Cross-Over Gait Correction

March 24, 2018/in Sports Injury/by admin

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How to Fix a Cross-Over Gait

The best way to work on cross–over gait is to perform running drills! Many runners are simply unaware that they run with a cross-over gait. Specific running drills to address a this type of gait will significantly improve running efficiency and decrease risk for injury. At our Mission Valley sports injury clinic, we stress the importance of running drills to all of our running patients.

There are three main drills that significantly reduce cross-over gait: increasing cadence, running wider, and activating the hip stabilizers while moving through gait.

Cadence– I talk extensively about cadence in our blog post here. In a nutshell, by increasing running cadence, there is less time for your feet to travel across midline. Slow cadence allows more time for your feet to creep over midline.
Run wide using a track line– Run around a track with lane lines (or white bicycle lane line). Run so the line is in the middle of your body. The goal is to land with the inner right foot touching the right outer border of the line and vice versa for the left foot. It may feel like you are running VERY wide but with practice it will feel more normal. Practice this drill on the straight away on the track about 4-6 times. Over time you will start to run wider naturally.
Walking hip hikers– The goal is to activate the gluteal muscles, and hold while taking a step. This builds the mind body connection to the hip/core muscles while moving during gait. Watch the video below for a detailed look at the walking hip hiker.

What About Increasing Core Strength?

Core and gluteal strengthening drills alone will not magically get rid of a cross-over gait; again working on correcting the gait will do that. That being said, working on the core and gluteal muscles in conjunction with gait retraining, will support proper running gait. The stronger the supporting muscles are, the more capable they are to resist fatigue during workouts and races. Some runners have no issues with their gait for runs between 3 and 10 miles. Once long runs increase to the 12, 14, 16 mile range, gait issues begin to occur. In this scenario, strengthening workouts to the core and gluteal muscles are paramount to avoid running form breakdown during longer runs. Here are a few of our favorite core and gluteal strengthening exercises:

Gluteal bridge

Lay flat on your back, knees bent, and feet flat on the floor just wider than hip width apart. Brace your abdomen to engage the core. Press through your heels to lift the pelvis upward until it is in line with the knees and shoulders. Avoid arching through the back. Add a band around the knees for more gluteal activation. Sets: 3 Reps: 10-20

Monster walking

Place a medium resistance mini-loop band around the ankles. Spread feet shoulder width apart and sit into a shallow squat, keeping your core engaged. Step forward and slightly outward with one foot and then repeat with the other. Take 5-10 steps forward and 5-10 steps backward. Continue until you feel a good exercises burn in the muscles of the outer hip. Sets: 3 Reps: Go until it burns

Crab walking

Place a medium resistance mini-loop band around the ankles. Spread feet shoulder width apart and sit into a shallow squat, keeping your core engaged. Take a step to the side, then take the same distance step with the other foot in the same direction; important to not over step inward with the follow up step as this looses tension in the band. Take 5-10 steps one direction and 5-10 steps back in the other direction. Continue until you feel a good exercises burn in the muscles of the outer hip. Sets: 3 Reps: Go until it burns

Dead bug

Lay on your back, with your knees and hips bent to 90 degrees and arms held straight in front of shoulder. Brace your core by squeezing back and abdominal muscles. Slowly lower one leg towards the ground, resisting the back from arching up off the ground. Alternate legs keeping a slow pace the entire time. If this version of the dead bug is too difficult, keep the knee bent when moving the leg and perform heel taps. Sets: 3 Reps: 10 per leg

Side plank

Begin by laying on your side with the elbow tucked underneath the shoulder and feel sacked. Keep the body as straight as possible and lift the pelvis off the ground. Focus on contracting the muscles on the side closest to the floor. Perform the side plank on both sides. Sets: 3 Reps: 1 Hold: 30-60 seconds

Self Myofascial Release to the Gluteal muscles

Take a look at the video below. By using a lacrosse/massage ball into the muscles, muscle tension will decrease which can help with soreness, pain, tightness in the area.

These strategies help with correcting a cross-over gait. If you are experiencing shin, knee, hip, back, or foot pain from running, I highly recommend getting the injury evaluated. A targeted approach to your specific injury can prevent time lost to injury. At our Mission Valley office, we perform Active Release Technique, Graston technique, and rehabilitative exercise to keep our endurance athletes competing pain free!

