Part-time Glute Pain, Piriformis?

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April 1, 2020 at 10:47 am #40059

kylwalsh
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Hi UA Crowd,

I’m hoping someone might be able shed some light on a lingering pain/soreness I’ve had for a couple of weeks.

The best description I have is my L glute will occasionally hurt while walking, specifically when I take my weight off that leg (standing or walking on R leg). This is especially noticeable after getting out of bed or laying down for a while. I’ll also notice a bit of pain, and maybe tightness, if I lay on my back on the floor – there’s a big difference in how my L and R glutes and hips feel in that position prior to any stretching.

This issue picked up when I began doing a more dedicated step up and step down strength program. I have trouble with both strength, and especially mobility, in each exercise. Running doesn’t seem to bother it much, though I’ll feel it occasionally on runs and have eased off if it’s very troublesome.

Foam rolling/ball rolling typically helps me through most hot spot issues. In this case it seems almost to make it worse. I found a piriformis stretch where you draw your affected side knee across the body. It seems to help quite a bit, certainly with immediate tightness.

I’m hoping someone might be able to shed some light on this issue and what could work to alleviate it! Thank you!
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Posted In: Injury & Rehab

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Pete Dickinson MS,PT on April 1, 2020 at 4:49 pm #40064

This sort of condition is certainly frustrating! Pain with walking, then with supine positioning would certainly lead me to consider spine involvement. The lumbar region loves to send pain to the glut and piriformis region. You could try doing an abdominal ‘set’ while getting out of bed etc. and see if that removes the pain by stabilizing the spine. When doing any step activity, make sure your hips don’t rock and stay in the same horizontal plane. Try actively performing a core contraction during these activities and see if that helps. Putting more training time into core strength and stabilization is always worthwhile.
Cheers,
Pete

Participant

kylwalsh on April 7, 2020 at 10:11 am #40262

Thanks for your quick reply, Pete! I’ve been working through your suggestions over the past few days.

I have noticed improvement in my L glute, particularly with the abdominal set. However, the early morning pain has “shifted” to my hips overall, mostly just below/near my low back area. I had some similar pain a couple of months back that seemed to respond very well to a chiro adjustment. I’m curious if you have any thoughts on pain in that hip region? It really seems to go away with movement throughout the morning/day.

Thank you again!

Participant

Pete Dickinson MS,PT on April 7, 2020 at 7:19 pm #40304

Yes, shifting pain in the area from glutes/leg to back is indicative of nerve involvement. Great job trialing lumbar stabilization, you are ready to add back mobility to the treatment mix. Manipulation is certainly great for short term relief of pain in the region, but the ‘fix’ is accomplished from doing the hard, long, slog of strengthening the core, and gaining greater mobility through the area. Its a biological system, so 4-6 weeks of training will yield robust results, and give the added benefit of improving all your uphill athlete activities.
Cheers,
Pete

Participant

Dada on April 9, 2020 at 5:07 pm #40362

Hi kylwalsh

I had the same pain in the periformis region and it was actually a herniated disc (L5/S1 with nerve involvement).

The Stuart McGill golden three exercises are very basically gold. I try to perform them every day and I did recover quite well from my surgery.

Nerve flossing could help you. And of course, everything Pete said.

BR
Dada

Participant

kylwalsh on April 22, 2020 at 11:07 am #40739

Hi Folks, thanks to you both for the responses. Dada, I’ve been doing 2/3 of the McGill Big 3 regularly for a while, and have incorporated those exercises into a light core/hips routine. Thanks for sharing your experience.

The past week and a half have been quite a struggle. The occasional L glute pain morphed into pretty terrible low back/illiac crest/hip pain in the early morning hours. It seems exclusively to ramp up at night, and the pain can be unbearable when lying on my side – especially the R side. Within ~30min of getting up the pain is gone. I was able to get some relief a few days in a row after a lot of back flexion (forward folds and some specific yoga). I tested things out with a light 40 min. Z1 run yesterday and the pain was worse again this morning.

I went to a chiropractor twice in the past two weeks. They did not think I had a herniated disc or any specific injury, and thought that the pain in early morning hours at night was due to a lack of blood flow overnight. They’ve been very helpful in identifying my functional issues and weak areas (esp. my R hip and very tight T back).

Pete et al., it seems to me light a dedicated stretch of hip and core strengthening and mobility work is needed before I get back into any amount of running. It’d be great to hear if you have additional thoughts – thank you again!

Kyle

Participant

Pete Dickinson MS,PT on April 22, 2020 at 2:42 pm #40743

Kyle,
With that level of pain, you likely have a nerve injury somewhere. They can be pinched at several exit points from the spine. Flexion exacerbation of pain might indicate a disc, side bending and extension might indicate the foraminal exits. I recommend pillow support of your back in sidelying while sleeping to keep your spine supported in a more neutral position, pillows under the knees while on the back might be another thing to try. I would recommend shortening your run, even to the point of doing a walk/run program. Find a running duration that you can tolerate, then you can consider increasing from there. (10% a week). You have to decrease inflammation around the nerve by minimizing irritating activities, and supplement this with improving core strength to limit shear and strain across the region.
Pete

Moderator

Thomas Summer, MD on April 23, 2020 at 2:50 am #40810

Hi Kyle!

What did the chiropractor do? Any mobilization of the SI-joint?
Are you taking any medications for pain and inflammation?
overall stress is also something to consider…
As Pete wrote, take it easy with running.

Thomas

Participant

Dada on April 23, 2020 at 3:11 am #40811

Hi Kyle,

what helped for me:
I just walk downhill, I do not run anymore. This causes some irritations.
I also took Diclofenac which eliminated the pain. But you should only use it for a couple days since it stresses your kindneys and liver a lot. Maybe I would use it as an experiment to check if an inflammation is existing.
Nordic walking also worked pretty well https://en.wikipedia.org/wiki/Nordic_walking

What does not help:
mobilising & stretching my back / harmstring. I need to keep it very stable & firm. Did the “cobra” exercise yesterday the first time and today it’s very bad.

BR
Dada

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