ExRx.net

As a slight change of pace from all the shoulder threads we've been having, i figured i'd make a hip thread.

Late last year, i developed hip pain. I learned that the symptoms are consistent with piriformis syndrome. It's been a real... well, a real pain in the butt. I believe it was caused by the following factors, which are listed in the order i addressed them in:

1) Hanging Leg-Hip Raises-
These are primarily a hip flexor exercise, as it turns out, but i was doing them as an ab exercise. It's my belief that my abs became weak relative to my hip flexors, which were already tight from years of running.

Solution: I've stopped doing them, as well as all exercises involving spinal flexion, just to be on the safe side. I'm strengthening the abs with isometric holds. I also learned to stretch the iliopsoas muscles correctly. I'd been doing it wrong and not getting a good stretch. These things brought my pain down to a much more manageable level, but didn't get rid of it entirely.

2) Wide stance squatting/deadlifting-
This might not be a problem for most people, but i understand that it's bad for the adductors and external rotators to become stronger/tighter than the abductors/internal rotators. A wide stance squat emphasizes the adductors and externally rotating the hip excessively, which i was doing, emphasizes the external rotators (particularly the piriformis). So i think it contributed to my existing imbalances (or perhaps the necessity of doing everything with a wide stance was a symptom of these imbalances, i don't know). I do know that my adductor magnus muscles are tight because they are the limiting factor in my squat depth.

Solution: It took a lot of flexibility and mobility work but i've successfully narrowed my stance. I can't go as deep on the squat and my numbers went down, but it helped. I've also begun to do strengthening exercises for the hip abductors.

3) Dominance of the TFL over the glute medius-
I'm not sure what might have caused this, but my my basis for thinking it might be the case is here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888398/
I've begun to do TFL/ITB stretching and i switched from lying hip abductions with ankle weights to standing hip abductions using resistance bands. It's too soon to tell if this last step is working.

So as a result of these countermeasures i'm better but still not cured.

Some other things i'm already doing: glute activation before leg workouts, foam rolling (actually tennis ball rolling), paying more attention to posture/gait, and trying to get up from the chair and stretch every once in awhile when sitting.

So, here are the things i need help with:

1) How in blazes do i stretch my piriformis? I've tried every stretch on the main site and they all seem to either stretch the wrong area or hurt my knees. Some resources such as this one ( http://www.rice.edu/~jenky/sports/piri.2.html ) suggest performing what are, according to the main site, actually glute stretches. Which leads me to my second point...

2) Should i stretch my glutes? Some of the clinical guidelines i've read indicated it but i don't understand it at all. I thought most of us had excessively loose glutes from sitting all day.

Piriformis syndrome/pain becomes inevitable when the piriformis increases in size by ~40%. When the hip flexors become overly dominant (see #1 in conjunction with modern lifestyles' emphasis on hip and shoulder flexion) the gluteals shut down and other structures take on the brunt of hip extension/rotation like the adductors and the piriformis.

1) train more glutes. Bridges, weighted bridges, cable pull throughs, single-leg dumbbell deadlifts, etc.

2)


3) don't stretch the glutes. But stretch the hip flexors like it's your fulltime job.

_________________
don't you know there ain't no devil
that's just god when he's drunk

Ok, so i THINK i found a way to stretch the piriformis: http://www.exrx.net/Stretches/HipAdduct ... agnus.html

"Piriformis and Quadratus Femoris become stretched if hip is slightly transversely adducted (knee toward opposite side of chest)."

I can sometimes feel a stretch in my butt if i internally rotate my leg while transversely adducting it. It's my guess that this is the piriformis. Is this an acceptable way of stretching the piriformis, even though i feel it in the adductor magnus more? Flexion/adduction/internal rotation is one of the provoking tests for Piriformis syndrome. I tried this http://www.exrx.net/Stretches/HipExtern ... tator.html but it made my knee hurt (in the bad way) so screw that.

Thanks for your post, by the way, Jason. I'm already training my glutes, stretching my hip flexors, and foam rolling the entire pelvic area, but i'll take your advice about not stretching the glutes. I'm having to spend enough time stretching as it is!

I wanted to bump this thread. Commodius, any progress?

_________________
Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan