The Piriformis Muscle
Do you have pain in your buttock? Low Back Pain? Your Piriformis muscle may be the culprit.
Your Piriformis muscle is a small, deep, buttock muscle. Many of us have a tight piriformis muscle which can cause pain issues in your gluteal/buttock region as it passes right over your sciatic nerve. When your piriformis becomes tight it can compress your sciatic nerve and start creating all kinds of issues. Many of us sit at computer desks for many hours on most days. This essentially means that you sit on your sciatic nerve, gluteal muscles and piriformis muscle every day. If your nerve is calm and not irritated, that feels ok but if it is stirred up from a tight piriformis muscle your gluteal and buttock region can become extremely painful.
Symptoms of piriformis muscle syndrome
If your piriformis is irritated you may feel pain in your buttock region, pain down your leg, numbness and tingling traveling into your leg and foot, pain on sitting, standing and squatting down.
Our therapists determine if your sciatic nerve pain is originating from your piriformis muscle or from your spine. If your piriformis muscle is the culprit, you will feel like your pain originates in your buttock regions, not your spine. Another distinction between the two origins of your pain is that with a tight piriformis muscle you usually won’t have muscle weakness in the affected lower limb side whereas you if your pain originates from your spine you may get symptoms down the affected limb side.
Some men have had a sciatic nerve irritation caused or aggravated by sitting on their wallet in their back pocket. “Note– Never sit on your wallet” Piriformis muscle pain doesn’t have to be isolated to the muscle itself. You can have SIJ (sacroiliac joint) pain and wider spread gluteal muscle pain too.
Piriformis Muscle Treatment
Your physiotherapist will first identify the cause of your pain and symptoms. This may include a biomechanical assessment of certain movements involving your lower limbs and pelvis. We will then target hands-on treatment to release your tight Piriformis muscle. We will also assess and treat any tightness or symptoms around your other gluteal muscles and lower back if they are contributing to your pain issues. Treatment techniques that may be helpful include IMS Dry needling and Shockwave Therapy.
What is it?
Hip bursitis is a fairly common condition, and involves inflammation of the bursae around the hip joint. The bursa are small fluid-filled sacs, and are present to reduce the friction between tendons and the bone and ensure that everything is able to move smoothly. However they can become inflamed and painful with overuse, trauma and incorrect muscle use or weakness. There are many, however the bursitis we most commonly see is the Trochanteric Hip Bursitis. The trochanteric bursa cushions the outside of the hip against the gluteal muscles (especially gluteal maximus) and the Iliotibial Band (ITB). It is the most commonly injured as these are muscles very commonly used and therefore give the bursa a lot of work!
What are the causes?
As mentioned earlier, there are a few key causes of bursitis:
Overuse (or muscles around the area) and repetitive stress – eg. With frequent running, jumping, squatting
Trauma – e.g. a fall directly onto the outside of the hip (where there isn’t much padding)
Incorrect muscle use and muscle patterns, causing altered biomechanics of the lower limb – this can also include weakness of the core muscles
Weakness in the deeper gluteal muscles (Gluteus Medius and Minimus), and tightness in the Iliotibial Band (a band that runs down the outside of the thigh). As a result of the weakness in the deeper gluteal muscles, the gluteus maximus (biggest gluteal muscle) is forced to work more than it should, and so places more pressure in the bursa, which over time causes irritation and inflammation, and pain.
Interestingly, there are recent studies to suggest that hip bursitis does not often occur on its own, and that there is commonly some element of Gluteal pathology – especially tendinopathy of the Gluteus Medius (the main stabilising glute muscle). This may be the causative reason for weakness in this area, however it is not known yet as to which comes first – the bursitis, or the tendinopathy.
What are the signs and symptoms?
Commonly, sufferers will have a sharp pain on the side of their hip (worst directly over the bony outer part of the hip, and often tender to touch). This pain may extend down towards the knee, or even upwards towards the lower back. In fact, as the lower back, hip and knee are so closely linked, it is not uncommon to see problems in all areas along with hip bursitis, including pain, stiffness and restricted movement of these areas.
