Insights on Hip/Piriformis Pain
By Charles Watts LMBT
Recently, I have come across a structural pattern with clients who present with pain in the piriformis muscle (think middle of the butt) and pain on the inside of the knee. Most of these clients have been dealing with this pain more than six months to a year with little or no relief of the pain. The common factor with each of these clients has been hyperpronation of the foot, a problem in which a person walks on the medial aspects of the soles, on the affected side.
What this means for a normal walking gait is that a person lands on the outside of a flat foot and then the foot rolls inward. This constant rolling of the ankle causes a chain reaction up the body. We call this an ascending pathology. Muscles, such as the Tibialis Posterior, start to weaken and overstretch which causes the arch to fall. The bones of the lower leg (Tibia and Fibula) rotate inward with the foot, while the femur and the external rotating muscles of the hip (Piriformis and Glute Max) must counteract the inward rotation of the lower leg by rotating out. This counteracting force puts a strain on Piriformis, which has been an area of unresolved pain in most of these clients. There are also other conditions that can be caused by a hyperpronation of the foot, such as IT band syndrome and medial knee pain.
Manual therapy is the most effective way to treat this condition. If one has these aberrant muscle patterns, it is important to stabilize all the muscles around the foot and ankle with muscle work and adjustments of the bones if needed. If the muscles around the ankle are not firing properly, then dealing with the pain at the knee and hip is difficult, if not impossible, as we are walking on the problem every day. If this problem is not addressed there is additional torsion force applied at the knee joint itself and the muscles get very hypertonic. This likely would precipitate a lateral shift of the patella, which causes friction between the patella and femur and may produce knee pain. Once, the muscles of the knee are balanced out; the upper and lower leg will track in a straight line. Therefore, it eliminates the strain on the knee itself as well as the Piriformis and Glute Max.
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