Injury Tips

Eliminating Your Pain in the The...

By Timothy Crunk, PT, DPT, MS, OCS, CFMT, FAAOMPT, Owner, Crunk Physical Theryapy

It is spring and the time of year when many are dusting off their bikes for a ride after a cold winter. Others have been slowly building a solid base and are preparing for a busy race season. Regardless of your cycling goals, pain often interferes with your well laid out plans.

Hip or buttock pain is one of the more common complaints we see in cyclists this time of year. Common diagnoses are bursitis, tendonitis, snapping hip syndrome and less commonly, labral or cartilage tears. One of the more often overlooked problems is piriformis syndrome.

The piriformis is a muscle that arises from the front of the sacrum (large triangular bone at the bottom of the spine) and attaches distally to the greater trochanter (tip of the hip). It sits deep in the larger gluteal muscles in the buttock area. It helps to outwardly rotate the thigh when the hip is below 90 degrees of hip flexion, and it inwardly rotates the thigh when above 90 degrees of hip flexion (knee towards the chest). It also abducts (raises the leg out to the side).

The sciatic nerve usually runs underneath the piriformis muscle but, in 10-30% of the population, it goes through the fibers of the piriformis. When the piriformis muscle is tight, it can compress the sciatic nerve, causing pain in the buttock that often radiates down the back of the thigh. In some cases this also causes tingling or numbness in the same region. These symptoms are often misdiagnosed as a herniated disc.

When cycling, especially pushing big gears and climbing, your piriformis muscle tends to tighten. Other activities, such as prolonged sitting (especially with the leg or legs abducted and outwardly rotated), squatting, and climbing stairs and hills also tighten this muscle.

A couple of simple stretches may help reduce pain and improve performance:

Stretch #1: Sit in a chair that allows your hips to be at a 90 degree angle when your feet are comfortably on the floor. To stretch the right piriformis, place your right ankle on the left knee, sit up tall and then wrap both hands around the right knee gently pulling it towards your left shoulder while at the same time going up on the toes of your left foot. Go until you feel a light stretch in the right buttock and hold 20-30 seconds.

Stretch #2: Position yourself on your back. To stretch the right piriformis, place your right ankle on your left knee. Wrap both hands around your right knee. Slowly bring the left foot off the floor pulling the left knee toward the left shoulder, while at the same time pulling the right knee slightly toward the left shoulder until you feel a stretch in the buttock. Finally, arch your back gently by pushing it away from the floor (anterior pelvic tilt). Hold the stretch 20-30 seconds.

Perform each stretch 3-5 times, several times per day. If pain persists or worsens, it is important to get an examination by a qualified Physical Therapist.

Joint restrictions in the lower back, sacrum and coccyx may keep the piriformis from loosening up. This can be treated with a combination of joint mobilization techniques and soft tissue mobilization to the piriformis muscle.

More serious conditions such as spinal stenosis and nerve root entrapment from a herniated disc can also be the source of pain, and may require further examination and diagnostic testing such as x-ray or MRI.

Finally, consider getting a professional bike fit to assure proper positioning which will reduce the stress on the lower back, pelvic girdle and hip.