Two great stretches for the glutes and the piriformis

Here Matt Hsu of Upright Health demonstrates a glute stretch that hits the spot! Most stretches I do irritate my glutes. This one can hit where I feel real tight without the irritation the next day. The stretch starts a little after the 2:30 mark.



YogaJP starts with a similar glute stretch to the one Matt shows, but this more well-known version irritates my glutes. However, after the glute stretch she goes into a piriformis stretch (about 1:45)  that for some reason works for me. I don't know if it helps the hips or low back along with the piriformis, but this one feels good to me too!

Detective Work

I had planned on chickening out on the Thanksgiving morning Great Gobbler 5k in Nashua, but woke up and decided to endure it as I haven't raced a full race since last years Great Gobbler ( I did do a leg in the Mill Cities Relay last December and did the first loop of a snowshoe race -2.5 miles last January).  It didn't go well, but it went as expected. I set an all-time personal worst over the 5k distance. I was huffing and puffing, but my stride was way off and was very discouraging to realize how far out of shape I now am. The only good thing was that I looked at all the results printed from previous editions of the race on the side of the shed and realized I have raced in all editions of this race.  It is now my only annual racing streak left. Listing the results show a huge decline in recent years in my times. I hope it goes on the upswing starting next year as I don't like running like a turkey!

Great Gobbler race results:
2003 19:59 16th originally called a Nashua High School Alumni race.
2004 19:38 15th
2005 19:19  7th  (Awesome snowstorm during the race!)
2006 18:16  13th
2007 18:09  18th
2008  20:10 28th
2009 20:46 31st
2010 22:00 77th  (off the fumes of summer training)
2011 24:45 170th (Ouch- even got passed by a guy dresses as a turkey!)

Last week I only ran twice: this race and 8 miles on Saturday. My body isn't working right, so I don't feel like running.

I know something is off with my body and I am still working on figuring it out. The last few days have been helpful. I had an MRI for my lower back about 10 days ago. Yesterday, I went for the result. I was expecting to hear something about my disks and nerve problems. I was stunned when I was told my back looks really good. I have had left lower back problems since the mid 1980s so this was a weird result. It is good news to have a good back, but what next?

The following is more to clarify my current thinking and keeping it for future reference, so don't bother to read if you have even gotten this far. I tell my students that they should enjoy solving math problems as it is like detective work and they are going to be solving problems all their lives. I feel like I have spent half a life trying to solve the problem of my back and hip. So it is back to asking questions and looking for answers.

I was absolutely floored that my back looked fine and I realised that I forgot to ask more probing questions about the MRI results. They did sign me up for another appointment with another doctor for the week before Christmas. This is another physiatrist at The Spine Center in Newton-Wellesley. This doctor will be looking more a musculoskeletal problems. I was told they made look to do things like trigger-point injections if they find a problem. I would guess they they might find a problem in the piriformis area.

I had a couple of valuable internet interactions over the weekend that were very pertinent and thought provoking. The limiting factor in my running now is my left foot/ankle "tibial torsion" or rotation outwards. The Gait Guys commented on this in 2010 for me- although their response was on their previous website and is now gone. My foot seems to be stuck and angling out more, the left side of my knee is also "stuck" and has a twisty feel to it, and because of this my femur doesn't feel right in my hip (where I was operated on), and my lower back gets tight. I have been stuck in this position for over a month now and nothing I do gets me out of it.  The Gait Guys had a post last week on an external rotation in the foot. I couldn't answer on their blog, but I did have a Facebook conversation with them on this post. It was an interesting post as the externally rotated foot was seen as a "brain issue" where the brain maps out what is the best position in space for a body part to work in it's perceived "best position".

It is quite possible and reasonable to assume that a motor pattern is a natural mechanism for joint and multi-joint protection. Consciously trying to alter a motor pattern is likely to drive an improper pattern or one that is deemed unstable by the brain.


Scenario: client has right foot spun externally into the frontal plane by 15 degrees more than the opposite side.

