Category: Uncategorised

Sports Injury, Sports Massage, Uncategorised

Piriformis Syndrome – a pain in the bum!

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The piriformis is quite a small muscle located deep within the buttocks but it can cause quite a lot of pain if it is injured or inflamed.

Piriformis syndrome is common in runners and cyclists, especially if they have a desk-based job or do not have an adequate stretching regime.  It can also be caused by sacroiliac joint issues or hip problems.  Pain deep in the buttocks (usually one sided) that worsens when sitting for long periods of time, especially on hard surfaces, could be piriformis syndrome.  Sometimes it can trigger sciatic symptoms with pain radiating down the leg.

So what is the piriformis muscle?  The piriformis is found under the gluteus maximus, it connects the sacrum (or tailbone) to the femur (thigh bone) and it’s function is to rotate the hip outwards.  Underneath the piriformis muscle is the sciatic nerve.   The sciatic nerve is the longest in the human body.  It originates in the lower back, passes under the piriformis muscle and down to the lower leg

Overloading the piriformis muscle causes it to spasm, tighten and/or swell, this puts pressure onto the underlying sciatic nerve. The pressure on the nerve causes the radiating pain in the back of the leg and sometimes right down to the foot.

Treatments.

Massage Therapy– deep tissue treatments such as trigger point release can help reduce the tension in the piriformis and reduce pain levels.  For those wondering about the practicalities of massage in that area, I work through a towel!  Massage on the hamstrings and general glute area can also help relieve piriformis pain.

Injuries and pain do not happen in isolation and the body will find ways to adapt, these compensation patterns can cause issues elsewhere.  With piriformis syndrome pain in the lumbar spine, mid-back (on the opposite side), sometimes even up in to the base of the skull (causing headaches) can occur. During a massage treatment these compensation issues will also be addressed

Initially massage treatment weekly is recommended, once symptoms start to improve the frequency can reduce.

Ice and Heat– sometimes an ice pack on the affected area can help as can alternating an ice pack with a heat pack.  Make sure you don’t apply either pack to bare skin and keep the total treatment time to a maximum of 20 minutes in one session.

Stretches– It is important to increase the mobility of the glutes and piriformis with daily stretching.   Warm up for 5 minutes before starting.  Hold each stretch for around 30 seconds, and repeat 3 times on each side.  Focus should be on the affected side but it is also important to stretch the other side as well to address any compensatory issues.

Glute Stretch.  Laying on your back with knees bent, cross one leg over the other, pull both legs up by clasping your hands behind the knee.

Seated Glute Stretch.  This is a very useful exercise as it can be done pretty much anywhere, if you’re desk-based you can do this one at your desk, ideally try to do it several times throughout the day.  Sitting on the edge of the chair, cross one ankle onto the other knee.  Making sure the torso is lifted, lean forward until you feel the tension in the glutes, use the elbow to gently press the bent knee outward.

Pigeon Pose.  Start from all fours (on hands and knees), bring your right knee forward and place it more or less behind your right wrist. Place your ankle somewhere in front of your left hip.  Slide your left leg back, straighten the knee and point the toes. Make sure your leg is behind your body and not drawing outwards and your heel is pointing up to the ceiling.  Keep your hips square.  Gently lower your upper body towards the floor.  This is quite a challenging stretch at first but it is very good for hip mobility.

Seated torso twist.  Sitting up on the floor with both legs straight in front, cross the right leg over the left with the right foot on the floor.  Slowly rotate the body placing the left elbow onto the outside of the right knee and place the right hand on the floor for balance.

Strength work– Strengthening the glutes and hip can help to reduce symptoms and prevent reoccurrence. Pilates or yoga are very good all round workouts that will help improve strength and flexibility.  Specifically exercises like the bridge, clam shells and squats will all help to improve strength.

Ongoing Prevention.

It is important to continue stretching to prevent the pain returning.  For runners it may be worth getting a gait analysis to see if there is any underlying biomechanical cause and for cyclists a bike fit.  Strengthening the glutes and hips is also important to prevent reoccurence.

If you have a desk-based job then try to stand and move about more during the working day.  This will also help to prevent back and neck pain and is just generally good for you.

Feel free to leave comments or questions below.

Ankle Sprain, Sports Injury, Sports Massage, Sprain Rehabilitation, Uncategorised

Ankle Sprain Rehab

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I had been debating what to write about for my first blog post but my son’s recent ankle sprain has inspired me to cover this topic first. His sprain was diagnosed by a doctor at a minor injuries unit but unfortunately he was sent away without any information on rehab or exercises so I thought this was the ideal topic to start with.

In this case it was a poorly timed jump at the trampoline park but an ankle sprain is a very common injury and can happen while playing sports, walking on uneven ground, running or sometimes simply slipping – particularly common during the icy weather at this time of year.