5 Ways to Strengthen Weak Ankles and Prevent Ankle Injuries

Prevent Ankle Injuries: 5 Ways to Prevent Ankle Injuries

December 10, 2015/in Sports Injury/by Dr. Kevin Rose

5 Ways to Prevent Ankle Injuries

Ankle injuries are one of the most common injuries among athletes. While it is impossible to completely prevent ankle injuries, taking precautionary measures before exercising can help limit the risks. Listed below are stretches to help strengthen and loosen up the muscles around the ankles. These exercises are great for both preventing injuries from happening and helping you recover from an existing injury:

Peroneal Stretches

One of the most important muscles to strengthen during any recovery or prevention of an ankle sprain is the peroneal muscle. These muscles extend from the top of the knee all the way down to where they attach at the bottom of the foot.

The exercise is easy: Gently roll onto the outside of your feet and walk around for 60 seconds. This helps strengthen your ankle muscles and gives them additional flexibility.
Ankle Circles

This simple exercise will help strengthen the muscles in and around the ankle, improving the joints stability. You can either sit on a chair or stand for this conditioning.

Extend your leg straight out, without bending the knee. Rotate your foot clockwise 10 to 20 times, rest leg for 5 seconds, and raise it again to rotate counterclockwise 10 to 20 times. Alternate legs and do 3 or 4 sets per side.
Dorsiflexion Stretches

The Dorsiflexion stretch is crucial amongst runners. This stretch is responsible for strengthening the muscles that run along the shin of the leg, called the Anterior Tibialis. This muscle is what controls the up and down movements of the toes. Therefore, strengthening this muscle will not only help prevent shin splints, but can also help protect the muscles and tendons in the ankle.

First, sit on the floor with your right leg straight out and the left leg crossed, with the sole of your left foot resting against the inside of your right leg. Place a towel or band around the ball of the right foot and gently pull your toes back toward you. Hold for 15 seconds, repeat the stretch 4 times, and then switch legs.
Write the Alphabet

This exercise is as easy as reciting the alphabet! All you are doing is tracing every letter of the alphabet with your big toe. This exercise is best if you are seated in a chair.

Hold your right leg straight out in front. Using your big toe as the “pen”, first write each letter of the alphabet in all capital letters. The same process again with lower case letters, then switch feet and repeat. Writing the alphabet is a challenging exercise that will help strengthen both of your ankles!
Achilles Stretches

Rupturing the Achilles tendon can set you back for quite a while. By doing regular Achilles stretches, you can help limit the risk of rupturing the tendon and help improve flexibility.

From a standing position, bend the knee of your left leg at a 45 degree angle. Step the right leg back and keep it straight. Ground the heel of your right foot and push the hips forward. Hold this position for 15 to 30 seconds and then switch legs, repeating 2 to 4 sets on each leg.

Athletes at Risk

At our Mission Valley Office, we see many athletes with injured ankles including: ballet dancers, MMA fighters, soccer players, baseball players, and foot ball players. It is important to perform the above mentioned exercises to help prevent ankle injuries. If you are currently experiencing an injury to the ankle, please schedule with our certified sports chiropractors today!

Iliotibial Band Syndrome

June 27, 2014/in Conditions/by admin

Check out our updated post on IT band treatment found here: New Methods in Treating IT Band Syndrome!

Iliotibial band syndrome (ITBS) is a painful, frustrating condition that affects the outside part of the knee. The IT band is a thickening of inelastic connective tissue which arises from the Tensor Fascia Latae and the Gluteal muscles and inserts into the outside of the tibia and Tibialis Anterior.¹ During movement, the IT band approximates the lateral aspect of the knee, creating an “impingement zone” and irritates the tissues found there, primarily a highly innervated fat pad.^2,5 With repetitive flexion and extension of the knee, particularly during excessive running, ITBS can develop and cause moderate to severe pain on the outside of the knee.

Who is at risk?

Active individuals are prone to iliotibial band syndrome due to chronic “overuse” type of trauma to the IT band and muscles of the thigh/buttock. A number of risk factors put a person at a greater risk for developing ITBS which include: training intensity/duration, running down hills, wearing shoes with poor arch support, biomechanical factors such as flat feet, gluteus medius weakness, etc.⁴Runners who run while fatigued, may be at more of a risk for developing ITBS due to increased flexion at foot-strike; this results in greater impingement at the “impingement zone” of the knee leading to greater tissue irritation.²

Examination

Sports chiropractors will carefully evaluate the knee including: ROM, various orthopedic tests, and a specific palpatory assessment, which allows the practitioner to identify muscles that have developed myofascial adhesions, causing muscle tension and pain.

