Tag Archives: #hips

False Sciatica

" False Sciatica" a.k.a "Piriformis Syndrome", refers to pain that begins in the hip and buttocks and continues all the way down the leg. This condition is often accompanied by low back pain, which can be more or less severe than the leg pain. In addition to pain, other sensations include spasms, tingling or numbness along the sciatic nerve that can travel down the hamstrings, legs and feet. These symptoms can be bilateral or can occur on one side.

What causes False Sciatica?

The cause of Sciatica can range from a misaligned vertebra or disc, to tightened muscles surrounding these structures, to tightened muscles anywhere along the length of the sciatic nerve. It is called true sciatica when a herniated lumbar disc compresses one of the contributing roots of the sciatic nerve. It is called false sciatica when contracted musculature in the buttocks or lower extremity compresses the sciatic nerve. The symptoms are the same for true or false sciatica.

The sciatic nerve passes through a mass of the hip’s external rotator muscles. The sciatic nerve exits the greater sciatic foramen and can run superficial to, deep to or even through the pirformis muscle. Spasm in the piriformis muscle can cause compression on the sciatic nerve sending pain, tingling and numbness down the posterior leg. This description falls into the category of false sciatica and is referred to as piriformis muscle syndrome.

Sciatica

False Piriformis Syndrome

Piriformis Syndrome is sometimes referred to as “back pocket” sciatica. People that keep a wallet in their back pocket and sit on it throughout the day often develop symptoms of pain in the rear and down the leg. The extra pressure on the buttocks can cause tightening of the buttock muscles which can compress the sciatic nerve. In “back pocket” sciatica, the removal of the offending wallet usually brings relief.

Treatment

In general,  soft tissue manipulation techniques such as deep tissue massage, active release therapy and Graston, applied to the offending muscles (overly tight) will bring relief, as well as continued stretching. once the previously inhibited tissues have regained pliability.

If this is a condition that seems  to describe your symptoms, do not hesitate to make an appointment with a qualified Registered Massage Therapist, so that he/she can get to the "butt" of the issue, and send you merely on your way back to recovery! (Cheesy pun totally intended!)

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Do Tight Hip Flexors Correlate With Weak Glutes?

Lower crossed syndrome, as originally described by Vladimir Janda several decades ago, is commonly sited to describe the muscle imbalances observed with anterior pelvic tilt posture.

Indeed, Janda described lower crossed syndrome to explain how certain muscle groups in the lumbopelvic area get tight, while the antagonists get weak or inhibited.  Or, as Phil Page describes in his book overviewing the Janda Approach, “Weakness from from muscle imbalances results from reciprocal inhibition of the tight antagonist.”

When you look at a drawing of this concept, you can see how it starts to make sense.  Tightness in the hip flexors and low back are associated with weakness of abdominals and glutes.

Lower Cross Syndrome

 

I realize this is a very two dimensional approach and probably not completely accurate in it’s presentation, however it not only seems to make biomechanical sense, it also correlates to what I see in practice everyday.

Yet despite the common acceptance of these imbalance patterns, there really isn’t much research out there looking at these correlations.

Yes.. They absolutely do!

Do Tight Hip Flexors Correlate to Glute WeaknessA recent study was publish in the International Journal of Sports Physical Therapy looking at the EMG activity between the two-hand and one-hand kettlebell swing.  While I enjoyed the article and comparision of the two KB swing variations, the authors had one other finding that peaked my interest even more.  And if you just read the title of the paper, you would have never seen it!

In the paper, the authors not only measured glute EMG activity during the kettlebell swing, but they also measure hip flexor mobility using a modified Thomas Test.  The authors found moderate correlations between hip flexor tightness and glute EMG activity.

The tighter your hip flexors, the less EMG was observed in the glutes during the kettlebell swing.

While this has been theorized since Janda first described in the 1980’s, to my knowledge this is the first study that has shown this correlation during an exercise.

 

Implications

It’s often the little findings of study that help add to our body of knowledge.  This simple study showed us that there does appear to be a correlated between your hip flexor mobility and EMG activity of the glutes.  There are a few implications that you can take from this study:Kettlebell-Swing-e1419741700687

  • Both two-hand and one-hand kettlebell swings are great exercises to strengthen the glutes
  • However, perhaps we need to assure people have adequate hip flexor mobility prior to starting.
  • If trying to strengthen the glutes, it appears that you may also want focus on hip flexor mobility, as is often recommended.
  • So yes, it does appear that hip flexor mobility correlates to glute activity and should be considering when designing programs.
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