The most common form of ankle sprain is an inversion sprain where the weight of the body is put on the outside of the ankle, damaging the ligaments on that side of the joint. This type of sprain can also damage the muscles on the outside of the leg, the peroneal muscles.

If you twist your ankle it is important to get it checked out by a medical professional to rule out any fractures. Once a sprain is confirmed it should be treated as follows.

The first 3 days are known as the Acute Phase and the advice is to follow the PRICE protocol.

  • Protect: Prevent further damage to the ankle by resting as much as possible and using an ankle support or taping to stabilise the area. Be especially careful of any side-to-side movements. Weight bearing should be introduced once pain levels allow.
  • Rest: No dynamic activities such as running, sports etc. If possible try to minimise the amount of time standing.
  • Ice: 15 minutes per hour for the first day, then 4-5 times per day from then on. Do not apply ice directly to the skin, wrap in a towel or use a proper ice pack. Do not apply for more than 15 minutes at a time.
  • Compression: a mild compression bandage can help reduce swelling but care must be taken not to reduce the circulation to the area.
  • Elevation: Elevating the ankle can assist with lymphatic drainage and reduce swelling.

 

Betwen the third day and approx. 3 weeks is known as the sub-acute phase. It is important at this time to start mobilising and strengthening the ankle joint and the surrounding muscles and improving proprioception.

Continue with the PRICE. Hot and cold therapy can be introduced, apply a heat pack for 1 minute then an ice pack for 1 minute, repeat this cycle 5 times, 2 times per day.

If the pain levels and swelling allow then ankle mobility exercises can be introduced.

Active plantar flexion and dorsiflexion. Sitting on the floor, legs straight out in front, slowly point the toes down and then up (within the limits of any pain). 20 repetitions, 5 x per day.

Basic proprioception – This should be done while partial weight-bearing at this stage. Balance on the affected leg with your back against a wall for support. One minute, 5 x per day.

Inversion and eversion. Slowly turn the feet so the soles point outwards and then inwards, within the limits of pain. 20 reps, 5 x per day.

No running, or other strenuous activities. Exercises in water can help to disperse swelling but no actual swimming as it puts too much strain on the ankle, a pull buoy can be used to support legs and use only the arms to get a workout. General fitness levels could also be maintained using an exercise bike and possibly some weight machines in the gym. As before, try to minimise standing during the working day.

 

After a few weeks and as the ankle mobility improves and pain levels reduce you can increase the resistance and add in further strengthening exercises.

Active plantar flexion and dorsiflexion. As previously described. Then once this becomes easier (and assuming no pain) you can add resistance. Sitting on the floor use a resistance band around the foot and secured to a fixed object while pulling the toes up towards the knee. Then place the band around the ball of the foot and hold it in your hands, point the toes down. 20 reps of each 3 x per day. This will increase strength.

Active inversion/eversion. As previously described. Once this becomes easier can add in rotating the foot around clockwise and anticlockwise, 5 times each way. Then progress to resisted eversion and inversion. Resistance can be provided by using a wall or chair leg, try to turn the foot outwards against resistance, hold for 5 seconds, rest for 3 seconds. Repeat 3 times and gradually build up to 10 reps. For inversion turn the foot inwards against resistance, reps as before.

Calf raises. Standing with feet hip distance apart, smoothly rise up and down on the toes. Start with 10 reps and then build up to 3 sets of 10 reps 3 x per day. Once this is easy try on one leg only, starting with low reps and building up again.

Basic Proprioception – Initially this should be done with support available (so standing close to a wall), stand on the injured leg for one minute, eyes open. Once this is easy progress to one minute with the eyes closed. Then progress to adding in arms movements, hold arms out at shoulder level, bend each arm at the elbow towards the body and then back out.  Once the basic proprioception exercise is found to be easy then you can progress to using a Wobble board.

Stretching – It is very important to stretch all the leg muscles, calves, quads, hamstrings, glutes especially after any workouts.

 

The link below gives some good advice on stretching.

http://sprintphysio.co.uk/patient-exercises/leg-hip-knee-and-ankle/lower-limb-stretches.html

 

It can take between 4 -12 weeks for an ankle sprain to heal depending on the severity of the sprain. Sports massage can help by providing pain relief and helping with muscle rehabilitation. Patience is essential however. It is important to listen to your body and only return to running or other sports gradually and not rush the recovery process.

There are many resources on the web giving exercises, stretches and rehab tips for an ankle sprains. I have put some links below to sites I have found particularly useful.  I hope you find this information useful, please feel free to comment or pass this information on.

http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/sprained-ankle

https://www.active.com/fitness/articles/12-ways-to-build-ankle-strength-for-top-performance