My 50th birthday falls on the weekend of the 2014 Disney World Marathon. It has been my dream to celebrate by doing Goofy's race. Unfortunately, I have been struggling with piriformis pain since my last marathon, two years ago. Is my dream a wash, or could it be possible with careful training, lots of massage and plenty of ice baths? I am willing to try just about anything to make this dream come true.
Regards
Cindy
Dear Cindy,
The piriformis muscle can be a real bugger for runners and a very common source of pain. It is often the victim of abnormal mechanics, so the cure lies in finding the culprit. The muscle is located in the buttocks and is part of a group of muscles that are labeled the lateral rotators. The individual function of the piriformis is hard to separate from its mates, but it is located in a position that can irritate the sciatic nerve so it often takes the blame for a group of muscles that are not functioning well. I think of the muscle group as the set that turns your foot out from the hip when you are standing. This external rotation of the hip is only part of the role for these muscles.
For efficient running, the pelvis has to be held in a stable position during the foot plant phase. The piriformis muscle contributes to the stabilizing forces the keep the pelvis level. If the piriformis and its crew do not fire on time and in concert, the pelvis drops on the side opposite the foot plant. So this group of muscles is working hard during running to keep the pelvis level and the running motion most efficient. If the muscle group is not conditioned for the repetitive load, pain follows.
The piriformis is often a victim of too much, too soon. That is, the muscle is asked to do more than it is conditioned to do and it gives way, resulting in a chronic strain that cannot heal under its current load demands. The piriformis also takes a beating when the pelvis is not in its normal alignment, much like car tires wear abnormally when the alignment is off. Simply putting the pelvis into its intended alignment will often take the piriformis spasm and resulting pain away.
Many physiotherapists in Canada are trained in manual therapy and are good at getting the pelvis alignment and motion back on track. Finding a “physio” with a running interest and good manual skills may help you recover your running form. That would be a good place for you to start your evaluation and hopefully get you on the road to Disney for your 50th birthday celebration.
Cheers,
Bill
Have a question for the Sports Doc? Email him at sportsdoc@rodale.com. NOTE: Due to the volume of mail, we regret that Dr. Roberts cannot answer every email.