Sometimes there will also be a visible swelling over the outside of the hip, or even just the feeling of swelling.
There is often difficulty lying down on the side (due to the direct pressure), or even on the unaffected side (due to the stretch). This may cause trouble with sleeping.
Walking is also aggravating, especially first thing in the morning, or after a busy day. A limp may be present. There may also be pain with sitting cross-legged, or rising out of a chair after sitting for a while.
What are the treatment options?
There are several options when it comes to improving pain and keeping the bursitis away.
Physiotherapy – this is highly successful for treating trochanteric bursitis. Initially, treatment will involve techniques to reduce the pain and swelling (eg. Ultrasound, ice, gentle massage, acupuncture, taping). Following this, your physiotherapist will aim to return full range of motion of the affected hip (and also lower back, knee if affected), correct any muscle imbalances around the hip and restore full function of the stabilising hip and core muscles, and work to eliminate any excess tightness that may be contributing to the problem. Due to the nature of trochanteric bursitis, and the danger of it recurring, a long-term program may be required.
Ice – due to the inflammatory nature of trochanteric bursitis. Ice for 15 minutes at least once per day, and also after aggravating activities
Cortisone Injections – this involves injecting a corticosteroid (anti-inflammatory) along with a local anaesthetic into the bursa in order to settle the inflammation and stimulate healing. A guided injection (usually via ultrasound) is preferred as it will assist with needle placement. Cortisone injections can be very helpful, however repeat injections have been shown affect tendon health detrimentally – it would be wise to discuss side effects with your GP.
What can I do to help?
If sleeping is a problem, it can be improved in the short term with a pillow between the legs, to level out the hips when laying on the unaffected side.
Driving can be aided by sitting slightly higher (so your hips are not as bent). This may involve lifting the seat (in newer cars), or simply sitting on a pillow. Do make sure you can still reach the pedals & drive safely however!
There are several helpful exercises that will assist in recovery and strengthening. These will ideally be performed after the initial healing phase is completed (that is, when the pain and swelling have diminished). These exercises should be performed within your comfort levels, without causing pain.
Seated gluteal stretch
Sit on edge of chair, cross one foot over the other knee, SIT UP TALL, and lean forwards
There should be a comfortable stretch in the buttocks, or even down the side/back of the leg
Hold 20 seconds, repeat 3 times each leg
Lying gluteal stretch (Single knee to chest)
Lying on your back, slowly bring one knee up towards the opposite shoulder as far as comfortable.
You should feel a gentle, comfortable stretch in your lower back, or buttocks
Hold for 10 seconds, repeat 5 times
Start on your back with knees bent (no pillow is best)
Slowly roll pelvis/hips off floor, followed by one vertebrae at a time
Aim to lower down, one vertebrae at a time
Try 10 repetitions
Prone Knee Bend
Start by lying on your tummy, feel the front of your hips on the floor.
Bend one knee to 90 degrees and then slowly lift thigh off floor (the front of your hips should stay firmly on the floor)
Once lifted, straighten your leg in the air, then slowly lower your straight leg
Repeat 10 times each leg
Start lying on your side with knees bent slightly. Make sure your shoulders, hips and feet are in a straight line.
Keep your feet together, back still and gently open your knees apart.
Repeat 10+ times on each leg, or until fatigue
* This exercise is especially helpful as it targets the Gluteus Medius
As above, make sure your body is aligned well.
This time, lift your feet up, keep your lower knee on the floor and lift your knees apart.
Repeat 10+ times on each leg, or until fatigue
Sports Injury Prevention for Baby Boomers
While there may be no single fountain of youth, you can slow down the aging process by staying physically active. Regular exercise enhances muscle and joint function, keeps bones strong, and decreases your risk of heart attack and stroke.
Here are some tips developed by the American Orthopaedic Society for Sports Medicine and American Academy of Orthopaedic Surgeons that can help you exercise safely.
Always take time to warm up and stretch before physical activity. Research studies have shown that cold muscles are more prone to injury. Warm up with jumping jacks, stationary cycling or running or walking in place for 3 to 5 minutes. Then slowly and gently stretch, holding each stretch for 30 seconds. Do not stretch cold muscles.
