As you may recall from our intro post on kinesiology taping, we’re going to focus on each muscle group/joint and show you how to use kinesiology tape in three distinct ways:

•  Immediately after injury  (for swelling and pain)

• During the healing process (correction techniques to restore normal position and allow for healing)

• Techniques to help improve strength + function

In this post, we’ re going to be talking about a taping application designed to decrease the amount of pull on the piriformis muscle. This is perfect for recovering muscles and tendons where you want to provide support and allow for rest so that the injured muscle/tendon can heal.

This type of application is called an inhibition technique. The key for using it is to use the anatomy! Remember, the tape is specifically made to pull on itself. That is what the weird spirals and shapes are when you look at the back of the tape. When trying to inhibit the muscle, you want the tape to move from the muscle insertion to origin so that when the tape pulls on itself, it results in an eccentric pull (eccentric = lengthening of the muscle). This is ideal for trying to diminish the contraction which will allow for rest and more importantly recovery.

Important anatomy to know!

The first step in applying the tape correctly is to find the right place to put it. The piriformis runs from from the inside of the sacrum (tail bone) out to the greater trochanter on the femur). To correctly apply this tape, you need to be able to follow the path of the muscle. Let’s start with finding the origin on the sacrum.

To start, we’re going to find the PSIS (posterior superior iliac spine). Start with your hands on your hip bones (iliac crest) so that your thumb is pointing towards your back and your fingers are pointing forwards towards your stomach. As you reach behind with your thumbs, you’re looking for two small bumps on either side of your spine. Visually, you can see them. They are the two “dimples” at the small of your back.

When applying the tape for this application, we will be starting just below the PSIS!

The next landmark is the greater trochanter. To find it, start with your thumb on top of your hip bone at the highest point of the iliac crest. From there, simply lay your hand down over the outside of your hip with your fingers pointed down towards the floor. The GT can be found under or close by where your middle finger is (it will be a small bump).

Here’s what it looks like together:

The lower blue X is your PSIS. The upper is your greater trochanter. The green line below the PSIS is where the piriformis starts. Before you try to apply the tape, take the time to find these spots on yourself!

 

What you will need:

1) Roll of kinesiology tape

2) Sharpest scissors in the house.

Prep work:

1) Clean skin. The pictures shown here have bike shorts, but you want this to be directly on the skin. This means no oils or lotions of any kind. You want your skin to be clean and more importantly dry. Moisture of any kind = tape will fall off or fail to stick altogether.

2) Hair care. Ideally, the less hair the better. Guys, this means that for best results you will need to trim any long leg hair or shave the calf area.

3) If clean, dry, and hairless skin still = no sticking of tape. Time to get some adhesive spray like Tuf Skin.

4) The tape should last 3-5 days. You can get it wet and shower with it on. Just towel dry it after. No hair dryer! The tape is heat activated.

Taping Techniques

1) Piriformis application

In this installment of our “injury of the week” series we’re going to be talking about piriformis strains. We’re going to keep the same format we’ve had all along. First we’re going to start off with a review of what the injury is and talk about if this is what you have and when you need to worry/consult your doctor. From there we’re going to take you through the steps of the A-T-A self treatment system so that you’ll have a “sample treatment session”.

Of all the areas I’m asked about, the hip is easily one of the most popular. It’s also one of the most complex in terms of it’s muscle/mobility and joint structures. On a muscular level, there are multiple layers working together to move the hip through three different planes of motion:

1) flexion and extension-forward and back

2) adduction and abduction- in and out from the vertical midline of the body

3) internal and external rotation- rolling the leg so that the outside of ankle is up towards the ceiling (internal) and rolling the leg so that the inside of ankle is up towards the ceiling (external).

On a bony/joint level, the hip is part of the lumbo-pelvic-hip complex. This means that the hip joint is part of the pelvic bone and can be influenced by the lumbar portion of the spinal column and vice versa. If one end of the chain is disrupted, the other end will also be affected.

So how does the piriformis get injured?

This area is susceptible to injury for several reasons. As your leg moves into full extension during the push off portion of the gait cycle/pedal stroke/etc, the gluteus maximus is the primary muscle responsible for hip extension. The external rotators assist in providing this extension and take on a much larger role in situations where the leg is rotated and extension is required. If the leg becomes rotated for an extended basis due to muscle imbalances, weakness, or contractures (chronic shortening of a muscle), the smaller rotators can become overused and injured. Essentially they try to pick up the slack when the glutes are unable to contract fully.

To give you some examples of how this might occur:

1) Hyperpronation/Hypopronation at the foot/ankle. Chronic abnormalities at the foot and ankle joints are commonly associated with rotation of the entire lower leg. This rotation occurs over time as a compensation mechanism to maintain propulsion while walking (as the foot rotates in/out the gastroc is unable to provide push off). The result is that instead of push off coming from the calf, quads, and glutes, the workload is shifted up the leg chain to the hip extensors (hamstrings, glutes, external rotators). With the rotation of the leg, the workload is shifted more and more to the small external rotator muscles.

2) Tight Adductor Muscles/Weak Abductor Muscles. In the hip joint, the outer abductor muscles help stabilize the pelvis while walking, keeping it level as you stand on one foot and the other swings through. It is common for these muscles to become weak/overused, resulting in tight adductor muscles that over time can become contracted. In addition to pulling the thigh bone (femur) in towards midline, the adductors can also assist with hip extension and internal rotation. As they become contracted, hip extension will become limited (increasing the workload on the gluteus max) and the tight internal rotators can put the external rotators on stretch (making them more susceptible to injury).

