I have a client in her late 40s who has been diagnosed with Piriformis Syndrome. Besides doing all the stretching that is recommended, what other exercise should I be prescribing to her? Are there any lower body exercises she can do to help build strength that won't aggravate the condition?
Piriformis Syndrome (PS) seems to be generated by a muscle or muscles in the hip region that become weak, inflexible and inflamed - not a happy combination. Your client’s physician has given you a course to follow for flexibility but no strength work. The strength needs for PS seem to target the same type exercises for sciatica and sacral problems. Before getting to our intended goal of training exercises, we should have your client follow a pain-free warm up routine
A good warm up routine for people with this problem is a must. Ideally, the warm up is through a hot bath or whirlpool, the prescribed stretches and then exercises. If hot water therapy is not available, a topical analgesic like Ben-Gay or other liniment works. The client rubs liberal amounts of the agent on and around the surrounding tissues 10-15 minutes before training. After the liniment application, have the client pick a piece of aerobic equipment and get sweaty. The aerobic warm up should not irritate the area. Stretch after warming up.
You can start lifting after the client has achieved an elevated core temperature. People with PS generally demonstrate weak/tight hamstrings, weak/protruding abdominal muscles, weak/tight gluteals and quads. Our aim is to find some exercises that do not cause a pain response. My suggestion is to start with one exercise option, and when completed without pain for a week or so, add another. Choose light resistance with two to four sets of four to six reps, working on range of motion (ROM) without pain.
Squats are one test that some people perform when diagnosing this syndrome, so squats may not be an option. Compound exercise is preferable due to the conditioning effect, but if there is pain, stop. Some compound might be leg press at different angles with one and two legs with different ROM. Next, try back extension work on the floor, a ball and a machine. ROM before adding any loads. Add the single joint work of leg extensions and leg curls when needed. After getting to this point, try a few stationary reverse lunges and then moving reverse lunges. No weight and work on ROM.
Training the abdominal muscles will begin with the same: exercise that does not create pain. Start with floor crunches, ball crunches and incline crunches and then try reverse sit ups (bringing the legs in) on the floor, on a decline bench and hanging. At this point, you can progress into some rotational work with no weight, then rubber tubing and finally with a cable system.
This progressive training pattern works well for most people with hip and lower back problems. Do not rush the client, and explain to her it will take some time for total conditioning to take effect. Dedication is everything for success.