Just like warming up, it is important to cool down. Gentle stretching after physical activity is very important to prepare your body for the next time you exercise. It will make recovery from exercise easier.
Consistent Exercise Program
Avoid the “weekend warrior” syndrome. Compressing your exercise into 2 days sets you up for trouble and does not increase your fitness level. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks. Remember that moderate physical activity can include walking the dog, working in the garden, playing with the kids and taking the stairs instead of an elevator. Parking on the far end of a parking lot will increase the distance you have to walk between your car and your destination.
Take sports lessons. Whether you are a beginner or have been playing a sport for a long time, lessons are a worthwhile investment. Proper form and instruction reduce the chance of developing an “overuse” injury like tendinitis or a stress fracture.
Lessons at varying levels of play for many sports are offered by local park districts and athletic clubs.
Invest in good equipment. Select the proper shoes for your sport and use them only for that sport. When the treads start to look worn or the shoes are no longer as supportive, it is time to replace them.
Listen to Your Body
As you age, you may find that you are not as flexible as you once were or that you cannot tolerate the same types of activities that you did years ago. While no one is happy about getting older, you will be able to prevent injury by modifying your activity to accommodate your body’s needs.
Use the Ten Percent Rule
When changing your activity level, increase it in increments of no more than 10% per week. If you normally walk 2 miles a day and want to increase your fitness level, do not try to suddenly walk 4 miles. Slowly build up to more miles each week until you reach your higher goal. When strength training, use the 10% rule as your guide and increase your weights gradually.
Develop a balanced fitness program that incorporates cardiovascular exercise, strength training, and flexibility. In addition to providing a total body workout, a balanced program will keep you from getting bored and lessen your chances of injury.
Add activities and new exercises cautiously. Whether you have been sedentary or are in good physical shape, do not try to take on too many activities at one time. It is best to add no more than one or two new activities per workout.
If you have or have had a sports or orthopaedic injury like tendinitis, arthritis, a stress fracture, or low back pain, consult your Physiotherapist who can help design a fitness routine to promote wellness and minimize the chance of injury.
So we all know that feeling that we get after exercise – we feel generally happier, less stressed, less anxious and also sleep better. Exercise produces a rush of happy hormones we also know as endorphins. So what are these endorphins and why do they make us feel happy?
Endorphins are chemicals that are produced in our brains in response to stress or pain. Running, doing a hard workout, playing a sport or any exercise at all that increases our bodies stress response has the ability to make our brains release endorphins. The endorphins have the ability to travel through our neural networks as a neurotransmitter. One thing we do know about endorphins is that they make us feel really good. So how does this work then?
A part of the brain called the hypothalamus sends a signal to increase endorphin uptake through our bodies neural network when we subject ourselves to certain activities like exercise, sex, eat certain foods or experience pain. The endorphins then attach themselves to specific receptor sites within our neural network – these are called opioid receptors. These special receptors have the ability to block out pain signals and also to increase that euphoric happy feeling we get after we exercise. It is the same receptors that are locked onto when we take pain relief in the form of opiates.
Once we achieve a positive result in something we do, either though through exercise or simple activities like sticking to a plan you’ve made, your brain will also release another happy hormone called dopamine. Dopamine is responsible for us feeling addicted to pleasure seeking behaviors. By setting regular and achievable exercise goals that you reach it is highly possible to make exercise the trigger for your brain to release dopamine.
Serotonin is another one of our brains happy hormones that act as a natural anti-depressant. When we exercise serotonin levels in our brain increase and so does your level of happiness.
I know all these terms may seem confusing but there is another very important happy hormone called oxytocin. Oxytocin is released when we feel loved, cared for and connected to others. Your brain will also release oxytocin when you are kind to others.
So no matter how hard it may seem to get yourself moving on some days, putting one foot in front of the other and pushing yourself to move and exercise is not only good for your muscles and joints but also stimulates your brain. You’ll produce your very own happy hormones, reduces your stress levels and have you wanting to repeat it all over again next time. Give your fellow team mates, friends and family an encouraging kind words regularly as well- it will not only help them feel happy but will increase your happiness as well.