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If I had to pick just ONE, what is the BEST exercise to relieve Piriformis Syndrome (or a literal pain in the butt)? Here’s the most valuable exercise, when you should do it, how you should do it, how to know if it’s actually right for you and the “why” behind it… the Figure 4 STRENGTH!
Super important STEP 1 before actually doing the exercise: Find a movement or activity that bothers you (perhaps it’s moving your leg a certain way, or climbing the stairs, or walking, or squatting). Do it once or twice or for a very short amount of time to get an idea of what it feels like.
STEP 2: It’s time for treatment using movement as medicine with the Figure 4 Strength exercise (aka Clamshell).
Warning- This exercise should make your buttock muscle tired- but it should NOT be painful… if it is, don’t do it. Also, if your hip on the painful side is SUPER stiff, then you simply won’t have the range of motion to perform the exercise effectively.
HOW TO DO IT: Lay down on your painfree side, so that the painful side is on top, and your heels, butt and back are all in line. Place your hand on your hip. Keeping your heels together, slowly spread your knees apart until you feel yourself wanting to rock/roll backwards.
Hold this position until you’re tired (you should feel a burn in the buttock) and repeat 3 times.
HOW TO KNOW IF IT WORKED FOR YOU: Immediately get up and retest the movement or activity that bothered you before doing the exercise and ask yourself, "Is it same, better, or worse?"
Better = you’re done! This exercise helps you and I would generally recommend 3 holds until tired, 2x daily.
Worse = the exercise is NOT for you- it doesn’t help (you’ll need to find another motion).
Same = holds didn’t help, but try the same “clamshell” exercise in a different way - doing repetitions.
In the case of a piriformis issue (piriformis muscle or deep buttock pain), there are really only two things that can be done- you can either lengthen or shorten a muscle.
HERE'S THE WHY: Years ago, we were taught to prescribe piriformis stretches (figure 4 stretch, pigeon pose, sciatic nerve floss or nerve glide) to folks who we thought had Piriformis Syndrome. They’re the "cookie cutter treatment" for Piriformis Syndrome. I found that they didn’t work very well- in fact they made most people feel worse. So, I began to challenge what I had learned and asked myself these questions…
If lengthening makes most people worse…what’s the opposite of worse? Better!
And what’s the opposite of lengthening? Shortening! (or contracting a muscle… bringing two points closer together)
So, if we attempted to shorten the muscle- would it make things better?
SURPRISE- When I started taking this ANTI-STRETCH or SHORTENING approach, it was proven to be much more successful.
Here’s a quick recap:
The process of seeing if this exercise will work for you is to find a yucky motion and then see if you can use this exercise to fix that yucky motion. Ideally you see an immediate change for the better! (If not, don’t waste your time)
And- if you’ve tried stretching and it hasn’t worked… well, the opposite of trying to stretch (lengthen) something, is to shorten (contract or strengthen) it… and the opposite of not working is working.
Final Tip! If you do find this exercise helps, don’t mix it with other things. Stay scientific and stay focused on only things that work!
#drcharliejohnsonpt #piriformissyndrome #clamshell #TheBESTExerciseForPiriformisSyndrome
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