Well, we have gotten there again – the last Thursday of the month. This is going to be a long entry, instructors, so buckle up. Last week, I started to explore dysfunction in the piriformis, and today, we will examine what might cause it, as well as looking into solutions that we have at hand as Pilates instructors.
To start, if you have client who is experiencing chronic gripping of the piriformis, begin to take a look at the musculature around it. Overusing hamstrings, as well as improper glute firing (squeezing in the lower fibers, inhibition that manifests itself as either turned on or turned off all the time) puts an unhealthy pull on the piriformis. This can also be caused by a pelvic rotation, including intrapelvic torque. Move out and down – what are the feet doing? Both pronation and supination can create changes up the entire chain of the leg and alter the demand placed on the piriformis. Keep in mind that any of these things can be unilateral or bilateral, and unilateral piriformis pain is often in response to dysfunction on the contralateral side. Finally, a piriformis that is tight, chronically engaged OR chronically on length (there we are with a pelvic rotation again!) can start to effect the sciatic nerve which becomes tethered down, preventing proper gliding. None of these things are comfortable, but we do have tools to begin to help to offload and restore proper piriformis function.
Posterior Muscles of the Hip
The goals here are to restore balance by working symmetrically through the body. Start with the feet and work up the chain, investigating and creating proper joint/load distribution. It is essential to work on both form and force closure balance, and to work towards creating a neutralized pelvis. It can be a mistake to avoid external rotation in the hip even with piriformis syndrome. Rather, we want to stabilize the pelvic bowl, and restore optimal alignment through all planes – front/back and side/side including through both sides of the pelvis. Finally, creating balance through the hip musculature as a whole will help the piriformis immensely.
And this is where the fun starts! There are many Pilates exercises that we can do to work towards the goals listed above. On the reformer, we can begin with Second Position footwork, working our client through lateral rotation. Get them on their side and try Sleeper, including the modification with the extension strap from above. To challenge stability and balance, try Frog during your feet in straps series, encouraging proper joint alignment and bilateral firing. Ankle Exercise on the chair is another great one for working on alignment. Finally, on mat, get some extension with Swan Dive prep using the arc barrel to support the lumbar and pelvis. Another great one is Single Leg Extension with assistance – have your client lie flat on their belly with their hands under their forehead. Place a small therapy ball beneath the gesture leg to give good tactile feedback while they work on their terminal extension.
Single Leg Extension
Any questions? Feel free to email or comment, and make sure to check back next week for a whole new muscle!