In this scenario, this could be the reason why merely attempting to turn inwards a right foot that has drifted its way in time outwards does not hold even though it is clearly a deviation from symmetry. It is likely the fact that the brain, in such a scenario, has calculated that there is not sufficient stability in a more neutral symmetrical foot progression angle and thus has found the necessary stability in a more turned out position. As we have always said, subconsciously turning the foot outwards helps to cheat into the frontal plane, likely because that plane is less stable with a neutral foot and with the foot “kickstand” turned out, stability is achieved. Thus, engaging the foot better in that plane gives the brain and body the perceived and actual stability that it feels it needs to more naturally provide joint or multi-joint stability. (read more)

So I wanted to know "what to do about this"... and I was told firstly that,

"The labral tear does not surprise us and the "wanting to turn the foot out more" is most likely a compensation to avoid internal rotation of the hip and impinging on a labrum that isn't there. The fix depends on the etiology: does it start at the foot or is it from above down?"

Ahh, the question I have been asking for years! Their suggestion for me was to visit Tom Michaud who is a chiropractor in Newton and who has worked on many runners including those of international stature. It seems Tom Michaud just published a new and well-received book this year called Human Locomotion.

In the course of a year, more than 1.9 million runners will fracture at least one bone and approximately 50% will suffer some form of overuse injury that prevents them from running. Despite the widespread prevalence of gait-related injuries, the majority of health care practitioners continue to rely on outdated and ineffective treatment protocols emphasizing passive interventions, such as anti-inflammatory medications and rest.

If you start here and forward ahead to pages 8-9, that is a picture that pretty much looks like how my left leg works. The book is $100 and is written for doctors, so it is not something I would buy, but the parts online sure look interesting as it addresses abnormal gaits and even has a section on labral tears. Do I think this guy could look at the whole picture of what my body is doing? I sure do. So I called to set up an appointment. His office is just down the road from the Newton-Wellesley Hospital where I had my hip surgery and where I am going now to their Spine Center. I got a call into his office yesterday. He doesn't take my insurance, which stinks, but still I wanted an appointment. Seems he is a busy guy. I got the first available appointment. It is for April 19, 2012. Well. that is a bit of a wait!



This weekend I saw another interesting video on the piriformis. I guess since I don't have a back or nerve problem, according to my MRI, that this video is even more important, as I still have an extremely tight or knotted piriformis that can be aggravated by running. I left this comment on the site, because the doctor talks about a link between the piriformis and a foot turning out (hey,  my two problems):

I enjoyed the video and have a question. You said this about the piriformis: “Piriformis – this muscle extends from under the front side of the sacrum and attaches to the greater trochanter in the upper leg. The major action is to laterally rotate the hip as well as turn the foot out.” I am a long time competitive runner and my left foot turns out so it is not pointing the same direction as the knee. Could this be related to the pirifomis? I do have a lot of problems on the left side including a pain in the butt post runs, I had arthroscopic surgery to repair a torn labrum in the hip this summer, but the foot twisting out is always there (sometimes worse than others). I am curious about the pirifrmis’ effect on this or does the twist create the pain in the butt?

 

Dr. Gangemi wrote this in reply:

Hi Jim, yes I’d say that is exactly what is happening to you. The left foot would be the tight piriformis (could be your psoas too), with the right side being inhibited (“weak”). The twist is really not what is causing the pain, but the piriformis being too tight is causing both the pain and the lateral rotation – that puts a significant amount of stress on your labrum, hence your surgery.

It is interesting learning about the connection between the piriformis and my left foot as well as the resultant labral tear, But I really don't' want to wait until April to see Dr. Michaud or even the end of the month to have an initial visit at The Spine Center. Will they address the piriformis? Is there where I could get a trigger point injection? Will it help my misaligned left side?

On the way back from the hospital, it suddenly occurred to me what to do short term. Today, I set up an appointment with Dr. Dannanburg, the podiatrist who gave me shoe inserts and later orthotics for my functional hallux limitis in my 1st MPT joints. When I first got the inserts in the summer of 2010, my foot felt great, within a week I was doing a 65 mile week, which I soon bumped up to 85 miles. My leg had a new alignment. However, while I continued to run, my left hip got worse and worse till I had a full blown labral tear in less than two months and I couldn't run at all. My feeling is that my foot and leg were tracking better and my left leg couldn't compensate and "hide from" the torn labrum (which it had been doing for years).

I was thinking about my orthotics post surgery, my leg turn-out and misalignment is getting worse. Then I remembered that it just wasn't orthotics or inserts that Dr. Dannenburg gave me. He adjusted bones in my foot and ankles as well as my fibula. So I think I might need him to adjust my bones again, as several bones in my ankle, foot, and where the fibula joins the knee feel stuck or trapped. He doesn't take my insurance either, but he is a podiatrist who is known throughout the world for his work, so I set up an appointment and will see what he says and does next week. Hopefully, he can get me up and running again with his manipulations.

