Pain in the Butt? - Piriformis dysfunction for amateur/professional athletes.

Piriformis dysfunction for amateur/professional athletes.

This week Mr Frazer Donaldson gives us the lowdown on an all too common problem, piriformis dysfunction.

Frazer's primary interests within Foot Medic is biomechanics and sports injury. His passion for both functional anatomy and problem solving  make him an outstanding sports podiatrist.
 

Read on to find out what exactly the condition is and how you can prevent and treat it.

The piriformis is a flat, pyramid-shaped muscle that lies parallel to the gluteus medius muscle's back margin and underneath the gluteus maximus muscle in the hip area. The piriformis laterally rotates the femur with hip extension and abducts the femur with hip flexion allowing body weight to shift to the other side when walking in single limb support. However when the hip is fully flexed to 90 degrees or more piriformis does the opposite function and internally rotates the femur. And the function during walking is primarily to externally rotate the leg at late stance to allow the foot to ‘lock’ making it a rigid lever.  

So basically it is an important muscle in how your hip moves when you walk and move!

In terms of activity, ie; Running, the piriformis plays an important role in the various rotations of the hip and can commonly be injured or through weakness/tightness to the area cause knock on effects elsewhere ie over pronation due to a poor ability to externally rotate at late stance phase (weakness) or supination of the foot through stance phase as thee leg is too externally rotated (tightness).

As the muscle runs adjacent to the sciatic nerve the symptoms often include:

1. Shooting pain/electric shock
2. Some numbness/tingling sensation
3. Dull ache across the mid portion of the glutes during or after exercise.
4. ‘Trendelenburg gait’ whereby during walking there is minimal support to the opposing swinging leg causing instability. Julia Roberts has it don’t feel bad!
5. Over pronation of your foot or flat footed-ness (weakness)
6. Supination of the foot (tightness)

Symptoms can be due to tightness or weakness of the muscle or poor stretching before and/or after exercise.

You’re local Podiatrist should be able to assess weakness and tightness, however if these symptoms compute to your own it is important to stretch and strengthen the muscle. RICE therapy (rest, ice, compression and elevate) should be applied post exercise or when most painful) As well as this ask to be assessed for other foot conditions and review footwear and orthotic options.

STRETCHING

Sit on a normal chair and cross your left foot on to your right knee, then slowly lean forward, with a straight back, and hold for up to 60 seconds. Complete stretch daily on each side, repeat more frequently pre and post exercise.

 

INCREASE TONE & STRENGTH

Lie on your side, bend your knees and put your feet together. Keeping your feet in contact, lift your knee, as shown above as high as you can very slowly and hold at the peak for 3 seconds then bring your knees into contact again. Repeat 15 times on each side daily. It is important to maintain strength in the muscle even if there is no weakness especially athletes or runners.

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Barefoot / minimalist running - where do we go from here?

My advice about barefoot running......beware of trends

‘Barefoot’ or minimalist running is the latest trend for runners. As a podiatrist I am asked frequently for my opinion about it being a good thing or bad. 

The fact of the matter is not enough is yet known about the effects of barefoot running on caucasian feet. Some people think that barefoot running is harmful. Part of this could be for physiological reasons but part of the solution involves the runner learning to run as a barefoot runner. Podiatrists are seeing one stress fracture after another directly related to poor barefoot running technique. 

Caucasian feet are different from the traditional barefoot running races normally associated with it such as the african runner, zola budd being an exception. White athletes have become used to running in a shoe, on tarmac. The African foot is much flatter, and unlike white posterior muscle compartments which tend to sit lower, the calf muscles in black athletes sits higher with longer tendon and ligamentous tissue. 

Traditional barefoot runners are also ‘forefoot strikers’ meaning the initial contact phase of gait is on the ball of the foot rather than the heel. White runners tend to be heel strikers, which is completely normal for them and inconsequential when wearing a decent running shoe. The style of running is completely different and unless you change the way you run you can soon look forward to joining the thousands of others sporting injuries from barefoot running. 

If you must run barefoot there are a couple of  things you can do to prevent injury.

First of all, start slow and keep it short. 

Run on grass only, and always try to run somewhere unlikely to have broken glass lying around. 

Speak to someone who knows about barefoot/minimalist running. Take advice on footwear. Most of all remember, it is not for everyone, and everyone is not the same. 

Remember that just because someone makes a picture like this...

Does not make it a scientific fact.