Piriformis IT band Syndrome Patella Femoral Hip Pain- Zombie Leg - Inhibited Glutes

“The glutes are responsible for hip extension, hip hyperextension, hip abduction, hip transverse abduction, and hip external rotation.” (t-nation.com)

“Due to their natural strength and the leverage advantage they have over your legs, the glutes should always be the primary muscles that drive lower body movement.”(higher-faster-sports.com)

If one or both of your glutes are inhibited like mine- your training, balance, strength, running, swimming, biking, well being, recovery, healing, and everyday life is affected and you most likely don’t even know it. I believe my left glutes have been inhibited for over a decade. You’ve got nothing to lose- I feel 3 months of solid glute and core work 10 years ago would have prevented countless injuries during that time span.

I would like to start by saying I have no medical training, I am not selling anything, nor do I have affiliation with any of the sites that may be linked. I understand there are many of you that know more than me on this subject, and I understand this is also old news to some of you. However, I believe there is still a gross lack of knowledge and appreciation for the importance of this muscle group, so I am sharing my story. If you feel that you have something beneficial to add, or feel the need to correct me on something, please feel free to post a reply. I am simply trying to convey my message, and what worked for me, in hopes to help others with similar issues.

Much of what follows is taken from the net, but if you keep entering search queries like “tight hip flexors”, “IT band syndrome”, and “piriformis syndrome”, you will keep ending up at the same sites I did, the ones only advising you to strengthen your hips with hip hikes, banded side steps, banded clams, squats and so forth. Don’t get me wrong, these are, and were a necessary part of my healing, but it wasn’t the breakthrough needed. All of these exercises can be done without fully activating the glutes. The zercher squat reportedly only activates the glutes around 45% while a properly done hip thrust is around 119% (www.t-nation). Below I have included what worked for me, but most of the information is contained in the sites I have linked. I cannot stress enough how important it is to educate yourself on the glutes and the effect they play on your performance.

“Squatting, dead lifting, and lunging, can make the glutes sore but they don't strengthen the glutes much. They target the quads and erector spinae. Even box squatting, walking lunges, and sumo dead lifts don't activate much glute in comparison to the exercises below.” (https://www.t-nation.com/training/dispelling-the-glute-myth)

Quick history- I am 42yr old male, 5’6” 142lbs. I have stayed somewhat active over the years, hitting it harder during the past two, but often plateaued from the same old injuries- patella femoral syndrome, it band syndrome, piriformis syndrome, hip pain, leg pain, sciatic nerve pain down leg. Much, if not all of these problems I believe stem from inhibited glutes and weak hips.

“When considering the human body, we know that some muscles are more prone to inhibition than others, and the glutes are one of these “easily-inhibited” muscles. Several decades ago, physical therapists such as Vladimir Janda noticed that the glutes are quite prone to inhibition, and in the last decade strength coaches for professional teams began to notice that their athletes’ glutes were not functioning optimally.

There are a few reasons why the glutes could shut down. Neural and mechanical inhibition involving opposing muscles can interfere with gluteal activation. For example, tight or shortened hip flexors may lead to what’s been coined “reciprocal inhibition” of the gluteals. There may even be inhibitory consequences to excessive sitting, as compression slows down vascular function and interferes with nerve function. We’ll learn below that pain inhibits muscle contractility and is a major player in glute inhibition. Moreover, gluteal inhibition can negatively impact posture, and poor posture can further inhibit the glutes, thereby creating a downward spiral in gluteal function.

However, probably the biggest reason why the glutes shut down is due to inactivity. If you fail to consistently activate a muscle, and you fail to regularly activate a muscle to high levels of capacity, it will inevitably quit working properly.” (http://bretcontreras.com/how-to-fix-glute-imbalances/) .
During the last couple years I’ve done some 5k’s, 4 or 5 Spartan races and two tri sprints. These problems are nearly gone, and still improving, as my lower left quadrant loosens up and my glute and hip strength increases. I am currently performing 6-7 workouts a week.

To paraphrase Kelly Starrett (www.mwod.com) - “saying someone has piriformis syndrome is like saying someone has leg syndrome”. These syndromes are usually part of a bigger picture. In my case they all stemmed from left glute, or lack thereof. I did not realize how little I used it until I felt it getting stronger. When I began to feel my left glute firing again I told my PT guy I was going to trademark the condition as “Zombie leg”, which is how I felt my body was treating it. Dragging it along by use of my hams, hip flexors and whatever else it could call into play. I had my gait measured and checked during all this, and my left stride was an inch or two shorter. I was literally driving with my right glute then yanking my left leg fwd. It was all starting to make sense.