So it is all about problem solving. I can't tell if there is an end in sight, but I will keep trying to figure out how to get my body out the door and running pain-free again. Never give up!

Release the piriformis and stop jamming your hips

As I am recovering from the hip labral tear surgery, I am still learning new and useful things about the way the body works and correcting poor movement patterns. The book Foundation: Redefine Your Core, Conquer Back Pain, and Move with Confidenceis quite a revelation. I had been doing the basic workouts in the book for only two days and I have already noticed some positive things. As I mentioned on the previous post, I had only done 7 miles of running in the previous 2 1/2 weeks with no run over 2 miles. My body was basically saying, "Don't run like this!" so I didn't.

Yesterday, I woke up feeling aligned and moving well again, and so off I went for a run: an 8 miler and it was the best I have felt post surgery. Here is an explanation of probably the most important of the "Foundation" exercises. It is called the "Founder".



Notice how you press the hips back and where he locates the hinge point. This and the other exercises have already started their work. On the run, my piriformis did not hurt, something it has done on my longer runs, whether during the run or post run. I also noticed my hips are much looser and not jammed tight, as well as I was getting a nice rotation in the hips. These are new experiences for me! Of course, today I am sore, but for a change most of it is muscle soreness in the quads, like you get post Boston Marathon, so maybe I was using them more.

Today, I found these other videos which demonstrate the same lessons on using the hips and freeing the piriformis. They say things in a clear way. If you are having piriformis pain and tightness, maybe it is because you are "squeezing your glutes" and if you hips aren't working right, it is because squeezing the glutes might be jamming your hips. These videos are by Dr. Evan Osar at http://www.fitnesseducationseminars.com/free-videos. There are a lot of interesting videos here worth exploring.

This one shows proper femur postition during exercise and why you shouldn't squeeze your glutes.



In this one Dr. Evan Osar demonstrates  a squat exercise to create more motion and decrease tightness in the hips. This exercise incorporates proper core function during the exercise.



Dr. Evan Osar demonstrates exercises to begin working the piriformis for strength, endurance and stabilization.



Dr. Evan Osar demonstrates exercises for tight piriformis muscl


 Dr. Evan Osar demonstrates exercises to begin working piriformis for strength, endurance and stabilization.



Oh and after 2 days of working on this, I went to my PT session (after the 8 mile run). I was doing squats on a Bosu Ball with an exercise band around my knees to push out against. I was told I was doing excellent squats! I also showed the "Foundations" book to the PT and she said it looked excellent. She liked the exercises and how well the exercises were explained. She said it looked like the book that the FMS (Functional Movement Screen) people should have written.

What to do about that Pain in your Butt: Piriformis or Gluteus Medius?

There are so many things to be thankful for at Thanksgiving time. One thing that I am thankful for this year is that my back and hips have probably felt the best that they have felt in about 25 years. I can stand, sit, walk around, and go through my day without the pains that I have had since the mid 1980s. My daily life feels so much better. When I stop running for a few days it feels really good. At this point however, once I start running and particularly when I try to run fast it doesn't work so well. I seem to have lost a lot of the little bit of speed I had over the past two years.

When I do try to run fast my imbalances take over and the success I have had during the sedentary part of my day hasn't been accomplished yet. I am learning how to get out of the pain and tightness I have had in the past where once I get stuck or imblanced and my body would go through a week or two week cycle where I couldn't fix it. Now I can usually fix things in a day or two. That is all great and I feel I am on the right path to regaining some running success. One thing I have noticed this year is that after most track workouts or races my left gluteal muscles tighten up and I end up limping for a few hours or days before it calms down.

I had the same thing after yesterday's Thanksgiving 5K race at Nashua South High School. The gluteal and lower back region tightened up during the race and by the end I was limping and unable to even run a warm down. I am guessing that I get this due to my poor biomechanics and running with imbalances which leaves to a stress on the muscles. It comes when I run fast and demand more from my body in power and more specifically range of motion. So what to do?

