The Most Important Muscle You’ve Never Heard Of…Part 4 – The Piriformis

The piriformis muscle is a very important muscle that lies deep in your buttocks.  Oftentimes, runners are affected by stress and injury to this muscle, but it can definitely be a problem for everyone.  As seen in the picture above, it sits just on top of the sciatic nerve.  In approximately 15% of people, the sciatic nerve actually travels right through the muscle!!!  Could you imagine???  Anytime that muscle becomes inflamed or injured, pressure can be applied on the nerve causing a host of issues.

The main function of the piriformis muscle is lateral (external) rotation of the hip when the hip is extended.  Think of it this way…when standing, the piriformis acts to rotate your leg so that the toe points away from the body.  Other lateral rotators of the hip include the superior gemellus , obturator externus, obturator internus, inferior gemellus and quadratus femoris.  When learning these muscles in Anatomy class, we used this pneumonic…”please send out information quickly”.  P for piriformis; S for superior gemellus; O for both obturators; I for inferior gemellus; and Q for quadratus femoris.  When the hip is flexed, however, the piriformis has a different action.  It actually abducts the femur (thigh bone) meaning it brings the femur away from the body.  Abduction of the thigh with hip flexion is a very important movement during the gait cycle when walking by shifting the body weight to the opposite side of the foot that is lifted which prevents falling. 

Injury to the piriformis muscle can lead to trigger point formation.  When trigger points are formed, pain manifests.  The figure above demonstrates referral patterns of pain when the trigger points are active.  Also, depending on the severity of injury, an inflamed piriformis muscle can apply pressure to the sciatic nerve causing sciatica symptoms to occur.  This is called Piriformis Syndrome.  As seen in the figure, irritation of the piriformis can refer pain to the sacroiliac region of the low back which can make diagnosis of the syndrome difficult.  If the sciatic nerve is involved, you will experience pain down the back of the leg into the calf and maybe even all the way into the foot.  If the syndrome goes untreated, numbness, tingling and weakness may happen as well. 

Due to the action of the muscle itself, symptoms worsen with prolonged sitting and with activity…such as running, especially uphill.  There are a wide variety of risk factors that may increase the likelihood of developing piriformis syndrome:

- running
- sedentary jobs where you sit most of the day, especially in a chair where your knees sit higher than your hips
- having a longer second toe
- overpronation of the foot during the gait cycle (see the figure above – the arch flattens too much causing the foot to roll inward)
- one leg longer than the other which throws your pelvis off balance
- misalignment of your sacroiliac joint (GO SEE YOUR CHIROPRACTOR!!!)

There are also a wide variety of causes of piriformis syndrome:

- a direct blow to the muscle
- running
- sitting on your foot
- catching yourself from falling or other sudden muscle overload
- car accidents, especially when hit from the driver’s side
- twisting while lifting a heavy object

There are several different ways to attack piriformis syndrome.  There is not one treatment better than another, but combining treatments like moist heat, myofascial release, stretching and chiropractic adjustments  seems to help the most.  Moist heat helps to penetrate deeper into the muscle to promote blood flow into the affected area.  This can help to relax the tissue and speed healing times.  Apply the heat for about 20 minutes then you can move on to stretching and myofascial release.  Using a foam roller or a tennis ball are great ways to apply pressure to the existing trigger points to relieve the tension and relax the muscle, thus reducing symptoms.  Do this for a few minutes 3-4 days per week.  Stretching the piriformis can also help relax the muscle.  There are a few different version of the stretch so be sure to find the one best suited for you.  Hold the stretch for about 10 seconds.  You want to feel a light stretch without pain.  If you feel pain, back off on the stretch.  Always stretch both sides…even if only one side is bothering you!  Supplement these great at-home exercises with consistent chiropractic adjustments.  Not only will the adjustment help to realign the pelvis, it will reset your central nervous system and relieve pressure from nerves and improve the function of the muscles those nerves supply.  At Pro Chiropractic, we also have a state of the art dynamic gait scanning system that can help us to determine how your feet move throughout your gait cycle and allow us to create custom orthotics to fix any issues…such as over pronation!!!  We can also correct a leg length deficiency with orthotics by adding a heel lift if necessary. 