The knee is caught between two other main joints of the lower extremity: the ankle, and the hip. The IT band connects to the hip musculature and also has fascial connections to the tibialis anterior, the bulky muscle in the front of the lower leg.¹ Examination of the hip, lower leg, and ankle may also be assessed in an attempt to determine dysfunctional muscles, joints, and structures which may be causing excessive stress at the outside of the knee.

A functional evaluation will also be performed to determine movement patterns that may cause excessive stress on the knee/IT band. A gait assessment both walking and running may reveal over pronation at the foot, or hip dropping during the stance phase of the gait cycle. Squats and lunges may reveal deviation of the knee towards midline, which may indicate glute medius weakness on the same side.

Treatment

Graston® Technique applied to IT band/Quadricep.

Treatment depends on the stage at which the ITBS is found at the time of examination. To combat swelling and pain associated with ITBS, treatment primarily involves ice and modification of activity.^3,4 Patients can ice the knee at home using ice massage for 3-8 minutes, two times per day to combat the inflammatory process.

Sports chiropractic care primarily involves addressing the soft tissue structures that affect the IT band. Active Release Technique (ART®) is used to remove myofascial adhesions (scar tissue) that have developed in the muscles that surround or connect into the IT band: gluteus maximus/medius, TFL, vastus lateralis (outside quadriceps muscle), biceps femoris (outside hamstring), and in some cases the tibialis anterior. The practitioner will have you perform specific movements for each structure involved, while deep pressure is applied to the structure to help stretch the myofascial adhesions to help restore proper function to the muscles and remove excessive tension that may be exacerbating the ITBS.

Some ART® protocols are designed to break down adhesions within the muscles, while other protocols are designed to restore relative motion between myofascial structures. The latter is important for IT band syndrome as the band itself lies over the large vastus lateralis and biceps femoris. Improving the movement between these structures will help remove tension at the outside of the knee.

Chiropractic adjustments may be used to improve the joint function of the low back, pelvis, hip, knee, and ankle to help improve the symptoms at the knee.

Rehabilitation

Once pain has significantly decreased, specific exercise protocols will be given to help prevent recurrence of symptoms and strengthen weak muscles such as the gluteus medius muscle. Gluteus medius weakness results in greater adduction angle at the knee (knee moves inward) during gait which results in over stabilization of the IT band leading to ITBS, trigger points, and contracted muscles.^6,7Proper strengthening of the glute medius will result in greater hip stabilization and keep the knee from deviating towards midline during dynamic movements (running, squatting, jumping).The IT band is an inflexible structure, however, IT band stretching can help relieve tension in the muscles that insert into the IT band. In addition to static stretching, the use of ischemic compression through the use of a foam roller can be used to successfully decrease the sensitivity and intensity of trigger points.⁸

Iliotibial band syndrome exercises San Diego

Raise knee as high as possible without losing positioning.

For runners, once pain has been minimal for 2 weeks and strengthening exercises are performed, a running routine can resume.^3,4Running should take place every other day on a flat surface with easy sprints and no hills.^3,4 Gradual increases in frequency and duration of running should occur over a period for 3 to 4 weeks.⁴

Other Treatment Options

Other treatment options for ITBS include NSAIDs for pain and swelling.⁴In chronic cases that have not responded to conservative care, corticosteroid injections may be warranted.¹⁰ In rare cases surgery may be performed to release the tension of the IT band over the lateral knee.¹¹

Conclusion

If you are experiencing knee pain, it is important to get evaluated by a sports chiropractor to determine the exact cause. ITBS is a very common condition affecting approximately 8.4% of injured runners.⁹There are a number of conservative options for patients who are affected with this condition, particularly Active Release Technique (ART®) to help relieve pain associated with ITBS. ART®, chiropractic adjustments, stretching of the TFL/IT band, followed by gluteus medius strengthening and a gradual return to activity will result in most patients recovering from ITBS in 6 weeks.⁴

References

Meyers, T. W. (2009) Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. New York, NY: Elsevier.

Fredericson, M., and Weir, A. (2006). Practical management of iliotibial band friction syndrome in runners. Clinical Journal of Sports Medicine, 16 (3), 261-268.

