Piriformis Syndrome

What is it?
Piriformis Syndrome is a misunderstood condition that is commonly misdiagnosed as lower back pain or sciatica. It is an irritation of nerve and/or muscle tissue due to overpronation of your foot or weakness of your hip/pelvic stabilizers which then allows for excessive leg and thigh internal rotation. This repetitive, excessive motion results in overuse of the muscles beneath your gluteal muscles causing a dull, deep, aching pain in your lower back, hips, glutes and sometimes the hamstring when running.

How did I get it?
There are two anatomical factors that contribute to the development of Piriformis Syndrome. Flat, hyper mobile feet cause overpronation which in turn causes excessive stretching and pulling of the Piriformis then causes micro tears where it passes through your gluteal region. Having one leg shorter than the other is also a known causative factor. There are anatomical short legs (the actual bone is shorter) and functional Short legs (muscles are tight making the bone appear shorter).

How is it treated?
There are many ways that Piriformis Syndrome can be treated. What is important is that the right treatment is provided for the right cause.

Custom Orthotics: The proper custom-made, biomechanical orthotic can address the underlying cause of your gluteal pain. By aligning an overpronated foot you reduce the excessive internal rotation of your leg and hip which reduces the strain on your Piriformis muscle. Abnormal joint position, overpronation or foot rigidity can be addressed and the biomechanics normalized. San Diego Running Institute orthotics are custom molded to your foot and designed with your specific body weight and activity in mind. The restoration of correct mechanical function takes the abnormal stress off the Piriformis and allows it to heal.

Stretching: Often we are told by runners that they have been stretching in an attempt to help Piriformis Syndrome. The stretching exercise is directed at lengthening the muscle. The problem is that the Piriformis is difficult to stretch effectively. When the proper stretches are employed for the proper frequency and duration only then will stretching help.

Strengthening: Certain muscles may be effectively strengthened but it is important to remember, it takes 4-6 weeks before muscles begin to strengthen in response to training. In addition anyone who has worked out in a gym can tell you that if you stop strengthening muscles they begin to shrink, lose strength and atrophy within two weeks! Since Piriformis Syndrome is already a strained and overworked muscle, then why in an attempt to strengthen it would you want to overwork it more?

Self Massage: The Foam Roller is a popular device used by runners to help massage out muscles. When using the foam roller properly with the right techniques it can be very effective in aiding the recovery of Piriformis Syndrome.

Rest: For many rest is not a realistic option, the race you are training for is looming. Our bodies are wonderful “machines,” if you rest long enough it will heal itself. How long? This is uncertain. Some patients report that they rested for months and even now can not run or walk up hill without pain. Some undergo painful back surgery and the pain still persists.

Drugs/Anti-Inflammatories: Drugs such as Ibuprofen are anti-inflammatory agents not healing agents. They actually impair the healing process and many times allow the runner to injure themselves further. Studies have shown that these medications are harmful to your body, can cause ulcers and strain your liver and kidneys.

Ice: Ice is often recommended and is another example of a non-healing modality. A runner often reports that they have been icing their gluteal region after running. Doing this may help with the pain and inflammation at the moment but how will it help to remove the abnormal stress that is occurring in your hip as a result of another variable? It won’t. What it will allow you to do is further damage your Piriformis eventually resulting in permanent damage. Addressing the underlying biomechanical cause prevents further damage from occurring and allows you to complete your race or goal injury-free.

Steroid Injections: Steroid injections are extremely painful and most doctors are reluctant to inject the Piriformis anyway. Recent research has shown that in the majority of patients diagnosed with Piriformis Syndrome the tissue is not inflamed but strained. During the initial injury, inflammation was present but inflammation only last up to seventy-two hours, then scarring takes place. Steroid injections have also been shown to increase the chance of rupture to tendons, muscles, and ligaments.

How long will it take to heal?
This depends on how long you have been suffering with Piriformis Syndrome. By correcting the cause of the injury with San Diego Running Institute orthotics and following the treatment regimen provided by Dr. Runco, you can expect 50-75% relief usually within two weeks. Ask your SDRI San Diego Running Institute expert about how to fix your hip/back/glute pain today!

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