 

 

If you or someone you know in the Gallatin Valley area is looking for a chiropractor, please call Dr. Shea Stark with Pro Chiropractic at 406-219-2462 to schedule an appointment in our Belgrade, Manhattan, or Bozeman office.  Dr. Stark is a board certified chiropractor and the author of this blog post.  To learn more about Dr. Stark and the many benefits of chiropractic care, please visit our website: www.prochiromt.com.

 





The Most Important Muscle You’ve Never Heard Of…Part 3 – The Adductor Group

The adductor group, or more commonly known as the “groin”, is located on the inside of the upper thigh and consists of 5 muscles: pectineus, adductor longus, adductor brevis, adductor magnus and gracilis.  The main function of this group pf muscles is to bring your leg closer to the midline of your body or cross one leg in front of the other.  If that isn’t cutting it for you, think “Thigh Master”!  The Thigh Master works the adductor group and helps tone the medial (inside) thigh. 

These five muscles originate on the pubic bone and insert on the femur (thigh bone).  These points of connection dictate the movements these muscles perform.  Shortening of these muscles, or concentric contraction, bring the femur closer to the pubic bone thus creating the movement of adduction. 

The most common injury to this group is a muscle strain, also known as a groin pull.  Symptoms of a groin pull include stabbing pain in the groin area that may or may not radiate down the inside of the thigh, swelling and/or bruising, muscle spasms, and the inability to adduct the leg.  There are three different grades of muscle strain in the groin. 

Grade 1: Minor tearing of muscle fibers with mild discomfort and mild to no pain while walking.
Grade 2: Moderate (more than 50%) tearing of muscle fibers with swelling, bruising and moderate to severe pain with difficulty walking.
Grade 3: Almost complete to complete rupture of the muscle fibers and tendon with severe pain and inability to walk.

While the belly of the muscle can be injured, the musculotendinous junction between the belly and the tendon is thought to be the most commonly injured area of the muscle.  This can cause problems with healing because that area of the muscle has less blood supply than the belly so it does not get the nutrients needed to properly heal. 

How does one injure their groin?  There are several different mechanisms of injury for a groin pull including sprinting, quickly changing directions, overstretching the muscle, jumping or landing after a jump, running uphill and rapid movements against resistance (kicking a ball).  Sports such as ice hockey, soccer, football, basketball, rugby, martial arts, gymnastics, dance and track and field tend to have higher incidence of groin injuries.  In fact, about 2.5% of all karate injuries are groin related and between 10-18% of all soccer injuries are to the groin.  There are also factors that can increase the risk of an athlete pulling their groin.  Those include not warming up properly, preexisting weakness in the adductor group, previous injury to the area, tightness in the adductor group, biomechanical factors and lower back problems. 

Treatment of a groin injury can be tricky depending on the area of the muscle that is affected.  Injuries to the muscle belly, for example, are best managed with light stretching, a protocol of strengthening exercises and pretty quick return to activities.  Injuries to the musculotendinous junction, however, require a more conservative approach to treatment, including rest until the athlete is pain free, mild stretching and strengthening over several weeks, working their way up to running and sprinting then finally running and sprinting with quick directional changes. 

In the acute stage of injury (1-3 days), cold therapy such as ice can help relieve pain and swelling, as well as decrease bleeding within the muscle that causes bruising.  Rest is also recommended during this time.  It is important for the athlete to seek professional treatment following a groin injury to help guide them through their recovery.  Chiropractors, especially those who specialize in sports medicine…like most of us at Pro Chiropractic…have many different tools to aid in recovery.  Modalities used at Pro Chiropractic to promote healing include:

~ Electrical muscle stimulation to help relax and potentially rebuild injured muscles

~ Therapeutic ultrasound provides deep heat into the tissue to relieve pain

~ Soft tissue mobilization techniques (i.e. Graston Technique, fascial manipulation, myofascial release, etc.)  can help guide the healing muscle fibers to lie in the proper orientation to avoid scar tissue formation and trigger points

~ Kinesiology tape to decompress the injured tissue and promote blood flow to the area which aids in healing by bringing the proper nutrients to the injured muscle

~ Therapeutic exercises and stretches to actively involve the athlete in their recovery away from the office

If you or someone you know in the Gallatin Valley area is looking for a chiropractor, please call Dr. Shea Stark with Pro Chiropractic at 406-219-2462 to schedule an appointment in our Belgrade, Manhattan, or Bozeman office.  Dr. Stark is a board certified chiropractor and the author of this blog post.  To learn more about Dr. Stark and the many benefits of chiropractic care, please visit our website: www.prochiromt.com.