-- By Erica Sastre, LMT
Did your massage therapist hit a particularly tender spot in your glutes? Did you have pain or tingling running down your leg? Why is your chiropractor trying to make you do so many squats?
This week we are putting the spotlight on the piriformis muscle!
The piriformis muscle is a muscle under the gluteus maximus, it attaches at the anterior surface of the sacrum, and the superior aspect of the greater trochanter (SI joint to the top of the femur). It Latterally rotates the hip (twists your thigh outward) , and abducts the hip when the hip his flexed (pulls your thigh away from the body center-line).
What could possibly go wrong?
Piriformis can be a literal pain-in-the-butt! A tight or knotted up piriformis muscle can cause pain on its own, or limit strength and flexibility. However, this small muscle can cause much bigger problems.
The Piriformis is often to blame for sciatic pain symptoms. The sciatic nerve runs right past the piriformis muscle, and sometimes even through the piriformis muscle. Due to its placement in the body, tightness in the piriformis and adjacent muscles can pinch the sciatic nerve. This can send pain, numbness, or tingling down all or parts of the leg! If you have ruled out a spinal issues as your source of sciatic, it's time to address the piriformis muscle.
How does the piriformis affect my posture?
Check out your toes! If your feet tend to turn in when you are standing, walking, running, or squatting you may have a weak piriformis muscle. Likewise, if you see that your feet tend to turn outward when standing, walking, running, or squatting, it may be a sign that your piriformis is overdoing it. Either one of these postures can cause problems in the legs, hips and knees, especially with load-bearing exercise. Squatting and lifting weights with misalignment can spell disaster for the knees! Keep in mind that if it is a hip/piriformis weakness, the positional problem will originate from where the hip and thigh meet. If the positional problem originates in the knee or ankle, we will have other muscles to look at! That's why it's a good idea to see a professional, like your chiropractor, to help evaluate postural problems.
How do I stretch it?
Pigeon pose is everyone’s favorite piriformis stretch! There are a number of modified pigeon poses you can try if you are less flexible. If floor stretches are uncomfortable, try doing a pigeon pose on a chair, couch, or low table. The 'figure 4' can be done sitting or supine (on your back), or even standing if you have good balance!
How do I strengthen it?
Piriformis is a lateral rotator. Meaning, it twists the thigh 'outward' from your hip. Working the gluteal region will generally build the piriformis, as well as create support for the piriformis with the other gluteal muscles.
Squats are an easy way to develop the glutes. Add a band for extra resistance! Try a one-legged dead lift and keep in mind that the grounded leg is the piriformis that you are strengthening. Work one leg at a time, grab on to the back of a chair, bar, or ledge. Lift the other leg out to the side, you can do this exercise with your feet paralell (both toes facing forward) or 'turned out' (feet make a V shape with your toes pointing outward, like in ballet). Try this one with a band as well! 'Fire Hydrant' starts on all fours. Keep your knee at 90 degrees then swing your leg out to the side, keeping your frame strong to isolate and work the glutes.
Fun facts about the piriformis
The piriformis is only one of six muscles in the lateral rotator group. The others are; gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus.
In 17% of the population the piriformis muscle is pierced by all or part of the sciatic nerve.
The word piriformis comes from latin, meaning ‘pear shaped’.
Hopefully you learned something fun about the piriformis today! Stay tuned for our next Q&A, and send your questions to NorwalkSportsandSpine@gmail.com! What muscle should we feature next?
-- by Erica Sastre, LMT
A: The answer is… Probably!
Let’s be honest, most of the time the answer is yes. Even if it is not the root cause of your back pain, wearing a backpack incorrectly can seriously worsen other conditions such as disc herniation, scoliosis, hip and shoulder disorders. Most people wear backpacks improperly, or are overloading their backs.
How heavy are our backpacks?
“Researchers visited three New York City schools and weighed more than 50 children’s backpacks. They found that kids in the 2nd and 4th grades are carrying about 5 pounds worth of homework and books. But once kids reach the 6th grade, the homework load gets heavier. On average, 6th graders in the study were carrying backpacks weighing 18.4 pounds, although some backpacks weighed as much as 30 pounds.”
School books are just the beginning of spinal stress for students, most of whom are doing extracurricular activities. Imagine a 30 pound backpack, a tuba, a poster board presentation, and a soccer bag that all need to be transported to and from school! How heavy is ‘too’ heavy?
“The American Academy of Pediatrics recommends that a child’s backpack weigh no more than 10 to 20 percent of a child’s weight.”
Yikes, textbooks add up fast! Most parents are not checking to see if their kids backpacks are weighing too much, and few students are self monitoring their posture or the weight they are carrying. They merely accept whatever the coarse-load demands of them. In addition these same students spend a lot of time studying at a desk or computer, most of their day encourages a slouched, leaning forward posture.
Schools are slowly changing with the times, some students have options to have electronic books, or share books at school so they don’t need to carry so much. Each situation is different, but most still need to carry all their books, and do their best.
The WRONG way to wear Backpacks
The Correct Way to Wear a Backpack
Notice how the spine is straight, shoulders are even, hips are even. The straps are used so that weight is evenly distributed between the hips and torso! This is the part that most kids want to skip, but if you look at climbers, hikers, military, they all use straps with their packs to distribute the load properly, this helps them move more freely and prevent injury!
Why is this so important?
Most students spine are in the process of growing! Teens are experiencing their growth spurt, some don’t finish growing until their 20’s so this concern even applies to college students.
