Monday, April 27, 2015

April 2015 Piriformis


Advice on finding, feeling, and freeing up the Piriformis muscle for its full potential

Good Old Piriformis.  Even if you don't know much about muscles, most people have heard of this one. Any one who has had trouble with this muscle knows right where this guy is located!! This small but very important "pear-shaped" muscle is one of 6 deep hip rotators, located underneath the buttock muscle, gluteus maximus, on the back of each hip. Piriformis attaches to the front of the sacrum then extends deep through the back of the hip to attach onto the top of the hip bone, on the "greater trochanter" of the femur. This muscle runs right over the Sciatic nerve, which is the huge nerve that runs throughout the back of the leg, allowing us to feel and move all the muscles on the back of the leg.  

"What exactly does the Piriformis muscle do for our bodies," you ask? Well, a lot! The Piriformis muscles help to keep our sacrum stable and in a balanced position. When the hip is extended, this muscle is a hip "external rotator," meaning it rotates the hip and leg outward.  Think about the motion required to cross your leg and place your ankle on your opposite knee...thanks Piriformis! The Piriformis also works to abduct the hip, or move the leg out to the side, when the hip is flexed. This motion is important during walking to maintain our balance and help us shift weight to the other side of the body so we don't fall. What I think is particularly fascinating about this muscle, is that as we "flex" the hip up to bring our thigh toward our chest, the function of Piriformis reverses to be a hip "internal rotator." Think of the motion involved at the hip as you put your shoe on or take it off with one hand while standing.  Now, I'd say those are some pretty important functions!

Want to feel your Piriformis working? Lie on your stomach with your knee bent to a 90 degree angle. Slide your bent knee slightly away from your opposite thigh. Using the Piriformis muscle deep in the hip, allow your lower leg to come across to the back of the opposite leg while still maintaining the 90 degree angle. Feel the muscle contracting in the center of the buttock area? Pretty cool, huh? Another way to feel it is to lie on your back with your knee bent all the way up toward your chest.  With the knee bent and your lower leg parallel with the floor, rotate your hip inward so that your foot moves out to the side, away from your body. Now can you feel a muscle in the back of your hip working for you? That is your Piriformis, my friend.

What happens when Piriformis is not working correctly? This poor guy gets the blame when folks have tightness or pain in the center of the back of the hip, or when they feel weakness or pain extending down into their leg. These symptoms are also known as "Sciatica" symptoms. Some people's Sciatic nerve, or parts of it, pierces right through this muscle, so that can create some of the same symptoms.  One of my biggest pet peeves is when people are told that the Piriformis muscle should be "released," or stretched to the max, as is often recommended in traditional Physical Therapy sessions or group fitness classes. Maybe the Piriformis muscle just wants to be understood, not stretched!!! Sometimes Piriformis is crying out for help as it compensates and tightens up, when the other bigger, more efficient hip rotators are not performing at their full potential. Sometimes it is crying out as to say, "Dude, STOP sitting on your wallet!!!"  Other times, the Piriformis becomes compromised if the pelvis is not in an ideal position or alignment due to other muscles not functioning properly. It may just need a little reminder of how is is designed to work properly throughout its entire range of motion, followed by some re-education activities.  A whole body assessment must be performed to truly identify if the symptoms in the hip and leg are from an injury to the actual Piriformis muscle itself, or if the symptoms are simply your body's way of getting your attention to help a bigger issue.

Over the past 16 years of Physical Therapy practice, this muscle has been the recipient of many of my treatments. Ever since becoming a Muscle Activation Techniques (MAT) Certified Specialist in 2010, I have changed my approach to assess for weakness and then specifically re-activate and correct the imbalances in and around the Piriformis, which has taken my clients results to a whole new level. I have to say that it is a whole lot more fun for all of us than the old way I used to treat, using my elbow to dig out the tightness, followed by a stretch. For those of you who worked with me prior to 2010 for your Piriformis issues, I do apologize for any discomfort I may have caused you.  I promise to make it up to you should you choose to try some new and improved Muscle Activation Techniques treatments... :)