This article is a transcribed edited summary of a video Bob and Brad recorded in June of 2021. For the original video go to https://youtu.be/bvezPgtmpsc.
Bob: Pain here? How to fix it in three steps. We’re talking about pain in your butt.
Brad: Ah, the ole’ buttocks.
Bob: This used to be called piriformis syndrome because there’s a little muscle in your butt called the piriformis. It’s a little muscle, it crosses over the sciatic nerve. The sciatic nerve goes all the way down your leg and that muscle can cross over the nerve and cause pain all the way down your leg. A lot of people think that it’s sciatica because it acts like sciatica, but you don’t feel any back pain along with it.
Brad: Right. They sometimes call it fake sciatica.
Bob: Right. Now as progress would have it, over time they have come to think that there may be more than one muscle involved.
Brad: I wonder who ‘they’ is.
Bob: Yeah, I don’t know. But there are other muscles, the gemelli muscles, obturator internus, and your hamstrings.
Brad: These are all little supportive muscles around your hip joint that are critical for supporting, but they can cause problems like this.
Bob: Now they call it Deep Gluteal Syndrome.
Brad: Ooh. Good choice.
Bob: A simple test on how to determine whether or not you have it. You’re going to lie on your side and do a clamshell with the painful side up.
Brad: So, you’re sidelined.
Bob: I lift the leg and you’re going to have a friend help you or your wife.
Brad: I’m going to push the leg and hold resistance.
Bob: If that increases the pain or sends symptoms down your leg, it’s a possibility you have it.
Brad: Right, it doesn’t mean you have it. But it is a positive sign.
Bob: You could also push on the hip and find a spot that’s tender, that’s very common. I always do this next one too. I have people lie down on their back and pull their leg across their bodies.
Brad: The knee to the opposite shoulder.
Bob: It feels tighter on that side.
Brad: So, you compare one to the other and it’s a noticeable difference. I’ve done that one with many patients.
Bob: Yup. It seems like it’s consistent on that. The other thing you might have a hard time doing is sitting. You’re sitting on that muscle. In fact, the last person I saw who had this, she was an accountant, and she sat all the time, of course. The pain was worse when sitting. The first thing you’re going to want to do is to decrease the pressure on the area. When you’re sleeping, I would sleep on the other hip. Take the pressure off it.
Brad: How about sleeping on your back?
Bob: You can sleep on your back, although your kind of hitting it close.
Brad: You’ll know. If you’re on it and it’s irritating it and you want to sleep so it’s not irritating it, you might want to put some pillows.
Bob: That’s right. So, with sitting, a lot of times if you sacral sit, do you know what that is, Brad?
Brad: On your sacrum. So, you’re slouching.
Bob: Yeah, you’re slouching. If you sit up straighter, you can maybe keep the pressure off that area.
Brad: Once again, posture, posture, posture.
Bob: Then, of course, standing. Don’t put all the weight on one side. So, we have found massage to be almost the most effective treatment for this.
Brad: You can combine it with the stretching.
Bob: Yeah, with the stretching. We’ll do stretches too. I have found you can’t do it with your hand, it just fatigues.
Brad: Well, you must get in deep because you’re going through your gluteus maximus and your hand's fatigue rapidly.
Bob: Generally, what we do is we start with a wide target around the whole sore area. Then we eventually narrow into the tender spot as you can tolerate it. Now we have a bunch of massage guns that work well. This is a tiny one we have and it’s powerful. This past weekend I had a bunch of friends at our cabin, and these are big guys, some of them. They all loved this. They were all passing it around.
Brad: I have a patient with a hip problem right now and he prefers that just because it’s easier to hold. Especially if you happen to have a hand problem, arthritis in your hands or something of that nature. If you’re a younger person and built, you will want to get the bigger one, the X6 Massage Gun with Stainless Steel Head.
Bob: If you have a lot of muscle, you want to use that one. Now, you can lie down and put a pillow between your legs and make yourself comfortable and just work that area. You will find the spot.
Brad: You’re going to do what’s most comfortable. I’ve done it where if you flex the hip a little bit, it kind of allows you to get into that area better and work it. So, the right leg is completely relaxed right now. I enjoy getting around that SI joint area. It’s always been a problem of mine and that’s very close. You’re going to work what feels good on the piriformis or that part we’re talking about. Like Bob said, you get right over that sore spot it might make you jump. Go around it and work your way into it. It may take a few days before you can do that.
Bob: Exactly. Again, I don’t know. Sometimes I wonder, Brad, if that muscle has been torn a little bit and maybe there’s some scar tissue around there.
Brad: It’s possible.
Bob: It seemed like that was the case with some of my patients. Then you’re going to stretch the muscle too. One way you can tell, Brad, if it’s tight or not, is you externally rotate your legs. If one turns out more than the other. You just sit there and go like that. Now look at mine.
Brad: Well, your left toe is going out and the other one not so much.
Bob: Yeah, I am a little tight into external rotation, my external rotator is pulling me out a little bit.
Brad: Either that or you have tibial torsion.
Bob: That’s true.
Brad: So, what I meant is you can’t always say that’s it, but you must look at and combine these tests.
Bob: What you do to stretch it, there’s a couple of ways. So, for you therapists out there, beyond 60 degrees of flexion, the piriformis is an internal rotator. To stretch it, we’re going to put it into external rotation. So, you do a figure four stretch. You bring your right leg up, I’m stretching the one on the left. I’m going to cross my left ankle over my right knee and I’m going to press down like this.
Brad: This should not create any sharp pain. It should just be a stretch, feel like the muscles are stretching the hip joint.
Bob: Now, the muscle is also an abductor. I’m going to stretch this way too. I’m just going to pull it over like that.
Brad: Lying on your back or seated up. Sometimes I’d pull with the other arm. You could do the pretzel stretch too.
Bob: Keep good posture.
Brad: There’s a lot of different little things you can figure out as you do it, you’ll know because it’ll be stretching it. What about the seated one? Does this count?
Bob: Yeah, because you’re in greater than sixty-degree flexion. That’s probably the easiest one to do is just to go ahead and do it that way.
Brad: When you put your shoes and socks on, give them a stretch.
Bob: All right, massage and stretch and hopefully it’ll go away.
Brad: I have had good luck with this.
Bob: I have had too, and it’s always been the massage that has helped these people in my mind. Remember, Brad and I can fix just about anything except for a broken heart.
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