Trigger points in the piriformis muscle

The piriformis muscle is a small muscle deep to glute max and lies over top of the sciatic nerve. It originates on the anterior sacrum, and inserts on the greater trochanter of the femur. It’s main action is to laterally rotate the femur. When trigger points developed in this muscle they will refer pain into the sacro-iliac region, across the posterior hip and down the leg. This muscle can also be a cause of sciatic nerve irritation if it gets tight, causing “sciatica” symptoms.


Scapular Dyskinesis (Yes, its a thing).

Your shoulder is formed by three bones; the scapula (shoulder blade), the clavicle (collar bone), and the humerus (long arm bone.) These bones come together to form a shallow ball & socket that relies upon the surrounding muscles for support. All of your shoulder muscles must work in a coordinated fashion to have a healthy and stable joint. Disruption of the normal rhythm of your shoulder blade creates abnormal strain on your shoulder and rotator cuff called “Scapular dyskinesis”. This dysfunction crowds the area of your shoulder where your rotator cuff tendons live and may create a painful pinching of your tendons or bursa each time you raise your arm. Many shoulder problems, including sprains/strains, tendinitis, bursitis, or rotator cuff irritation, result from this often overlooked culprit.

Scapular dyskinesis most commonly originates from weakness or imbalance of the muscles that control your shoulder blade. Sometimes the problem is caused by other shoulder conditions like prior fractures, arthritis, or instability. Irritation of the nerves that control the shoulder muscles is the culprit in about 5% of cases.

Although scapular dyskinesis can cause a variety of shoulder problems, it may initially go unnoticed. Up to 75% of healthy college athletes show some form of abnormal shoulder blade movement. If the condition is left untreated, you may begin to notice pain near the top of your shoulder. Sometimes the discomfort can radiate toward your neck or into your arm. Patients will often complain of a tender spot on the front of their shoulder. Long-standing altered mechanics can lead to bigger problems, including rotator cuff injury, shoulder instability, and arthritis.

The good news is that we have recognized the underlying cause of your shoulder problems and have treatments to correct it. You will need to perform your exercises consistently. You should also be conscious of your posture and try to avoid sitting or standing in “slouched” positions, as this is known to aggravate your problem.

Piriformis Syndrome; a real bummer.

Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle.

When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.

Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year olds and affects women more often than men.

Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.

Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day.

Osteoporosis and Compression Fractures

Most of the tissues in our body are in a constant state of rejuvenation, wherein old cells are removed to be replaced by new. In our skeleton, when the production of new bone cannot keep up with the rate of tear down, our bones become progressively thinner and weaker in a process called “osteoporosis”.

Bone fractures occur when stress to a bone exceeds the bone’s ability to support that load. In healthy vertebrae, significant stress is required to cause a fracture. But in osteoporotic bones, the threshold for injury is lowered to the point that “compression fractures” may occur with seemingly minimal stress like bending, coughing, or sneezing. A compression fracture causes a wedge-shaped collapse of the front of the vertebral “body”- resembling what would occur after stepping on one edge of an aluminum can.

Compression fractures are two to three times more common in women, and the risk of developing the problem increases over time. People who have had a prior compression fracture are at greater risk for developing a subsequent fracture. Additional risk factors for compression fracture include a family history of osteoporosis, low body weight, recent weight loss, smoking, a sedentary lifestyle, poor dietary choices, inadequate calcium or vitamin D intake, excessive alcohol or caffeine intake, and scoliosis. The American Academy of Orthopedic Surgery recommends bone density screening for osteoporosis in all women over age 65 or post-menopausal women who have suffered a compression fracture. If you have not already done so, you should schedule a bone density screening.

Symptoms of a compression fracture include an “aching” or “stabbing” pain in the back, near the site of fracture. Symptoms can range from minimal to disabling. Often times, pain is referred to the ribs, hip, groin, or buttocks. Be sure to tell your doctor if you have pain or numbness that radiates into your legs, weakness, clumsiness, loss of bowel or bladder control, impotence, fever, unexplained weight loss, night sweats, excessive fatigue, or a history of cancer.

Symptoms from a compression fracture typically lasts for six to 12 weeks. Occasionally, patients will require surgical treatment of a compression fracture, but fortunately, most respond to conservative care. In general, you should maintain a relatively active lifestyle and try to avoid bed rest. If your pain prevents movement, you may talk to your doctor about wearing a brace to limit stress.

Our office will prescribe exercises to help you recover and reduce the risk of subsequent fracture. As your symptoms improve, you can begin incorporating some aerobic exercise, like walking on a treadmill. Studies have shown that light resistance training (i.e. weights and elastic bands) may help you maintain bone density and reduce the risk of future fractures. Supplements to help manage osteoporosis include daily intake of 800-1000 IU of vitamin D and 1000-1200 mg of calcium.

Did you know that you can breathe “wrong”?

Your “diaphragm” is the dome shaped muscle beneath your lungs. When it contracts and flattens, you breathe in. When it relaxes, you breathe out. But do you know your diaphragm plays an important secondary role in protecting your trunk and spine by controlling abdominal pressure?

The muscles that support your trunk form a “canister.” The front and sides of the canister are created by your abdominal and rib muscles. The back of the canister includes those muscles attached to your spine. The bottom of the canister is formed by the muscles of your pelvic floor, while your diaphragm serves as the roof. Together, these muscles control your abdominal pressure and core stability.

A well-braced core provides a stable foundation for moving your arms, legs, and head – in much the same way that when firing a canon, a large ship serves as a better platform than a rowboat.

During normal breathing, your upper chest should remain relatively still. Patients with “dysfunctional” patterns frequently overuse their upper chest muscles instead of their abdomen and lower rib cage. This depressurizes and destabilizes your core, leading to other problems like back pain.

You should not need to always think about proper breathing – this should happen subconsciously. Unfortunately, many of us have “learned” poor mechanics and need to re-learn proper breathing. One of the easiest ways to re-train proper breathing is to sit or lie still with one head on your breastbone and the other hand on your abdomen. When you breathe in, only the hand on your abdomen should move, while the hand on your chest remains still. Your normal breathing rhythm should be about there seconds of inhalation followed by six seconds of exhalation. If you find that you are exhaling too quickly, you may try “pursing” your lips to gradually increase the length of your exhalation.

The exercises that follow are essential for your recovery. Once you have restored normal breathing mechanics, you will enjoy increased core stability and your treatment will be much more successful. It is important to perform your breathing exercises consistently, as repetitive exercise will allow your body “re-learn” to subconsciously move in a safe and a coordinated fashion- thereby reducing your risk of injury.

Trigger points in the gluteus minimus

The gluteus minimus is a small but important muscle that lies deep to the gluteus medius. It originates on the gluteal surface of the ilium, and attaches on the greater trochanter of the femur. It’s main actions are to abduct and medically rotate the hip. Trigger points in this muscle refer pain into the buttock and down the lateral and posterior leg, mimicking sciatica. This muscle should be the first to be examined if a straight leg test turns out negative.