Piriformis Muscle
Runners often come to our office complaining of glute tightness however they are dealing with tightness in the piriformis muscle. The piriformis muscles lies beneath the glutes and is responsible for external rotation of the hip as well as stabilizing the pelvis during running. Too much tension in the piriformis can result in localized pain or pain that radiates to other parts of the body because it impinges the sciatic nerve. The most common cause of piriformis issues is glute weakness. This is important to understand because distance runners often have poor glute strength specifically because of the lack of glute activation during a runners training. The amount of time spent seated at a desk factors into this as well. This weakness results in compensation by the piriformis to facilitate the actions needed by the glutes.
Symptoms of of piriformis issues can range from point/localized tenderness to pain that mimics a herniated disc. When pain begins to radiate it is diagnosed as Piriformis Syndrome.
Recommended treatment for piriformis issues include manual therapy techinuques such as Active Release Technique, stretching, self-myofascial release(video above) and glute strengthening. In regards to glute strengthening it is important to target both glute max and glute medius. Basically movements should include extending the hip and abducting the hip. Strengthening should also focus on muscular endurance over muscular strength. High reps vs. High resistance. Examples of these exercises include side lying hip abduction in various planes, kick backs, bridges and monster walks.
It is very important to ensure that there is glute activation during these exercises and you are not simply bypassing the glutes and utilizing the hamstrings and piriformis to carry out the movement.