Blog Talk with Lori Duncan – Piriformis Syndrome (Episode 2)

Blog Talk with Lori Duncan – Piriformis Syndrome (Episode 2)

Blog Talk. A Video Podcast of Physical Therapy, Healthy Movement and Patient Stories.

Episode 2 is dedicated to another popular Blog Post: Piriformis Syndrome: It’s Not About the Tennis Ball . If you don’t do anything else expect read this one sentence: throw away that tennis ball and stop stretching! This episode gives visual life to the original blog post, reviews the two glute exercises that “usually” work and explains two new exercises that you might try. You have to find the Good Glutes (Max, Med and Min) to truly heal this syndrome.

Thanks for listening! ~Lori

 

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40 Responses to Blog Talk with Lori Duncan – Piriformis Syndrome (Episode 2)

  1. Hi Lori,

    I had written to you a little over a year ago. I think your advice is always spot on and I think glute activiation is critical in preventing other injures as well as piriformis syndrome. I have suffered with sciatica or pseudo sciatica on and off for over a year. A year ago, I had thought it was due to PS, but after only brief relief from visits with, doctors, accupunturists, chiropractors and spinal specialists my condition would always come back. Even after doing the glute exercises you suggest, my condition still resurfaced, which led me to believe that my case was disc related. About 6 weeks ago when suffering a flare up, my daughter who is also a PT suggested that I see a McKenzie therapist. After 2 visits per week for 6 weeks of intense Mckenzie protocol exercises for a bulging disc, I have been pain free for about a week now. However, my therapist did tell me I had some lingering muscular issues with my glute med and min, possibly due to compensating from limping with pain, or from compressed nerves preventing the muscles from firing efficiently, but she wasn’t certian. I know there are still some muscle issues because I can tell those muscles are different on my left side(bad) versus my right side(good). She feels I would greatly benefit by starting to strenghten those muscles going forward. It seems like there’s no sure way of diagnosing the source of sciatic pain. MRI’s are usually not helpful, and glute med/min spasms can also mimic sciatica by referring pain down the leg. My question is: how does one know if the condition is caused by disc, the piriformis or other glute muscles, and if the glute med/min are the culprit, will activation exercises on the those delay healing? I know those muscles don’t compress the sciatic nerve like the piriformis but they can still spasm and refer pain down the leg.

    Thank you and I really enjoy hyour blogs,
    Ron

    • Hi Ron,

      Glad you got relief. GREAT question. This is why you need a good PT or other medical professional to be thinking and constantly evaluating the symptoms. Piriformis syndrome (without spinal involvement) truly does resolve once the good glutes are found. Additionally, PS does not hurt so bad you can’t get up from the floor. So, if someone is not starting to have pain relief after a few weeks with glute work, then the spine must be considered. For herniations and stenosis. The glute min/med usually refer to the outside of the leg, not down the back of the leg. So, that’s a cue for those. Again, it’s why I encourage people to have good PT in their corner. Hope that helps!

  2. Hi Lori,

    One more question if you don’t mind. Doing the clamshells, and fire hydrants feel great during and after, yet I cannot do a single legged glute bridge on my affected side without a “cramping” in the left buttock. I assume that is the gluteus maximus. Any suggestions for that?

    Thank you,
    Ron

  3. My PT, my pain doc, and my PCP all told me to stretch that piriformis muscle, as well as well-meaning friends. So, just to clarify, are you saying don’t EVER do those stretches for piriformis syndrome? Throw out the pigeon pose and the ankle over the knee one? I have been thinking those stretches are my problem, but until today when reading your blog posts, not one doctor has said to NOT stretch. Definitely going to try NOT doing them. But, is there ever a time when you should do them? Is there a good hip or glute stretch I should be doing instead?Thank you so much for taking your valuable time to write this blog and reply to comments and questions!!!

    • Hi Sydni,

      I am not a fan of figure 4 stretching EVER. It doesn’t control the pelvis rotation/alignment. A safe glute stretch is to sit in criss, cross legs one foot in front of the other. Tall spine and lean forward. You should feel that in your glute of the leg that is in front.