Ellis, R., Hing, W., and Reid, D. (2007). Iliotibial band friction syndrome- a systematic review. Manual Therapy, 12, 200-208.

Fredericson, M., Wolf, C. (2005). Iliotibial band syndrome in runners innovations in treatment. Sports Medicine, 35 (5), 451-459.

Fairclough, J. et al. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Jounral of Anatomy, 208, 309-316.

Miller, R. H., Lowry, J. L., Meardon, S. A., and Gillette, J. C. (2006). Lower extremity mechanics of iliotibial band syndrome during an exhaustive run. Gait and Posture, 26, 407-413.

Ferber, R., Noehren, B., Hamill, J., and Davis, I. (2010). Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic & Sports Physical Therapy, 40 (2), 52-58.

Hanten, W. P., Olson, S. L., Butts, N. L., and Nowicki, A. L. (2000). Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Physical Therapy, 80 (10), 997-1003.

Taunton, J. E., Ryan, M. B., Clement, D. B., McKenzie, D. C., Lloyd-Smith, D. R., and Zumbo, B. D. (2002). A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine, 36, 95-101.

Hong, J. H., and Kim J. S. (2013). Dignosis of iliotibial band friction syndrome and ultrasound guided steroid injection.The Korean Journal of Pain, 26 (4), 387-391.

Sangkaew, C. (2007). Surgical treatment of iliotibial band friction syndrome with the mesh technique. Archives of Orthopaesic and Trauma Surgery, 127, 303-306.

Strength Training Tips

June 24, 2014/in Tips/by admin

Strength training is an important part of an overall fitness program. Traditionally, it’s been encouraged to participate in aerobic activities such as swimming and bicycling, however, strength training can also be safe and effective for youth and adults, provided that appropriate guidelines are followed. Strength training is a method of conditioning that involves a wide range of equipment and activities, with dumbbells, medicine balls, weight machines, and body weight exercises that are specifically intended to improve or maintain muscular fitness. Furthermore, a routine strength training program can reduce the risk of sports-related injuries in athletes. Despite its reputation as a “guy” thing, strength training is an important part of overall health and fitness for everyone of any gender or age.

Strength training helps develop strong bones by increasing bone density and reducing the risk of osteoporosis. It can help control your weight as well, because as you gain muscle, your body starts to burn calories more efficiently. Strength training also aids in boosting your stamina and sharpening your focus. It can also help reduce the symptoms of chronic conditions, like arthritis, back pain, obesity and many other ailments.

Although every combination is different depending on your desired results, a safe and effective strength training program should follow these important guidelines:

A warm up and cool down of about 5 -10 minutes is ideal. Walking is an excellent way to warm up and stretching is an good way to cool down.
Remember to focus on form, not weight. Use correct body alignment and smooth movements through each exercise. Poor form can increase injuries. Also, when learning a strength training routine, many professionals advise starting with no weight, or very minimal weight. Try to concentrate on gradual, smooth lifts.
Keeping a consistent, moderate tempo helps you stay in control. For instance, you can count to three while lowering a weight, then hold, then count to three while raising it back to the starting position.
Pay close attention to your breathing during workouts. It’s best to exhale as you work against resistance (whether by lifting, pushing, or pulling) and inhale as you release resistance.
By slowly increasing weight or resistance used, you can keep challenging your muscles. The appropriate weight you should use differs depending on the exercise. Choose a weight that wears out the targeted muscle or muscles by your final two repetitions, but still allows you to keep good form. If you choose to add weight, remember that you should be able to continue to do all the repetitions with proper form and the targeted muscles should feel drained by the last two.
Stick with your routine. Working all the major muscles of your body two or three times a week is best.
Keep in mind, it’s good practice to give your muscles some time off. Always give your muscles at least 48 hours to recover before your next strength training session.

Participation in routine strength training has the potential to offer great value to the overall health and fitness of athletes and those participating at any age, provided age-appropriate training guidelines are followed.

Chiropractic and Whiplash – San Diego

December 18, 2013/in Back Pain Prevention, Conditions, Sports Injury/by admin

Whiplash is the medical name for an injury to the neck that is created from a sudden jolt from front to back that creates a whip style movement. Whiplash is more often sustained in motor vehicle accidents; however, it can occur from a fall or sports/work related injury and so forth. The Whiplash injuries are normally due to the result of a sprain-strain to the neck, where the ligaments which provide support, protection and also limit the movement of the vertebrae are damaged. The most commonly injured joints are the facet joints which are located in the back portion of the spine. However, these are usually not the only injuries.

