Skip to content

It was Pain in the Bum, Before my ITBS

23/09/2009

If the center of your buttocks is not unduly tender then try firm pressure on the area of your buttocks where you actually sit. Near the bottom of your buttocks just above the crease where it separates into your thigh you’ll find a bony prominence called the Ischial tuberosity. Firmly probe with your fingers all around that bony point. If it is painful, you may have bursitis.

Months ago on my training for my Marathon debut, around late February and early March felt a sharp pain in my bum just above my hamstring.  I ignored its just sore muscles.   I ran with it during the marathon scared it might act up but surprisingly it didn’t.  Then again after the Marathon it never went away.  So I researched about it, is there an injury on the butt area? who knows! its called Piriformis Syndrome!

It’s 8 months already and I still feel it on the same left leg.  Although not in the bum area anymore after some remmedial massage, its up the thigh area but still its a feeling of sharp pain.

What’s the Piriformis?
The Piriformis is a deep lateral rotator of the leg muscle, located deep under your gluteus maximus muscle, bum cheek. It runs sideways under your glute and very near your sciatic nerve, large nerve that runs down the leg.  The piriformis muscle assists in abducting the and laterally rotating the thigh.  It lies deep in the gluteal muscles and originates from he sacral spine and attaches to the greater trochanter of the femur.  The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 10%  of the population, travels through the muscle.  It is thought that acute or chronic injury causes swelling of the muscle and irritates the sciatic nerve, resulting in sciatica.   The area may also be quite tender and sensitive to touch.

Warning before you reading further and do a self-diagnose, it is recommended you visit your physician, Physio or Chiro.

When is it an injury is called Piriformis Syndrome?
If that muscle gets really tight, it will cause that pain in the butt to creep down to a pain in the leg as well.    And then a “yes” to the following questions
– Tender in the center of your buttocks muscles?
– When you put firm pressure into the center of your buttocks does it radiate pain downward or out to the hip area?
– When you sit down and lift one thigh up. Reach down and grab your ankle and rotate your foot inwards towards the other leg (externally rotate hip), does this cause buttocks pain?
– Pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint, producing a bursitis. A bursitis is an inflammation of the fluid filled sac in a joint caused by an elevation of stress and tension within that joint.
– Pain directly in the center of the buttocks. This pain can be elicited with direct compression over the belly of the buttocks area. A tight muscle is a sore muscle upon compression due to a reduced blood flow to that muscle.
– Sciatic neuralgia, or pain from the buttocks down the back of the leg and sometimes into different portions of the lower leg. The sciatic nerve runs right through the belly of the piriformis muscle and if the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, tingling, and numbness.If you sleep with your knee of that leg kicked out to the side (we call it the figure four position) then you need to tuck those legs in to keep them closer together to allow that muscle some space. The worst is the belly sleeping position with one leg out, so that the inside of the leg is contacting the bed.

Cause?
The Piriformis is a prime candidate for repetitive motion injury (RMI). RMI occurs when a muscle is asked to perform beyond its level of capability, not given enough time to recover, and asked to perform again. The typical response from a muscle in this situation is to tighten, which is a defensive response. This tightness, however, manifests itself in several ways to a runner.

It’s because the muscle gets shortened due to leg position (same on ITBS) you stay in a position for a long period of time, day-in and day-out, your body starts to hold the pattern. So, if you stand with your foot rotated out to the side.
– If the leg is externally rotated for an extended period of time (such as when driving) the piriformis muscle can shorten.
– Faulty foot mechanics.
– Faulty spinal mechanics.
– Gait disturbances.
– Poor posture or sitting habits.
– Disc bulge or herniation
– Disc degeneration
– Subluxation or misalignment of spinal bones
– Spasm of the Piriformis muscle in the buttocks
– Tumor of the lower spine

Relative of Piriformis Syndrome and its Differences
1. Ischial Tuberosity Pain.
It is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the the path of the sciatic nerve.  The nerve pain, called “sciatica”, often goes down the back of the thigh and/or into the lower back.  The pains is deep in the buttocks.
If the center of your buttocks is not unduly tender then try firm pressure on the area of your buttocks where you actually sit. Near the bottom of your buttocks just above the crease where it separates into your thigh you’ll find a bony prominence called the Ischial tuberosity. Firmly probe with your fingers all around that bony point. If it is painful, you may have bursitis.

