GLUTEAL PROBLEMS — PIRIFORMIS SYNDROME

We now focus on that solid wad of muscle in the buttocks, so important in athletics, and so prominent indancers, skaters, and gymnasts. It’s primarily made up of three specific muscles, the gluteus maximus,gluteus medius, and gluteus minimus. That is, the “greatest,” “middle,” and “smallest” rump muscles—glutes,for short. The glutes are responsible for rotating your hip and leg outwards and for extending the hip and legbackwards. When a dancer does an arabesque, it’s the glutes that pull the leg back, up, and out. When askater glides over the ice, it’s the glutes that both rotate and extend the legs. When you run or walk uphill, theglutes provide the power to push your body ahead of your trailing leg. When you do a dolphin kick in the pool,it is the glutes that pull your legs up against the water.

But the glutes don’t do all this by themselves. Smaller muscles in the buttocks, muscles that liebeneath the glutes, assist them in rotating and extending the hip. One of these is the tiny piriformis muscle,only a couple of inches long. These small muscles can be irritated along with the glutes for a variety ofreasons. For example, if your quads aren’t strong enough to tighten your knee on their own, the glutes can becalled upon to help—not their preferred task. Similarly, weak hamstrings can lead to overused gluteal muscles.And overuse of muscles’ natural functions can also lead to irritation.

You’ll know it when it happens—painful and aching buttocks are no fun— the problem is oftenmisdiagnosed. This interesting tale involves the piriformis muscle. In about 20 percent of the population, thesciatic (sigh-at-ic) nerve—that large nerve that supplies sensation to much of the body from the hips down-ward—descends from the lower spine and runs right through the piriformis muscle on its way down the legsto the feet. In the remaining 80 percent of us, the nerve runs over the muscle. Either way, if the piriformisgoes into spasm, which is what muscles like to do when they’re irritated, it can squash or pinch the sciaticnerve.

That can mean pain that runs down the back of the thigh and calf all the way to the foot. Thecondition is called sciatica, and it can be accompanied by numbness and tingling as well. Meanwhile, thepiriformis and the other muscles in the buttocks are in spasm, which means that you have pain in the hip thatis particularly sharp when you try to rotate or extend your leg. Not only do you hurt in ballet class, but it’sgetting pretty tough even to get out of the car or out of a chair. And then the muscle tightens further, which throws your leg into a semi-permananent external rotation. You start favoring the hip, altering your gait, andbending in strange, awkward ways, all of which starts to affect your back. Finally you sort it all out and go tothe doctor, who says, “Where does it hurt?”

Well, you answer, “my back is killing me, and I have this pain in my buttocks that goes all the waydown my leg to my foot.”

“Aha!” the doctor replies. “Disk disease.”

For such are the classic symptoms: back pain caused by a degenerating or abnormal disk that pinchesthe sciatic nerve to produce pain all the way down the foot. And heaven help you if x-rays expose a bulgingdisk that you may have had for fifteen years and that never bothered you all that time. It’s off to the operatingroom. It happens all too often, and it can be scary.

But you may not have disk disease. You may not have a back problem. Your problem may be the littleol’ piriformis muscle. And what may be necessary is not surgery at all, but the kind of treatment that works sowell for muscle and tendon injuries: stretching and strengthening.

How can you know? There are a couple of ways to test yourself. Lie on your stomach with yourknees together and bent, so that the soles of your feet point heavenward. Then just let your legs fall apart, outto the sides. The motion causes your hips to rotate inward, stretching the external rotators, the gluteal andpiriformis muscles. If the muscles hurt, it’s a pretty good chance you’ve located the problem—the piriformis.

Another test is to sit in a chair or on the floor, place the heel of one leg against the outside of the kneeof the other leg, and pull the knee of the first leg (which should be on the side where it hurts) toward the middleof your chest. You should feel a good stretch in the buttocks in any case, but if it really hurts, you may belooking at irritated glutes and/or piriformis muscle. (An interesting thing about this test is that if you really andtruly do have a disk problem, this stretch probably won’t bother you. And doubly interesting is the following:the common test for disk disease-caused sciatica is something called the positive straight-leg raising test. Thatinvolves lying on your back and lifting your leg straight up and back, which, if you do have a disk problem,should cause sciatic pain. But if you pull up your leg with the knee bent, there should be no pain— if theproblem is caused by a disk. However, if the piriformis or glutes are at fault, then the sciatic pain will occur ineither case, leg straight or bent. So, if you get the same pain, knees extended or bent, you might look to themuscles and think about canceling your appointment with the back surgeon.)

+ What to do about it + Stretch and strengthen the muscles. It’s easy to do. One strengthening technique isto lie on your stomach and raise your leg behind you. You may find that you’re only able to raise the leg a fewinches off the ground, or not at all. It doesn’t matter. Do the best you can if that means only tightening thebuttocks at first. If you stay with it, you’ll start to notice results.

Another way to strengthen is by reversing the stretching motion discussed earlier. If you’re sitting ina chair, the heel of your injured leg resting outside the knee of the other, and you pull the knee of the injured legtoward the middle of your chest to stretch the gluteal muscles, strengthen them by pushing your leg backagainst your hand. The more resistance you offer with your hand, the harder it will be to push against it, andthe greater the strengthening.

You can do contract-relax exercises this way. Pull your knee toward the middle of your chest as faras is comfortable, then push back against your hand. Hold the push—which contracts the muscle—for aboutfifteen seconds, then relax. Pull the knee toward you a bit more, then push back with your leg. Hold it forfifteen seconds. Relax. You may have to start with a relatively straight knee and hip, then gradually work theknee back toward the chest. The more the knee and hip are bent, the greater the glutes are extended, and thegreater the stretch. It’s pretty slick—you can stretch and strengthen the muscles all by yourself with the sametest you used to determine the cause of the problem in the first place.

But remember, once you’re relatively pain-free and back to your favorite activity, the only way to staythat way is to deal with whatever it was that caused the problem. And with gluteal injuries, that somethingmay have begun in the thigh—weak quads or hamstrings—or might involve the way you go about youractivity. Getting rid of the symptoms, no matter how much relief it may bring you, won’t guarantee that you might not face the same problem again. The only way to escape that merry-go-round is to find out why youhurt yourself and change the way you go about things accordingly.

A caution: it’s certainly worth your while to see if sciatic pain is the result of a piriformis or glutealinjury. But if you try the things we’ve suggested and the pain persists, or you have a great deal of numbnessor tingling, and you feel weakness along your leg—strange sensations you’ve never experienced before—then don’t assume that you’ve done the exercises wrong and should give them another try. See a doctor.Sciatica is nothing to play around with. Nor is numbness, tingling, or weakness, no matter where it might showup. If you have any of these sensations, see a doctor.

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