Ask the physio: Piriformis syndrome

Getty Images

The issue: Neural tension

Strain on a nerve at rest and during movement is more common than you think. Nerves need to share an extremely small space with muscles, fascia, bones, blood, lymph, ligaments, fat and tendons. To work properly, they need to be able to slide and glide between these neighbouring tissues. Anything that reduces the space, be it swelling, prolonged muscle contraction or boney joints, can cause a plethora of symptoms, including numbness, pins and needles, and pain. The most common issue for runners is piriformis syndrome, where a tight piriformis muscle (located deep in the buttocks) causes compression on the sciatic nerve as it passes under the muscle before travelling down the leg; this causes pain, tingling and numbness in the buttocks.

How it affects form

Neural compression leaves you feeling like you have a limb that isn’t your own. You don’t feel in control, stride length is reduced, pain is present almost all the time and you are unable to push the pace. Your body will try to offload the compression: you may arch your back, overloading the hamstrings and hip flexors; or you may try leaning forward, which gives your calf muscles more to do. The worst side effect may be leaning to one side, causing more pain to your lower back and glutes.

The test: The slump test

Sit on a bench or chair. Put your hands behind your back and slump forward from your chest as far as you can, then bend (flex) your neck forward and down to your chest and lift one leg up – toes pointing towards you – until you feel a pull along the glute to the back of the knee. If this brings about your pain sensation then it’s likely there is a nerve issue. Lift your head slightly and see if the pain or pulling feeling eases. If it does ease then it has to be a nerve problem: only the nerve is moving if you lift your head; the strain will still be at the glute and hamstring. Use this test to, in effect, ‘floss’ the nerve by adopting the position and lifting your toes at the same time as you lift your head. Hold for three seconds, then lower your chin and your toes at the same time. You are flossing the nerve along its route between the muscles and other soft tissues. This constant movement frees the nerve and allows it to glide again, reducing the compression and, in turn, relieving your symptoms. Try these exercises to improve flexibility and avoid the problem.

1. Piriformis stretch

From a press-up position, fold your right leg up so the knee lies below your left shoulder. Lower down and press your hips to the ground so your weight is on your right buttock. You’ll feel a pull in the right hip and glute. Hold for 10 secs. Repeat on the other side.

2. Knee rolls

Lie on your back, knees bent and feet flat on the floor. Keep your knees together and slowly roll them to one side, ensuring both shoulders remain in contact with the floor. Breathe deeply feeling the stretch in your lower back. Do 20 on each side.