Piriformis/deep gluteal syndrome


**Transcript**

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Hey, Dr. McNamara here coming at you guys with a wellness Wednesday. Today I wanted to talk about something that's been a real pain in my butt for the past couple days. Literally I've had this pain in my left gluteal region for the past couple days due to running and the term for this type of pain used to be known as piriformis syndrome.


More recently the terminology has been changed to deep gluteal syndrome, which is more of an accurate term because there are multiple structures that could be compressing the sciatic nerve, which is what piriformis syndrome essentially is, which is compression of the sciatic nerve from the piriformis muscle. The piriformis muscle is a muscle that causes external rotation of the hip and its originates at the sacrum, and then inserts into the greater, trochanter of the femur.


Now, the reason why this may cause pain in certain individuals is due to the different anatomical variations that can occur in the piriformis muscle. For about 90% of people, the sciatic nerve goes underneath the piriformis muscle. And most of the time it doesn't cause any issues unless there's damage to the piriformis muscle or one of those deep gluteal tissues, but in about 10 to 15% of people, they could have piriformis syndrome due to the sciatic nerve splitting directly into the piriformis muscle, or it can kind of split some goes over top of it and some also goes through that muscle as well, or even underneath. There's a few different variations, but more commonly goes underneath in normal anatomy.


So if you're having this type of gluteal pain, it may even be traveling down your legs, similar to sciatica, but the cause of it's not gonna be in the back. It's actually in that hip. So to loosen that muscle, to reduce the compress. First thing we want to do is do some foam rolling and to foam roll this spot. You really just want to just do some self massage and focus on those sore areas and just kind of hold there.


Another great option is a double lacrosse ball or a tennis ball. It can get a little bit deeper. That's what I prefer, cuz it is a very deep muscle. But we're also gonna wanna stretch it. So there's a few ways we can stretch it. You maybe have to start somewhere like here, or maybe even on a chair, it might be easier for some of you with a lot of this pain. If you just kind of sit up on the chair and then lean forward, you'll start feeling that stretch in that gluteal region.


It feels really nice after you start getting a little bit more range, you may want to work onto the supine stretch where you pull in a little bit more, get a little bit more stretch outta that. You can kind of curl up too, get a little bit of flexion in the hips.


Another great way to free up that sciatic nerve when it's getting compressed is doing some nerve tensioning or nerve flossing. I've had some videos on that in the past, but just to show you quickly, the idea would be, it would be tensioning keeping that foot dorsiflexed, and then there would be flossing, which would be the opposite where we would extend a toe.


Another great way, which I also really like is it's 90, 90 position, which you can start leaning forward. And then as that pain gets away, you can start doing things like pails rails to fix the muscular coordination of that muscle so we don't have any symptoms like this again.


That's all I have for you guys today. Enjoy your week.