The spine is supposed to be extending upwards as it grows There is a normal amount of curvature within the spine, but not too much (which is called Kyphosis in the thoracic spine and Lordosis in the lumbar spine). Nor is it supposed to grow into a twist, or a side-to side bend (Scoliosis).
If we load up the back, and twist the spine because of weight, every single day, over time we are encouraging the spine to grow in a curve or twist. It much more difficult to correct posture later in life.
What can we do if our children seem to be suffering from posture problems related to their backpack?
1) Lighten the load. Two sets of textbooks, electronic textbooks, sharing books with friends. Talk to teachers and administrators to work out viable solution for your child and the other students!
2) Corrective stretches and exercises, as well as regular participation in activities that encourage correct posture and body mechanics such as yoga, dance, martial arts & climbing are all great examples.
Stay tuned for next weeks Q&A! If you have any questions yourself, please feel free to send in your questions to firstname.lastname@example.org
Sources and further reading:
-- By Jason Quieros, DC
A: This answer isn’t the same for everyone. No two people should use the same pillow. The point of a pillow is to support the natural curvatures of the spine and keep it aligned throughout the night when your body is in recovery and repair mode. Sleep position plays a significant role in the type of pillow you should use. As a general rule of thumb, back sleepers should use a thinner pillow to support the head and neck, while side sleepers need a slightly larger pillow to fill in the space between the mattress and head/neck due to the width of the shoulders. It is not advised to sleep on your stomach, as it is very detrimental to both your neck and lower back resulting in pain, headaches and numbness or tingling in the arms/legs.
The best way to sleep is on your back on a firm mattress which allows the spine and surrounding muscles to decompresses overnight. This also supports the natural curves of the spine and doesn’t compress any of your joints. A close alternative to sleeping on your back would be your side with the use of the proper pillows to support not only your head and neck but also your hips and shoulders. Sleeping while holding a pillow in front of you and another between your knees will allow your shoulders and hips to stay aligned, along with the spine.
If you are a side-sleeper, and your pillow is too small…
Neck: Your neck is forced to scrunch up and tilt downward on one side. Compressing the spinal facets and impinging nerves, blood, and muscles on this side. The other side is over stretched, and can weaken the muscles there. Over time this can create limited range of motion, neck pain, headaches, numbness and tingling in the arms, weakness, and other complications.
Shoulder: Your lower shoulder is taking all the weight of your upper body. Compression of the glenohumeral joint can cause problems in the labrum, bursa, tendons and muscles of the arm and scapula, not to mention strain on the very delicate AC joint and clavicle.
Spine: Your spine is is forced into an awkward ‘S’ shape. It is forced to dip down from your hips in the lumbar spine, then up over your shoulder (which remember, is bearing all this weight), then curve down again as your head weighs it down the other way. This can cause pain all on its own, and if you have any disc issues such as herniations, degeneration, or spinal impingement this sleeping position can make these more painful.
Hips: Because your lumbar spine is forced up by gravity, so are your hips pulled out of alignment. This effect is worse if you don’t have a pillow between your legs. If you have sciatic pain symptoms, achy hip or knee joints, arthritis in any of these joints, take a good look at your sleep position!
If your Pillow is too High…
Neck: Your neck is forced up into the other direction, scrunching one side and stretching out the other. We see similar problems as with a too-small pillow. Over time you might develop thoracic outlet syndrome, neck pain, headaches, numbness/tingling in the arms, weak and or tight muscles, and limited range of motion.
Shoulder: This one is a bit easier on your lower shoulder, but, it still isn’t ideal for the good ol' glenohumeral joint. Instead of your shoulders being straight across like a T, you are forcing them into a tilted angle. The upper shoulder will be dragging down on the torso because it is too high, compression the upper thoracic spine.
Spine: The spine is again forced into an awkward ‘S’. This time the lumbar spine is being forced down then curving up and over the too-high pillow. This can again causes pain, aches, and exacerbate symptoms of existing spinal problems.
Hips: With your lower hip now ‘down’ and your upper hip pulled up, we see that lower hip taking on more weight than it should. You really don’t want the hip joint and knee joints grinding together while you sleep, as it can weaken the capsule, joint, and connective tissues.
Doctors recommend between 7-9 hours of sleep. Less than 6 hours a night and your brain is operating the same as it does with a .08 blood alcohol level. More than 9 hours and you are disrupting the delicate hormone cycle in your body. We talk about posture all the time, and how repetitive motions and postures can cause issues in the body. 7-9 hours is a long time to be out of alignment! It is hard to ‘even out’ in the morning and achieve a good posture.
Side sleeping does complicate things when picking a good pillow. Everyone has a different body shape so keep a few measurements in mind when picking the right pillow: neck girth, shoulder width, neck length, and distance from base of skull or ear to the top of the shoulder. This is why we support the Pillow-Wise pillow here at the office. We take these measurements of your body and take into account the position you sleep in, along with the firmness of your mattress and come up with the perfect pillow thickness for your specific situation.
The best thing to do is get a custom-fitted pillow for your head, and also sleep with either a long body pillow or two smaller pillows for between your knees to take pressure of your hips, and under your arm to decompress the upper shoulder. The spine should be in alignment with your shoulders and hips even. This position will help your muscles relax the most, and you will get your best rest.
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Norwalk Sports and Spine | Norwalk, CT Chiropractor | Dr. Jason Queiros | Dr. Andrew Zomick | Sports Chiropractic