In the process of getting my butt kicked it kicked me back. Piriformis pain hurts! I have never really had any piriformis issues but my lower head got so pissed off last week I was seriously worried. What started as mild tightness led to right down pain after a leg workout. Not only my piriformis but the outer head of my hamstring attachment also got flared up. Have you have had a swollen butt cheek? Well not only is it ugly it's painful. I didn't get any sciatic stuff probably because it was more in the lower portion of the piriformis. Last Thursday's 10 mile run was darn painful and I found myself dragging my left leg along to the finish. All the downhill running was awful. It hurt so bad with every step. The flat stuff was not good either but manageable. When I got done and home I got busy. I needed information and I needed it fast. Here is what I found and it hits the nail on the head for me.
The obvious cause of piriformis syndrome is overuse. Ultra runners are a walking overuse injury. I know there has to be more to it. Since I haven't suffered from this kind of pain before and I have run a lot miles and at times overuse would be an understatement I knew there was another reason this hit my like a brick.
First ah ha: The movement pattern. The piriformis can get pissed when you do 3 things:
1. When the thigh bone swings too far back (hip joint in hyper-extension). Check! I do this and have blogged about it before.
2. The knee pointing too far outward (hip joint lateral rotation). No! I think I tend to do the opposite more.
3. Thigh bone swung too far out to the side (hip joint abduction). Not sure, so I would say this is not an issue for me.
Part 2 of the movement pattern theory is:
1. Glute Maximus is slow to activate leaving the piriformis as the sole workhorse for rotational movements of the hip.
2. The pirifomis muscle is being asked to do its solo effort working over a shorter range.
This movement theory is really interesting and part 1 causes part 2. So far I think I only do one of the bad movement habits. But, there is another part of the movement pattern and that is postural issues. The postural issues that most likely aid in a poor movement pattern are:
1. The shoulders are behind the line through the back of the butt hence "sway back". BINGO! That is me. With my natural anterior tilt to my pelvis and my years in the weight room I can have a sway back position while running. In my attempt to stand proud with my shoulders back which is a requirement for proper lifting form I have taken that a bit to far. Finding that neutral pelvis is always hard for me but now I have added a very proud chest resulting in the exact issue described here. I knew I was doing this especially on my downhill running. Well now I need to STOP doing it.
2. The gluteal development is poor, "flat butt syndrome". NO! I may have a bit of weakness in some of glutes but overall they are strong. I don't think this applies to me.
My action plan started on Thursday because I knew if I didn't get a handle on it was going to be a full blown injury. Not simply the piriformis but the compensation due to the pain was setting in my outer hamstring head. That was causing some serious pain as well. I started with some mild stretching but not over stretching the already limp muscle. I did not stretch my hamstring but instead rolled it out with a roller and sat on a massage ball which was positioned right in the sweet spot of my hamstring attachment. I cut short my track workout when I realized the lack length in my hip and hamstring along with the pain was not worth the workout. I trigger pointed the lower head of the piriformis with roller and my thumper (electric thumping device). I sat on ice 3 times a day for 20 minutes with 1.5 hours off. The inflammation and pain got better and last night I did some hip and gluteal exercises to help re-connect those muscles with their action and my brain. I also took Advil on my long run Friday. It's been at least 2 years since I have resorted to anti inflammatory stuff but I felt it better to dull the pain and not compensate. I still felt quite a bit of pain on the downhills but it was doable. With last Thursday's run being a 7-8 on the pain meter meaning my mouth would occasionally water it hurt so bad to today being a 2-3 I think I have made progress.
Watching my sway back positioning is key along with the hyper striding especially on the downhills. I sure hope I have dodged a bullet here but thought I would share the info. I found. The article on www.easyvigour.net which outlines all of this.
Despite the pain in the butt, which I deserved, training has been good. Absent the un-productive track workout I am getting stronger on the trails. I am ready for Chuckanut and excited to race. I have run this race 2 times and need to go back and dig up my best but I think it's somewhere around 5:40ish. I am hoping to better this but I remember being in pretty good shape when I ran it last. Plus I had Kris to chase but this year I will have Cheri to chase.
I have been eating non-stop! All great food an my body is digging the higher calories and the abundance of carbs. I have moved to almost all fish for protein. I used to eat tons of chicken but felt so bogged down in the digestion. Since I like to keep my lean muscle I need the protein. Fish is quick to digest so I can get more food in. I have grown a love for salmon and cod. If you have asked me a year ago about fish I would have scrunched up my face big time. The benefits are too good to pass up. The bonus is Alex loves fish, Bill not so much but he's coming around :). For me the issue while training hard is to feed myself enough food to sustain my training and fat loss. Pizza and hamburgers are not part of the plan. :) I made some other changes I am finding beneficial with food timing. Adding fruit at just the right times, recovery drinks directly followed up by a well rounded meal is helping. I am drinking a fair amount of BCAA's because along with running I am doing at least 4 weight workouts. Cheri gave me the book, "Racing Weight" and I have just started it. I am curious to see how the theory differs from the one I follow now.