  4. Hi Lori,

    Really interesting article and video. I’ve been rolling on balls and stretching like a mad man – although not on an apple! That’s hilarious! I think I’ll give it a rest now.

    Do you see any cases of a piriformis related issue without the sciatic nerve pain? I don’t have too much nerve related pain – some occasional burning but that was towards the side of the hip. My main complaint is just a general tightness and light spasming across the butt. And when I run (and sometimes when I walk), I get a dull ache approximately to the left of my tail bone (it looks to me like the area the piriformis attaches to the sacrum.

    It started a year ago after a hill run and I really messed it up doing jumping lunges not long after that. Since then, I’ve done all kinds to try and kick this. More recently glute work but mixed in with core and stability work which included lunges and I think this is what kicks off that ache near my sacrum.

    So I’m wondering if I’m just not activating enough glute strength yet, despite all the glute work! And I think you mentioned avoiding lunges if the glutes weren’t 100%.

    How do you know when you’re recruiting enough glute to perform glute demanding exercises? I have buns of steal at the moment from all the work but it doesn’t seem enough!!

    Keep up the good work.

    M

    • Hi Martin,

      Thanks! Are you sure your spine is cleared? Meaning, if you think you have really strong glutes and you’re still having pain, is that nerve/pain signal coming from your spine? Or, if you just take out lunges, does it feel better? You may just not be performing those correctly. The back glute is the main driver of the lunge and extends the knee straight. If you think the front leg is the driver, it will have the back hip behave strange. Hope that helps!

      • Lori, many thanks for your reply.

        I’ve had my spine checked by a PT and Chiro (they pressed and poked around that region) and they both didn’t have any concerns.

        Taking out lunges doesn’t get rid of the symptoms, it just causes a flare up. And since reading your other article on lunging, i was doing it completely wrong – it seems like such a simple movement but I was using the front leg as the driver, exactly what you said.

        I can deadlift and squat without any flare ups and this seems to help for some reason. Perhaps the increased load is forcing the joint to become more stable? I have no idea!

        Thanks again for your time.

        • Hi Martin,

          Well, pressing and poking is different than imaging. My only point is that if you are not getting relief, then you need to look in a different direction for the true cause. Sounds like your glute max works better than your glute med/min from the exercises above. And, work on that lunge :). Work on clams and some glute med/min stuff.

  5. Hi Lori,

    I thought you and your followers might find this interesting. I was watching a PBS show on chronic pain issues presented by a PT. He had a very interesting perspective on sciatica, and a protocol pretty much identical to yours for piriformis syndrome. He said something that I found very interesting, and not knowing human anatomy that well, I don’t know how accurate it is but it made a lot of sense. He said the only cause of sciatic pain that starts in the glute region and radiates down the leg, is from the piriformis due to it overworking and becoming enlarged because of other glute muscles, mostly the gluteus medius, either being injured or not activated and out of balance. He said it’s impossible for any mechanical structure in the spine to produce these symptoms because there are only nerve roots at the spinal level and not the entire sciatic nerve. He also stated that a technology, MRN(Magnetic resonance neurography) confirms this as it shows the sciatic nerve being squeezed by the piriformis in all cases where patients complained of pain radiating from the glutes to the knee and below. I would be happy to post the link to this here, but wouldn’t want to do so without your permission. He is very much in agreement with you on how to treat piriformis syndrome, but I am wondering/skeptical on the accuracy of him stating that sciatica originating in the gluteal region cannot come from a spinal issue such as a bugling disc.

    If he is correct, I think everyone suffering with sciatica, will greatly benefit from following the exercise you have posted here in your Blog Talk.

    Thanks,
    Ron

    • Hi Ron,

      I’m glad to knows someone else is thinking on the same lines. He thinking is a little “off” like you think. Sciatica is just a general term to state the sciatic nerve is irritated. Either that irritation comes from full compression at the sciatic nerve (at the level of the piriformis) or one of the nerve roots that feeds the sciatic nerve. Either way, it’s sciatica.

      • Thanks Lori,

        I didn’t do a great job explaining his thinking. The way he explained it was, if there is pain along the entire sciatic nerve, that can only come from the piriformis, as that is the only structure that would compress the actual sciatic nerve. Structures in the spine only can compress nerve roots so that would elicit pain only to specific regions(I think he called them dermatomes). So for example, a compressed nerve root at L5 would only refer to the L5 regions, not everywhere like in the glutes and entire leg as the piriformis would do.