First is a nerve flossing stretch that I really like. I previously wrote about nerve flossing here. I am working on things in my left foot and ankle that seem promising (haven't reported here yet) and that will give me more balance and effecient movement. As I make positive changes it does change the stress on the gluteal muscles (everything is connected) as I straighten up my stride. I have been trying a few new stretches and exercises for these muscles and thought I'd share them here. I am paying more attention to the piriformis nerve flossing stretch that I linked to in that post. For some reason, this time when I followed the video and did the stretch 20 times it worked a whole lot better. It seemed to be targeting exactly where I was tight so I will continue duing this one. Here is the video again:



Here is another stretch for the hip rotators and piriformis that I have never seen before. This one felt good too.



Finally, not knowing which muscle of mine is really being irritated: the piriformis, the gluteus minimus, or some other neighboring butt muscle, here is a good video explanation showing how to use a tennis ball to work on the gulteus minimus. You can use a tennis ball, a TPMassage ball, or a hard rubber ball. I use all three at different times.



Here is a good article on the anatomy of the hips and back and it shows how to use the TP Massage balls and rollers to loosen tightnesses and imblances.You could also use a tennis ball or a foam roller to do the same thing. I have had the TP Massage products for a couple of years and am learning how to responsibly use them (rather than beat myself up with them) through two of their DVD's that I recently bought. I got the Hip and Lower Back DVD and the Foot and Lower Leg DVD. Previously I had just used the Ultimate 6 book that they sold, but I work better when I see a video then read it in a book as I don't always pick up the subtle nuances and tend to do things to quick and too hard.

I ran the Great Gobbler 5k on Thanksgiving on limited mileage and no speed work and it showed. The course is a bit long (I see it is listed as a 5.25 K in the race results) and I ran 20:46 for 31st place and 2nd out of 47 in the 50-59 age group. It is a low key race so I don't think the splits and finish time are too accurate but at the one mile mark I was 6:07 and I was 12:10 at the two mile mark. Then I started passing people who had passed me in the first two miles. I was placed real well for the first 1/4 mile until Steve Wolfe bumped me at the corner around the purple shed and ruined my chance to run better and allowed 20-30 people to pass for a while! Anyhow that is 36 seconds slower than last year. It is also much worse than my 18:09 time in 2007 (shorter course) and my 18:16 in 2006. Did I really slow down that much in such a short time?

The Dorn Method: Can it be a simple fix for misaligned joints?

The past week my running wasn't going well. My left psoas continued to be tight as well as my left gluteus miniumus, piriformis, or something else back there that was real tight. I also had stiffness along the sacrum. It got that way last summer for almost two months and nothing I tried could ease the tightness. I knew I was headed in a wrong direction when I thought about using a heel lift again (never works-but who knows).

I was checking things out on the internet to see what else was out there: stretches were tending to make things worse. I came across something on Youtube that I had never heard of or seen before but it looked promising.

Hip Exercise




Sacrum Exercise





So I read what I could find and decided to check out further this Dorn Method. Seems it came from Germany and it is called a gentle relative to chiropractic and osteopathy. It was developed by and is touted as for non-medical practitioners. The founder meant for it to be shared freely and it can be used for self-help. Well that sounded a little different but I checked out the exercises and they seemed simple, gentle, and they made sense.

The exercises like many newer modalities involve movement and not just static stretching.The movement helps distract the muslces as you work on the joint. After reading about the method, I tried a few exercises and while they were nothing difficult, by the time I was done (just a few minutes) the tightness on my left side was gone and my leg was moving smoother. I actually felt movement within the left hip as I walked. The next day I felt fine again and when I did my run, I was running smoother than I had in over a week. In fact I noticed that my back and hip were not "stuck" so my quads and hamstrings were doing more of the running and were not hindered by the limited range of motion in my hips. Today I felt good but I didn't have a chance to run due to almost 12 hours of teaching, meetings, and workshops. I look forward to seeing if the exercises help compliment what I am already doing.

Some of the exercises (I did not do them all) work with movements similar to the joint mobility work I am doing, but the add a component of having a small force or pressure pushing on a joint or muscle. The self-help page displays many of the exercises. I also bought and downloaded the e-book here because it was less than $10 and I wanted to read what I could on the method and it was easier to refer to the exercises from a printout than on my computer screen. It looks like it may serve to unstick the joints around my hip and lower back and if it can do that it would be a great tool to know and use. I used the hip and sacrum exercises as well as the knee and ankle routines. I like that it is simple and sensible. The e-book also tells you what stretches and positions to avoid (some of them were ones I do to try to fix my back that seem to work at first but then throw other things off).