With more severe whiplash injuries tendons and muscles are strained and stretched, vertebral discs can be bulge or herniate, and the nerves may also suffer stretching and become irritated and inflamed. The most common symptoms that are felt with whiplash are stiffness and pain through the neck, generally found in the areas that have sustained damage. Most commonly pain will be in the front and back of the neck and turning the head will make the pain more severe. A headache is also a normal symptom of whiplash. Pain can also be found to extend through the upper part of the body.

In addition to the joint pain, some people experience dizziness, sickness, and even visual problems following a whiplash injury. These symptoms must not be ignored, and medical intervention should be sought if they do not resolve in a day or two. Whiplash symptoms are not always immediate and can take up to two days to appear.

Those suffering from whiplash need to stay active unless they have sustained an injury that requires immobilization. They may be worried but should move as much as possible. The doctor will more than likely prescribe some form of stretching exercises. These exercises are very important to aid recovery.

It is normal to use ice or heat to control the pain and reduce swelling after a whiplash injury. The injured party may also have electrical stimulation or ultrasound if necessary for short term relief. In the case of neck pain, spinal manipulation or spinal mobilization from a chiropractor can provide additional relief.

The Power of ART – Active Release Technique

December 18, 2013/in Conditions, Sports Injury/by admin

Struggling with carpal tunnel can be a debilitating experience. The inflammation around tissues and nerves in the wrist can make it difficult to perform daily tasks. The classic symptoms of carpal tunnel include numbness or pain that occurs on the thumb-side of the hand, pain that radiates up to the shoulder, and the muscles in the thumb becoming severely distorted. However, there is no need to suffer with this condition when there is ART (Active Release Technique) to help you relieve the symptoms.

One can experience the relief of the pain and numbness without invasive surgery or traditional procedures of medicine. The continuance of these symptoms is the direct result of misdiagnosis and the misinterpretation of what carpal tunnel actually is. It’s more than just the entrapment of one single nerve in the thumb; rather, it’s a more common problem that takes place further up the arm, in the muscle called the Pronator Terres. Because of this, adding a brace to the wrist can actually make the problem worse.

ART, on the other hand, is designed to eliminate the problem from the get-go, allowing patients to make a much faster recovery than with conventional methods. Instead of focusing on just one area, ART aims to restore unimpeded range of motion and function to the soft tissues of the arm and wrist.

Professionals who are trained in the technique of ART can evaluate the texture and mobility of soft tissue, and, using hand pressure, removes or breaks up the fibrous adhesions that are present in the soft tissues. This can drastically improve the recovery from this debilitating condition, and abate the symptoms for much longer periods of time between each treatment.

There are typically three levels of ART that are performed by the practitioner himself while the fourth requires the patient to be involved with the active movement of the tissue while the practitioner applies the required tension to improve the results of the treatment even more. It has been scientifically proven that patients who are actively involved with the process of their treatment are more likely to make a better recovery than those who don’t.

Understand the true source of the pain you’re experiencing, and take steps to resolving your condition before it becomes too much to handle.

Ergonomic Chair Setup

January 29, 2013/in Ergonmoics/by Dr. Kevin Rose

Comfortable desk work begins with proper chair setup. Follow these helpful tips to ensure a proper ergonomic chair setup.

Chair Setup

Push your hips as far back as they can go in the chair.
Adjust the seat height so your feet are flat on the floor and your knees are equal to, or slightly lower than, your hips.
Sometimes the desk height forces you to have the chair higher than you what will allow you to touch the ground. If your feet don’t reach the ground put a small box under your desk to rest your feet on.
The back of the chair should be at a 100°-110° reclined angle which should create an angle between your body and your thighs of 90° -100°.
From UCLA Ergonomics
Make sure your upper and lower back are supported. Use extra cushions at the small of your back if your chair does not have adequate support.
Adjust the armrests so that your shoulders are down and relaxed.
If your armrests prevent your shoulders from being in a relaxed position, remove them.

Keep your body straight with the head and neck upright and looking forward, not to the side. Do not hunch over or slouch.