        It’s an interesting theory and seems to make a lot of sense.

        Ron

  6. Lori
    I enjoyed your video and have begun the clamshell and hydrants. I have had this condition for over 10 yrs. and have tried everything. Sitting on the tennis made me sore as hell and the pigeon felt good while doing it but no improvement noticed. Sitting is uncomfortable .
    I will begin with 30 of each exercise morning and evening. No more stretches and tennis ball. Your theory makes sense as I am quite weak on the left side which is worse than the right. When I sit, I feel like I am on the coccyx bone.
    Should I ice after? How soon to increase the clamshell and hydrants?
    Thanks so much. This all makes sense to me.
    Jan

    • Hi Jan,

      You can ice if you want. It can sometimes help with pain. And, it’s fine to start with 10-15 reps of each exercise at first. You should increase the reps to 20 when you can hold good quality and feel a good healthy “burn” in your glutes. I’m glad this makes sense to you and I hope you get relief soon.

  7. I’m going to try these exercises. My problem started 8 weeks ago slightly higher than glutes just when I got up from standing, improved with physio but then started to flare up again but no sciatica. Then I slipped on a wooden floor but actually can’t say my symptoms were aggravated at that time. Since then more problems sitting and getting up but with sciatica in my lower calf above the ankle mostly. Comes and goes – had some relief yesterday with McKenzie prone position but physio keeps telling me my back feels ok and it’s piriformis. I’ve been given the standard 4 or versions of, stretch, and pilates bridges which I feel are not great (I’ve done bridges in the past at the gym and find they aggravate my back). I am mostly ok walking or lying in bed (occasionally leg aches) but sitting and getting up is the worst and I do feel that tightness in the glutes (had it around 5 years ago but not as bad or long lasting as this)

  8. Hi Lori, I have done these before and felt a massive improvement when I walk but then it just gets worse again do you know why this could be? Also I have a lateral pelvic tilt my hip is hiked on the side of the pain will this effect it in anyway? Should I concentrate on fixing the pelvic tilt first or fix the piriformis first?

    • HI Darryl,

      I would get someone to help you with the pelvis first. Could be the pelvis is truly “off” or you could just have a dysfunctional muscular patterning causing a change to the pelvis. But, if the pelvis is not stable, then everything that attaches to it does not activate correctly.

  9. Hi Lori, I find your blogs so interesting and accurate. I enjoyed this one very much as well as the one you did on Disc and spine issues.

    I am curious on your opinion on trigger points. Do the glutes get trigger points and not function efficiently which can cause the piriformis to have to overwork? I have been to a massage therapist many times for trigger point therapy in the glute and hamstring area, and I feel terrible the day after, but then feel really great after a couple of days. It seems to last for about a 4-6 weeks, then then I start to notice the muscles are not as efficient and need more therapy. There is so much information regarding them online, and a lot of disagreement on how to best address them. Are trigger points real, and if so, how do you think its best to treat them? Massage therapy, foam rolling, moist heat, all the above, none of the above, etc?

    Looking forward to your next blog 🙂
    Ron

    • Hi Ron,

      Trigger points are real. But, just having them released is not the answer. Trigger points exist because of poor muscle activation. So, if you get them released, you need to quickly activate (in a good way) that muscle. Foam rolling? Not a fan. Moist heat? Sure, can help, but not treating the cause. It’s fine to get them released, but if you continue to get them then no one has addressed the “why” of your pain.

  10. Hi Lori,

    Thanks so much. The source of my problem is overuse mostly caused by biking, ellipticals and tennis. I can really feel my gluteus medius being strained and overworked especially biking in high gears(I need to stop doing that I knwo) . I struggle doing a side plank on the affected side. A few months ago I had a therapist work on the trigger points, then she gave me some excellent glute activation exercises similar to yours but using resistance bands. I felt so good, but whenever I feel healthy I think I am all set and stop training the glutes and then overdo other activities and fall back to where I was. I need to really stay on top of this.