So what’s the difference between a muscle strain and a true “piriformis syndrome”?

A muscle strain is just that- an injured muscle that got overworked. When you get into piriformis syndrome territory now we’re talking about nerve involvement, namely the sciatic nerve. This condition requires a visit to your doc. If you’re getting numbness, tingling, burning, weakness starting in your butt and running down your leg? Get an appointment asap.

The back of my hip hurts. Now what?

First things first. Like we’ve said all along. This site is not designed to keep you from your doctor and healthcare team. It’s designed to teach you the things that you can do at home to help alleviate symptoms and prevent them from becoming a full blown injury. That being said, the back of the hip can be a complex place. If you have any of the following, time to see your doctor. Numbness/tingling in the buttocks/down the back of your thigh. Burning pain or pain in multiple locations (i.e. butt, outside of the hip, back of the thigh). Weakness into the leg/difficulty weight bearing. Pain that doesn’t improve with rest. See your doctor.  Remember, the thing to keep in mind with nagging symptoms in the hip is that it might not be muscular. It could indicate a nerve entrapment or something further upstream in the back. Numbness, tingling, and weakness down into the leg are big red flags, but so are continued symptoms that don’t improve regardless of treatment.

Be smart when self treating at home. If you aren’t getting better, get some help. I can’t tell you how many patients I get who wait weeks and even months before coming in for treatment. The longer you wait, the harder it is to get rid of. Here are some tips for finding the right health care professional:

• Find someone certified in soft tissue mobilization, whether it’s instrument assisted like Graston Technique or hands on like Active Release (ART). This is where you need to do your homework to see who’s near you. Follow the links to those sites to search their provider lists and read up on what each is all about. A tight hip will definitely benefit from some hands on/massage work. When looking for someone on the ART list you’re looking for spine and lower leg certified. Long Tract nerve certified is also a plus.
• Not every PT and chiropractor are created equally. Some do very little soft tissue work and rely mostly on exercise and manipulations. Others do not. We all specialize in our own little areas. Frustrating right? Not really. Most of us have websites to tell you what we are certified in. If we don’t? Pick up the phone and call us. There’s nothing worse than wasting 8 insurance visits not getting better only to switch places and have them fix it in two.

How to treat it.

**download PDF with links, sets, reps, progressions, etc here**

Step 1- Traditional R.I.C.E. treatment:

When a new muscle injury occurs, the first and most important goal is always to decrease pain and any swelling that may be present. In other words, we want to decrease inflammation. That means ice is mandatory. Absolutely no heat no matter how good it feels. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge and wear compression gear under your dress clothes. Use that to your advantage when working to heal an injury!

Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle/joint will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery.

Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact.

Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight (think recovery tights if you’ve ever worn them). For an injury like a piriformis syndrome, I personally opt for a pair of compression shorts.

 

Step 2- Kinesiology taping:

By now you’ve probably seen athletes covered in all kinds of colored tape. Some of you have probably even tried it out. Make sure to read the application instructions first! This stuff should last 3+ days, not fall off in an hour.

1) Piriformis application. Click here.

Step 3 – Getting mobility back

The next goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a piriformis injury isn’t about no pain, no gain. Don’t overdo it in an attempt to speed up your recovery. If you start feeling tingling/numbness, EASE UP. There are nerves running through this muscle and that means you’re hitting them.

1) R.I.C.E. + gentle stretching. There should be no pain with stretching.

2) Begin using the foam roller to work around the injury first. The goal here is to start getting slack into the back of the hipe without aggravating the injury itself. No tennis ball work or active/joint mobilizations. The order should be foam roll the muscles around the piriformis -> stretch -> RICE. Remember, with an injury like this, you are trying to fix two things: 1) the piriformis injury itself and 2) the restrictions down stream that led to that rotation of the leg in the first place.

3) Begin using the foam roller over the painful area to tolerance. The order should be foam roll the muscle around the injury-> over the injury -> stretch -> RICE.

4) As the muscle heals, we can really start to go after it using the mobilization techniques. For the piriformis, this will mean muscle mobilizations as well as joint both at the hip and down at the ankle. The order should be foam roll around the injury -> over the injury-> mobilizations -> stretch -> RICE.

How long do you need to R.I.C.E for??? Until it’s 100% gone.

Here’s what it looks like. Use the guidelines above.

Step 4- Strengthening

We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.

Why these exercises? The whole goal of this progression is restore muscle balance so that the large muscles in the back of the hip (glutes) are doing more of heavy lifting than the little ones (i.e. the piriformis). When you start to lose that hip extension, that’s when things start to get out of whack.

What you’ll need: 1) resistance band/tubing. This is easy to find in any sporting good store these days. You can probably even get it in walmart or target.

Optional equipment: 1) a balance disc. Always good to add difficulty to your strength exercises. Affordable too at $20.

Video’s for each level are here. Please note, in the PDF download you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.

Level One

Level Two

Level Three

To help put it all together, I’ve also created a PDF you can download to walk you through what a “treatment session” would look like. In it you will find everything you need including links to the videos and posts. Click here.

Hope that helps, and fire away with any questions in the comments.

References

1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.

2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

4) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.

5) Michaud, Thomas C. (2011). Human Locomotion. Newton Biomechanics, Newton, MA.

6) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.