tendon insertion points, or fiber types. Don’t worry about the ideal ratios; if something is out of whack, your body will tell you with pain and postural abnormalities.
[quote]I don’t remember details of how it started, but I had piriformis trouble a few months back. A chiropractor adjusted my sacroiliac joint (probably the opposite one, but don’t quote me on this) and haven’t had any trouble since. So you might visit a chiropractor if you know a good one.
[/quote]
The piriformis attaches to both the head of femur and the sacrum. If it’s tight, one of those will be pulled out of whack. An SI adjustment can make a big difference in the short-term, but you definitely want to loosen it up to prevent chronic problems. Mike and I will cover this in the rest of our “Neanderthal No More” series, but here’s a stretch for you in the meantime.
check out the massage ball. these things are absolutely amazing. they can help with some of the issues eric cressey listed in his neanderthal series, such as Plantar Fasciitis, IT Band Syndrome, Piraformis Syndrome, even low back pain and shin splints.
The piriformis is one of several muscles located deep in your glute, they are collectively known as lateral rotators of the hip (i.e if your leg is straight they will rotate the leg so your toes will point out). It is common for this area to become irritated. Often if there is signficant shortening of these muscles, you will walk with a toe-out gait. The chiropractic adjustment for the SI joint would help since altered joint mechanics can lead to abnormal strain being placed on the muscles, or abnormal muscle recruitment patterns. Myofascial (Active) release can help to stretch this region and break up any adhesions that could be contributing to the problem. If you use a massage ball, be careful about applying to much pressure to the area, as the sciatic nerve is in very close proximity to piriformis, and you could inflame it if you get too much direct pressure on the region. The stretch that Eric posted should help, I do a similar variation to try to hit the area from a couple different angles. Start off by doing the one he posted as that position approximates the squatting position. Then lay on your back and get in a sit up starting position, next rotate the leg as in the other picture, hooking one hand around the ankle to keep the leg rotated, and then hook the other hand over the knee and slowly pull the knee to your shoulder, after holding for 15-20sec, pull the leg toward your opposite shoulder and hold. When icing the area, you do not want to lay flat on an ice pack or lay face down with ice on the area, as the muscle is in a shortened position, instead try lying on your side with your leg flexed to 90 and then letting the leg drop toward to ground. You can put a pillow under the leg to take some pressure off the area if it feels like it to pulling to much. Ice for 15-20 minutes or until it feels numb. Do this several times/day. The question is, why does this area keep flaring up? Could be flex or stength imbalance side-side. Pelvic obliquity,leg length issues and foot biomechanics (pronation) should also be looked at. In addition, you may want to try doing single leg exercises such as lunges, step-ups, split-squats, etc. for a while to address any muscle imbalance, side-side. Some hip ab/ad-duction exercises should also be considered.
Try to find a chiro. in your area that specializes in sports injuries. They should be able to do therapy, myof rel, stretching, adjustment, rehab,etc. If you don’t know one, be sure to ask if they do all those types of treatments before you schedule an appt.
check out dr backman’s piriformis-muscle-stretch
I should also note that in 10% of the population, the sciatic nerve runs directly through the piriformis muscle (this is “true” piriformis syndrome). As such, these individuals are highly susceptible to sciatica when the piriformis is irritated/inflamed. Treatment is pretty much just symptomatic; it’s an anatomic abnormality with which you’re stuck.
I injured my piriformis and it took about two months of weekly massage to rectify the problem. Keep after it, it is not the sort of injury that can be ignored, as I don’t think it will go away on its own.
with the piriformis being a lateral rotator, and being an abductor at 90 degrees hip flexion, wouldn’t the adduction machine along with stretching help?
Stretching the affected muscle is something that I too often recommend, but with all the talk of how static stretching can weaken a muscle, I did some reading, took a course and can add another peice to the puzzle:
Consider the strength of the muscle in relation to other muscles that oppose external and internal rotation.
You could just try stretching your adductors to by sitting with the soles of the feet touching (and legs) bent, pressing the knees to the floor.
Another thing that you may want to consider is in what position do you tend to aggrevate the injury? Is it in a position of flexion or extension of the hip. The piriformis is an external rotator in an extended hip and an internal rotator in a flexed hip.
Something that may help is to sit and try and cross the injured leg over the other without using your hands to help or changing spinal or pelvic position. If there’s an imbalance, stretching the inhibiting muscles and continuing to strengthen the movement may also help.
Often tightness can be a symptom of weakness, not strength, especially with the erratic muscles about the hips.
Hope this helps and good luck