    Ron

  11. Hi Lori,

    Awesome blog and Glad to hear people’s reaction in above replies.

    I am facing this problem from last 2 year approx. and I am just fed up as its affecting my social life. Pain is in the hip area and from last 6 months pain started to grow in full leg. I am not sure it is a sciatica nerve issue or Piriformis disorder. I gone through the MRI scan and report says “1. MRI study of the lumbosacral spine reveals mild non-compressive disc bulges at L4-5 and L5-S1 levels 2. Screening of the rest of the spine has not revealed any significant abnormality”. I have only taken Ayurveda medication all over the course and also gone through “Panchkarma” treatments (Basti). I am not sure If you are aware of the terminology or not. But I want you to have all the details. Treatment was also included of normal Yoga Poses and Oil massage therapy.
    Please guide me which therapy/Medication I should try to get over this problem.

    Thanks in advance

    regards,
    Ashish

    • Hi Ashish,

      I would stop the yoga (stretching) for now until you can get your deep abdominals, glutes and scap muscles to fire. You need core stability!! The full core is glutes to shoulder blade muscles. If your symptoms are starting to run down your leg, I would also see a PT in your area to ensure you are not getting any motor loss (weakness associated with nerve compression). That can be a sign you need to see the MD.

      But, strengthening your core is good no matter what!!

  12. My piriformis is so tight and painful I can’t even do these excerciseswithout stretching first. I have switched to 2 yoga poses, child pose and downward dog instead of the opposite leg assist cross over. Sad to say I have to slowly work into even child pose 🙁 I am miserable

  13. Hi Lori,

    I’m so glad to find your video on piriformis muscle stretch. I wish the sound could have been better as it’s very low. I’m not a native speaker of English thus it’s not easy to fully comprehend your advice. I really want to start doing the exercises. Thank you!

    • Hi Jargal,

      Yes, some people hear it fine and others not. Since then, I bought a GoPro so the sound is more consistent. Make sure your YouTube settings are to HD and the volume is up high! Hopefully that helps. Find your good glutes, not that silly piriformis.

  14. Oh how I wish I lived in CO to see you. I have been dealing with annoying piriformis pain and now sciatica (bottom foot numb extending into posterior distal calf) for so long now that I have thrown everything but the kitchen sink at. I just want to feel good again – its making me crazy and Im so tired of spending money on it. I just came across your site in my millionth search on the internet for something different to try. I have been doing reformer pilates 3x/week now for past 6 months and it doesn’t help either. now that I have the sciatica I cant even do some of the pilates without pain
    (c-curve, rollups etc). I will try your firehydrants and clamshells. My question is this: I feel better with more movement throughout the day. So will I do more damage if I start jogging again in the ams and start the glute exercises? Im going crazy out of my normal routine and im so tempted to just push through it. I don’t really have too much pain when im running its the spasms/nerve pain later. So fed up and frustrated.
    Thank you!

    • HI Tracy,

      Sorry for the frustration. So, here’s the thing. There is no “through” the pain, we just compensate. If you don’t have your glutes activated with running, then running will ultimately be very painful. It sounds like you get a myofascial effect afterwards. Watch the BlogTalk on this too. I show a few other exercises to help kick the glutes on. That is the key! Make sure it is truly piriformis and not your spine. They do have similar exercises, but the approach is different. I do offer online consults if you are interested. [email protected].

  15. Hi Lori, thanks for your great help! Wanted to know your opinion on dry needling /acupuncture. Also, walking is good or bad? And last question,I have tight QL, do you think it can be related to the piriformis spasm? (did mri my disc is clear). Thanks so such!

    • Hi Anat,

      First these are VERY different interventions. Acupuncture is wonderful. Very effective and calming to the body. Eastern Medicine Philosophy. Dry needling? I’m not a fan. I just don’t think sticking a needle into a muscle and moving it around sounds or feels lovely. It’s a quick fix for possible inhibition to the muscle, but my hands can do that same thing and feels 1000x better. Acupuncture = Awesome. Dry Needling = Not Awesome. Walking is good for our body, so yes. QL is usually related on the side of pain. Are you sure your SI/Pelvis is not the cause of all of this? QL is always involved with SI stuff

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