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The Injurance Blog Pt5 - Piriformis and glutes can be pain in the arse...

In addition to our regular Endurance Blog, which covers topics related to endurance coaching and nutrition, we will also be publishing Injurance Blog, which cover common injury topics for endurance athletes.

We work in conjunction with A6 Physiotherapy and Axis Podiatry who contribute their expert advice for each blog post. If you have any questions, post them on THE ENDURANCE STORE Facebook Page, where this blog in posted.

Back pain is perhaps he most common of all ailments that we see with endurance athletes. This week Sam and Dr Lindsay give us the low down on the things you can do to ease glute pain.

In our last blog we talked about managing low back pain and continuing to run. We discussed hip tightness (in particularly hip flexors) as being a common cause of lower back issues and contributing to posture dysfunction such as an increased lumbar lordosis, but what about buttock pain?

One diagnosis that presents as buttock pain which can even radiate down into the leg is Piriformis Syndrome. It is thought this condition can be linked to repeated forward movement type exercise such as running and cycling. It is suspected that repeated forward movement type exercise can lead to weak hip abductors (outer hip/thigh muscles) and tight adductors (inner thigh muscles). This muscle imbalance can lead to the piriformis muscle to shorten and contract which can then impinge the sciatic nerve.

Piriformis syndrome can be mistakenly diagnosed when in fact it is a disc prolapse so it is important to see a qualified physiotherapist for the correct diagnosis in order to receive the appropriate treatment. Another cause of this syndrome is trauma. When the piriformis muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle. Conditions of this type are referred to as nerve entrapment or as entrapment neuropathies.

Piriformis syndrome refers to sciatica type symptoms but instead of originating from the spine (which is the case with disc prolapse or facet joint dysfunction with nerve root entrapment), it is more localised to the piriformis muscle overlying the sciatic nerve and causing compression of the nerve. You can see from the picture that the piriformis muscle comes from your sacrum (tail bone) and attaches to the top of your thigh bone (you're looking at the rear of the pelvis in that picture). The sciatic nerve passes through the piriformis and down the leg. If the piriformis is tight, it can compress the nerve.

1. Warming up properly including specific stretch
2. Self massage using a foam roller for symptom relief.
3. Progression to core strengthening exercises, once pain levels are under control. These would be directed at addressing the imbalance between weak hip abductors (namely gluteus medius) and tight adductors.
4. In the case where the spine is causing the sciatic type symptoms then the treatment would be very different hence, as previously mentioned, correct diagnosis is essential by a qualified physiotherapist.
5. A podiatry input is also important to highlight any biomechanical issues that could be contributing to postural nerve impingement, alignment issues or muscle imbalances. All of the above could all be helped by improving foot posture. Don’t ignore the feet and 'foot function' even if your symptoms are much higher up the kinetic chain.

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