My piriformis pain is nearly all gone, my left side and TFL are not chronically tight, my psoas / hip flexors have loosened up, and it band syndrome is gone, and left knee soreness is gone. All of these areas had taken over for my inhibited glute causing them to be overworked and chronically sore. Once I fixed the primary muscle, the secondary ones healed in stride, pardon the pun.
If you have any of the issues I’ve mentioned and you’ve tried doctors, therapists, and everything else, please read these-
http://bretcontreras.com/how-do-i-know-if-i-have-a-glute-imbalance/ (test your glutes)
https://www.t-nation.com/training/dispelling-the-glute-myth
http://www.higher-faster-sports.com/noglutes.html
http://bretcontreras.com/how-to-fix-glute-imbalances/ - Bret has built his entire site around glutes, I have only read about 5% of it
www.mwod.com – Kelly starrett is considered one of the world’s leading physical therapists and cross fit trainers. You have to pay like $7.95 for a one month membership to watch his videos but the stuff I learned from this guy played an integral role in my education. I have paid two or three times now.

Finally, the steps I took that worked for me-
1. Have your gait checked by someone reputable and wear the correct shoes. Don’t run in cheap unsupportive shoes. Strength train in bare feet if and when you can.
2. Back off on your distance running. Focus on form, stop running when form breaks down, or pain begins.
3. Start strengthening your feet; they are the foundation you must build on. Walk around the house barefoot. I always hated this, now I love it. Your foot contains 35 joints and 28 bones, held together by 120 ligaments, and activated by at least 20 muscles. Muffle that orchestra with a padded shoe or croc, and it messes with your kinetic chain all the way up your body. (Kelly Starrett- Mwod.com- rebuilding the feet video https://www.youtube.com/watch?v=ha6ZxfG6Tz8)
4. Make sure you have a foam roller, tennis ball, and lacrosse ball (educate yourself on how to properly use them). Start with tennis ball if lacrosse ball hurts too much.
5. Find a good sports therapist to work out the bound up muscles you have inevitably created. I worked out a cash deal since my guy was out of network and saw him once a week for $75 /session. He would perform myofascial release, rolfing, dry needling, and massage. He also helped tweak my hip strengthening routine.
6. Start a hip routine which includes- fire hydrants, banded sidesteppers, banded clams, glute bridges (double and single leg with lacrosse ball in hip pocket), hip hikes on step. When I progressed to being able to do 50 hip hikes per side I bought 5lb ankle weights. I incorporated most of this into my daily warm-up exercise routines.
7. After a month or two of the above, or depending on your current glute and hip strength, proceed to advanced - Weighted hip hikes on step, standing leg raises with ankle weight, donkey kicks with weight, weighted single leg glute bridges, goblet squats, and kettle bell swings. This is when I saw my most improvement, when I isolated the glutes. Don’t jump ahead to this advanced routine if you still get tired from the first routine, if your glute is highly inhibited other muscles will try to compensate.
8. Prior to running I now do the following full warm up including but not limited to- knee circles, bicycles, hip circles, fire hydrants, donkey kicks, bird dogs, glute bridges (single and double, don’t arch back, all extension must come from the hip joint). I then go to my basement so I don’t wake up the family and do 1 set of each 30 -50 jumping jacks, 20 med weight kettle bell swings, 20 goblet squats. Many of you will think of this as a waste of time. It takes about 20-30 minutes, but all of these exercises not only activate the glutes for my run, they supplement my hip and glute strengthening routine. Plus I workout early AM and need about 20 min for my carb drink to hit my system so what’s the use in sitting around.
9. Post workout- this should be your only time for heavy stretching. I have nearly quit all cold stretching and mainly stretch while my muscles are warm or hot. Some “dumbed down” light stretching, foam rolling, light yoga are OK while your muscles are cold but don’t push it or you’ll be achy and sore instead of loose.

In closing- Don’t underestimate the human body, it has the ability to keep chugging along when something shuts down, It has backup quarterbacks that aren’t as good but do get the job done; like the hip flexors, hamstrings, quads, TFL, and piriformis. I have spent two years prior to beginning my tri training in a gym working on core; plyometrics, crossift, and cardio. Yes, I worked myself into good shape, but at a cost to my hip, knee and leg. I assumed these were aches pains brought on by age. When in fact all I needed to do was address my hips and glutes. This glute problem was the final key to help me advance to my next phase- SO FAR PAIN FREE.
The tri-rock Geneva a month ago I finished around 60 of 350. Yes it was only the sprint, but keep in mind I had just begun tri training, and haven’t done any significant bike riding since I was a teenager. I am aiming toward a half ironman next year. So, don’t give up on yourself until you’ve fully addressed your glutes.
Thanks Chris W