OTHER TIPS

Don’t cross your legs while sitting. This can cut off circulation and/or lead to hip problems.
Make sure your chair seat has a soft, downward curved edge so that it does not dig into the back of your thighs. This can also cut off circulation.
When purchasing a chair the best feature is its ability to adjust each component separately.
If sitting is too painful, consider a standing workstation.

Next post “Ergonomic Keyboard and Mouse Setup”

Best Chiropractor in Mission Valley

December 3, 2012/in Uncategorized/by Dr. Kevin Rose

Congratulations to Dr. Rose, DC on being voted 2012 Best Chiropractor in Mission Valley by Mission Valley News.

Click Here for the entire release.

Mission Valley News offers community news and information on Mission Valley, Old Town, Linda Vista and surrounding areas.

Piriformis Syndrome Part III- Treatment

November 16, 2012/in Conditions/by Dr. Kevin Rose

Piriformis Syndrome Treatment

The two main goals of treatment are 1) to relief irritation to the sciatic nerve and 2) address any functional problems that may be contributing.

If the sciatic nerve is inflamed the first step is to decrease aggravation from compression. Things to avoid are leg crossing, sitting on your wallet, and sitting on hard surfaces. Things you should begin doing are applying ice to the piriformis, stretching of the piriformi, and taking oral anti-inflammatories (as directed). Stretching every 2-3 hours (while awake) is a key to the success of non-operative treatment. Prolonged stretching of the piriformis muscle is accomplished in while lying on your back with the hip flexed and passively adducted/internally rotated (see picture). Another exercise that can be helpful to decrease irritation between the piriformis and sciatic nerve is a nerve gliding exercise. This exercise tensions the sciatic nerve and allows it to move relative to the piriformis. It is sometimes called nerve flossing to better describe how the nerve moves through other structures. Two types of nerve gliding exercises are pictured below. (Pictures from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53203)

Manual therapy can be extremely helpful in releasing tension on the sciatic nerve and addressing functional deficits. Soft tissue therapies, including myofascial release and Graston®, aimed at releasing tension and muscular adhesions within the piriformis can be beneficial. Chiropractic spinal adjustments can help address functional contributions from the spine such as sacroiliac joint hypomobility and low back dysfunction. Hyperpronation of the foot can be addressed through orthotics in the short term and foot strengthening in the long term. Pronation is a normal foot motion however overpronation may lead to increased external rotation of the hip with walking putting tension on the piriformis and sciatic nerve.

Treatment may take several months of consistent work and it is important not to get discouraged. As long as there is no progression of neurological symptoms conservative treatment is the best option. Your symptoms should be monitored by a healthcare practitioner to ensure there is no progression.

-Dr. Kevin Rose, DC

Piriformis Syndrome Part II- Evaluation

October 22, 2012/in Conditions/by Dr. Kevin Rose

Clinical Diagnosis

Piriformis syndrome occurs most frequently between ages 40-60 and is more common in women than men. Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome; , possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the pelvis of women. Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%.

The most common symptom of patients with piriformis syndrome is increasing pain after sitting for longer than 15 to 20 minutes. Many patients complain of pain over the piriformis muscle (ie, in the buttocks), especially over the muscle’s attachments at the sacrum and medial greater trochanter. Symptoms, which may be of sudden or gradual onset, are usually associated with spasm of the piriformis muscle or compression of the sciatic nerve; these symptoms include radiating/shooting pain or tingling or numbness in the back of the thigh, leg, or foot. These symptoms must be evaluated by a healthcare provider to differentiate the possible causes. Patients may also complain of difficulty walking and of pain with internal rotation of the involved leg, such as occurs during cross-legged sitting or walking. X-rays or an MRI offer little help in directly diagnosing piriformis syndrome but may be used to rule out other causes of sciatica such as a herniated disc in the lumbar spine.

Functional Evaluation

There are many functional abnormalities that may have either caused or resulted from this condition. Once the diagnosis has been made, these underlying, perpetuating biomechanical factors must be addressed.

Functional biomechanical deficits associated with piriformis syndrome may include the following:

Tight hip external rotators including pirifromis
Tight adductors (groin)
Hip abductor weakness
Lower lumbar spine dysfunction
Sacroiliac joint hypomobility
Hyperpronation of the foot and prolonged toe-off

Functional adaptations to these deficits include the following:

Ambulation with the thigh in external rotation
Functional limb length shortening
Shortened stride length

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