Here’s a great question that came in for the recent MTA podcast episode on Injury.
In this Q & A, I discuss Active Release Therapy (ART) and the importance of getting to the root cause of Piriformis Pain.
The Piriformis is a very important muscle in the buttock region. It helps to stabilize the pelvis and femur (the long leg bone) and rotates the leg outward.
It is also a common location for pain!
Treating Piriformis Pain with Active Release Therapy
I am a Masters runner (53 years of age) and have been running since grade school. Over the past couple of months, I have been having issues and have been getting ART treatment for Piriformis Syndrome. I have had 5 treatments. I do prescribed stretching, rolling, and exercises. Plus, I stopped hill runs and speed work.
However, while it is slowly getting better, it is not responding to ART as quickly as other issues. Because of this, I decided to back way off on my miles (once or twice a week and only about 15 miles total) to see if that will help it heal.
Do you know if there are other treatments that work better than ART for Piriformis Syndrome (e.g. dry needling, ultrasound, etc.)? Thanks! -Greg J.
Dr. Ben’s Answer
Thanks for the question, Greg! For those unfamiliar with Active Release Therapy (ART), it was first patented by P. Michael Leahy, a certified chiropractic sports physician. It’s used for a wide array of pain conditions. ART is basically a proprietary form of deep tissue mobilization and myofascial release techniques. It works by manipulating soft tissue and lessening stress placed on joints and nerves in order to reduce pain.
Greg, it sounds as though you’re utilizing many techniques to help get the pain under control. ART, foam rolling, and ultrasounds are all possible ways among many to help to reduce the pain you feel in the piriformis region.
The issue with all of these techniques is that it doesn’t sound like you are truly getting to the actual cause of the pain. What about your biomechanics is leading to an increase in piriformis pain? Until you address the causative factors, the pain is likely to linger.
I’m not a fan of using ultrasound or dry needling as treatment options for piriformis pain in this particular case. I am not aware of any conclusive research that either modality is particularly effective for piriformis pain.
I have found that for most people, including runners, the three most common risk factors for piriformis pain are as follows:
- Poor Sitting Posture
- Lumbar Dysfunction
- Gluteus Medius Weakness
The first two risk factors are common among the entire western population. For runners, weak gluteus medius muscles are often the culprit. The function of the gluteus medius is to help stabilize the pelvis when weight bearing and to externally rotate the femur.
When this muscle is weak, it will fatigue as you run. As the fatigue worsens, other muscles, such as the piriformis, attempt to help compensate. The compensation for a weak gluteus medius is what usually starts the pain and trigger points in the piriformis.
- Find the root cause of the piriformis pain.
- Address the three most common risk factors for piriformis pain and particularly, work on gluteus medius strength.
- Continue with treatments such as ART, stretching, and foam rolling to help with temporary pain relief.
Greg, I hope that helps. Good luck!
Photo credit: Beth ohara~commonswiki
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Resilient Runner Program
For those who want to dive deeper, the Resilient Runner program includes detailed videos and rehabilitation guides on how to effectively SELF-TREAT each problem area of the body including lower back and piriformis pain.
Are you struggling with a running injury?
The Journal of Sports Medicine published a study that showed that the overall yearly incidence of running injuries is between 37-56% with rates varying between men and women. Other research articles place injury incidence rates as high as 70%.
Overuse running injuries are typically due to controllable variables. A vast majority of these injuries could then be considered preventable! However, rarely do runners know that they are about to commit a training error that will place them on the path to injury and pain. This ultimately leads to lost training days, missed races, and unmet goals.
That is why Trevor, Angie and I have created the Resilient Runner program. It’s designed to help you prevent and avoid injury so that you can continue to train and compete in order to meet your goals. If you do sustain an injury, you’ll be able to refer to in-depth information on how to quickly recover from all of the most common running related injuries.
Thanks Dr. Ben!
I have been doing different stretches and exercises prescribed by the chiropractor that performed the ART (glute bridge, clams, and side lying leg raises). Based on your comments, I went and searched on additional exercises for strengthening the gluteus medius. I now added these my rotation.
* Monster walk
* Side plank
* Hip Hitch
* Wall press
* Single leg squat
Thanks again for your insight!
Greg, sounds like you will have the strongest Glut Medius in 3 counties. Seriously though sounds like you are on the right track. Curious as to how the results are? Those are all great and effective exercises. I particularly like the single leg squat and Monster walk.
Hi Dr. Ben:
Just wanted to leave you a quick follow up. Doing 2 or 3 of these exercises every day along with twice a week leg weight workout (squats, deadlifts, leg press, lunges) has helped a lot! Since I am in a bit of an off season from running, I didn’t worry if my legs were a little sore. I would just scale back my running.
After a month I have started doing speedwork at the track again and I have very little pain. Sitting for long car rides is still troublesome, but even that is getting better.
Thanks for your suggestions! I feel I am now ready to start my fall ramp up in preparation for Dallas Marathon on Dec 10th.
Greg, that is fantastic news. Glad to hear you are on the mend. As best you can try to keep up with weight lifting as you taper back up the miles. If your working with a coach try to have them work that into the plan. Usually 2 days a week weight lifting will be sufficient, and keep with the back exercises. Good luck in Dallas!