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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18 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

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