2. Gluteus muscle strain
– Pain when you clinch your bum cheeks
– Stretching on the bum muscles when you lift your knee towards your chest
– When you stand using a table for support or lie on your back, bend your knee at 90 degrees and slowly kick your leg backwards (donkey kick), does that hurt your buttocks?

If these are “yes” then a strain from Nordic trainer is possible.

Piriformis Syndrome’s Remedies:
Assuming a physical exam that points towards Piriformis syndrome or other “muscular” problem:

  • Avoid speedwork; you should not run hills or on uneven terrain.
  • Cut back your training volume, and then return to running pre-injury training volume and intensity gradually.
  • Cut back your speed work and hill running
  • Applying heat pack and interferential electrical stimulation (IFC) surrounding the painful area for 12-15 minutes
  • Cut back your training volume, and then return to running pre-injury training volume and intensity gradually.
  • Cut back your speed work and hill running
  • Very gentle post-isometric stretching of the Glute and Piriformis muscles
  • 630 nM cold laser at 4,9,33 and 60 settings at the buttocks and thigh during the above stretching
  • Chiropractic manipulation as needed of the pelvis and sacrum
  • Ice for 10 minutes

1. Piriformis Stretch 1.
If you are avoiding the doctor, you will need to work on stretching your piriformis muscle. One method of doing so is to lie on your back, bend the affected knee and hip (illustrated above). Grasp your knee with the right hand and push toward your left shoulder. Grasp your right ankle with your left hand and rotate the leg inward.
piriformis

2. To stretch the hip adductor muscles, sit on the floor and put the soles of your feet together, holding your feet with your hands. Very gently pull yourself forward until you feel a stretch, not pain, in the groin muscles. Make sure to lean from the hips and lower back, not the upper back and neck. Hold this stretch for 20 to 30 seconds. Work on stretching all of the muscles of the hip, as they will have been affected by the alteration in gait.

3. Strengthening the hip abductors is very important. Lie on your side and lift the upper leg 25 to 30 inches, making sure that your pelvis remains perpendicular to the floor. Hold this position for 10 seconds. Perform 10 repetitions at the start and gradually increase the number over time. As you become stronger, you may wear an ankle weight while performing this exercise. You can work other major hip muscles in a similar manner, lying on your back for the flexors, on your abdomen for the extensors (upper hamstrings) and on your side with the upper (non-exercise) leg moved back for the adductors.

4. Pretzel Stretch.  Start off by lying on your back, bend your knees and cross your right leg over your left so that your right ankle rest on your left knee in a figure four position. Then bring your left leg towards your chest by bending at the hip. Reach through and grab your left thigh to help pull things toward your chest.)

5. Standing active stretch (lift injured leg, rotate leg inward, pointing toward other leg, and hold for 10 seconds, repeat).
6. Lying down active stretch (lying down face down, bend your knee at a right angle so that your lower leg is pointing straight up, now rotate your leg so that your foot moves outward, away from you, when you reach maximum stretch hold for 10 seconds, repeat).
7. Lie on back, flex injured hip and knee, grasp injured knee with uninjured-side hand, pull knee towards uninjured-side shoulder, grasp just above right ankle with injured-side hand, and rotate ankle outwards.
8. Stand on your uninjured foot, place injured foot on chair such that injured knee and hip are flexed at about 90 degrees. Now, using injured side hand, press the injured knee across towards the other side of the body while keeping the ball of the injured foot on the same spot of the chair.
9. Golf/Tennis ball massage. Sit on it.  If massage isn’t in your budget, try self-massage with a tennis or gold ball.  While sitting on the floor, place the tennis ball under your buttocks and gradually ease your body weight on the ball. While rolling the area slowly, take note of sensitive or painful spots (trigger points).  Sit on the sore area for 15 seconds and continue rolling.  This mimics a massage (not exactly) and can help break up the trigger points, relaxing the muscle and increasing blood flow to the area. A physical therapist can also help you perfect your self-massage technique.
Also, by using a foam roller you can begin to correct normal muscle function, releasing tension in the knee and hip joints.  Less tension means less risk for injury.

So now the pain has moved away from my bum muscles but still in my upper hamstrings same leg where I am nursing the ITBS :(.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: