Anne was running the White Rock marathon in Dallas in 2007.
It was a cold, wet day, and by mile 18, she had a "cramp"
in her hamstring and into her butt. It continued to get
worse and worse as it got colder and colder. First she
described that her fourth toe went numb, then the entire
bottom of her foot. By the time she got to mile 24, she
relates being freezing, wet, miserable, and could not feel
her left foot or calf! Quit? Never! It's not even in her
vocabulary....Although her running friends that were doing
their best to drag her to the finish kept encouraging her,
Anne was convinced she had somehow severed her sciatic
nerve with the muscle spasm in her butt! What was going on?
Piriformis syndrome!
Anne had just experienced a very rude introduction to her
piriformis muscle. This muscle arises from the sacrum,
passes through the sciatic notch (an opening in the pelvic
bone) and attaches to a bony prominence on the side of the
thigh bone (greater trochanter). The piriformis muscle acts
in outward rotation of the hip. The sciatic nerve exits the
spinal cord and passes through the notch in front of the
piriformis (in some people the nerve actually passes right
through the muscle).
What went wrong that day around White Rock Lake? Anne
irritated her piriformis muscle by getting tired (because
her pre-race training had been, when she was being honest
with herself, less than adequate), which caused her to
overpronate, and then she coupled that with running on
uneven surfaces and progressively colder temperatures which
caused Anne to tighten all of her muscles shivering anyway!
As the piriformis became inflamed, it swelled and
compressed the sciatic nerve, which caused her foot to
become progressively numb.
Most piriformis injuries are caused by overuse or by forced
rotation of the hip caused by running on uneven surfaces.
You can also irritate your piriformis by falling on your
butt and having a direct blow! Pain can usually be elicited
early in piriformis syndrome with direct palpation or
stretching of the muscle. Anne describes pain enough to
jump off the massage table pain when her piriformis was
palpated for a month after the marathon!
Why me? Look at your training schedule and you may see an
answer. Anne did! Worn out orthotics and not enough miles
coupled with an unusually cold day! Other factors come into
play like tight hip adductor muscles and excessive
pronation. If your adductors are tight, the piriformis has
to work harder to abduct the hip before it can help in
outward rotation. Also, when your foot excessively pronates
(or rolls in) when pushing off, your whole leg rotates
inward and the piriformis acts to externally rotate your
hip and has to work overtime every time you push off.
Can I keep running with piriformis syndrome? Yes and No. In
the early stages, you can run; if you continuously stretch
before and after, as well as making sure you warm up the
piriformis before running. Decrease your mileage at least
30-50%, slow down and avoid hills and speed work as well as
uneven surfaces. If you are finding that the muscle pain is
causing you to alter your gait, slow down and start therapy
before you end up with another injury. Think of it this
way, as the piriformis tightens, the pelvis is actually
pulled upward which gives you a functional leg length
discrepancy. This can cause major biomechanical injuries to
your other foot and leg! In other words, piriformis
tightness in the left hip can cause arch or knee pain in
the right leg!
What else could it be? The best answer to piriformis
syndrome is to get a true diagnosis from a sports medicine
physician. Lumbar spine injuries like a herniated disc or
degenerative arthritis as well as a pelvic stress fracture
can mimic piriformis syndrome. A complete physical exam
should highlight the culprit muscle and x-rays or even an
MRI may be needed to rule out other possible causes.
Piriformis syndrome is treated with physical therapy,
pelvic manipulation, tons of stretching,
anti-inflammatories, functional orthotics or shoe inserts
to align your gait, deep tissue massage and manipulation,
and even the dreaded cortisone shot to the butt in some
cases. Very few people need surgical release of the muscle
for complete relief of symptoms.
After Anne experienced piriformis syndrome, I bet she will
never joke about a pain in the butt again! Be smart!
Maintain your core strengthening routine, wear your
orhtoics if you pronate excessively, stretch your hip
adductors, and strengthen your abductors to ward off the
dreaded piriformis syndrome!
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For more information on foot and ankle health and running
injuries, visit our website at http://www.faant.com or my
blog at http://www.myrundoc.com . For a podiatrist in your
area, visit the American College of Foot and Ankle Surgeons
consumer website at http://www.footphysicians.com .
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