Ischial Bursitis and Piriformis Syndrome. Author: Anthony J Ross ATC, CSCS, M.Ed.

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1 Author: Anthony J Ross ATC, CSCS, M.Ed.

2 Contents About the Author Background/History Common Signs and Symptoms Treatment Options Sample Program Conclusion Reference Material

3 About the Author Anthony J Ross ATC, CSCS, M. Ed. graduated from Alfred University with a Bachelors of Science degree in Athletic Training and minors in Exercise Science and Coaching. After working multiple years in various sports medicine settings He began his journey as an educator and received his Master s degree from Wright State University. Anthony co-founded IREP Athletics with his good friend and business partner Scott Proscia BS ATC, M.Ed. They continue work to establish IREP Athletics LLC as the undisputed leader in its field creating and delivering uncompromising programs and advice for athletes in the fields of program design, education, athletic performance, injury care and prevention, strength, conditioning and weight management. Certifications: Certified Athletic Trainer NSCA-Certified Strength and Conditioning Specialist IRONMAN Certified Coach ACSM-Certified Personal Trainer NASM-Corrective Exercise Specialist NASM-Performance Enhancement Specialist Certified Instructor of American Heart Association Health Care Provider CPR, 1st Aid and AED Although Anthony brings multiple years of education, on-field, and clinical experience in the field to his work and writings, this article is written as an educational component for the athlete and is in no way a substitute for seeing a Physician. It is always recommended to consult your Physician prior to starting a new workout regimen and when treating any injury. I am excited to bring top quality, evidence and research based knowledge and experience into our programs at IREP Athletics. I hope that this article helps to serve as a guide for the struggling athlete looking to overcome physical issues, and will help them Respond, Evolve, Perform. Best In Health, Anthony J Ross ATC, CSCS, M.Ed. 3

4 History Additional Causes to note: Improper Warm-Up Poorly Fitting Shoes Increasing your intensity in exercise too soon Being older The presence of Arthritic like conditions and bone spurs Differential Diagnosis: Trochanteric Bursitis Illiotibial Band Syndrome Hamstring Strain Ischial Bursitis: This is inflammation to the bursa that lies between the ischial tuberosity and the tendon of the hamstring. The bursa s job is to help reduce friction between tendons and bones. This can commonly occur in conjunction with a hamstring tear or tendonitis. Pain will be located in the buttocks region primarily where you sit and can cause symptoms similar to sciatic nerve pain Piriformis Syndrome: This is a condition in which the muscle spasms and causes pain in the buttock region. Similar to ischial bursitis the pain will be in a similar region and can be a cause of sciatic nerve pain. The sciatic nerve in some runs through or beneath the piriformis and can cause numbness and tingling along the back of the leg and into the foot. This syndrome can be caused by muscle spasm, or irritation, tightening of the muscle, and or swelling of the piriformis due to overuse, weakness, and injury. Common Signs and Symptoms Ischeal Bursitis: Pain when stretching the hamstring Pain that increases with prolonged sitting Pain accompanied by shooting or burning pain into the back of the leg or foot Pain that gradually comes on following a sprinting session Pain is relieved when standing. Piriformis Syndrome: Pain down the back of the thigh, calf, and foot A dull ache in the buttock Pain when walking up stairs or inclines Increased pain after prolonged sitting Reduced range of motion at the hip joint Reduced pain if standing, walking or laying down Its always a good idea to see your doctor especially if: Severe pain is associated with a traumatic event such as a trip or fall this could be more of a sign of a fracture You can visually see the inflammation in the foot or lower leg Pain even at rest, or gets worse throughout the day and at night. Numbness and weakness occur in your feet while running. 4

5 Treatment Options Both Issues have common treatment options: Ice Massage Dialing back your training (rest) Beginning stretching and strengthening (Catch the injury early if possible). ***Example of Corrective Exercise will be outlined in the following section*** More serious interventions Platelet Rich Plasma Injections (PRP s) Cortisone injections or Anti-inflammatory meds Casting or being placed in a boots Surgical intervention ***consult your physician before starting any of the treatment options listed in this section*** The Magic of Corrective and Preventative Exercise! Corrective Exercise can, in most cases, be the cure. No matter what road your physician may choose ALL options will include some form of corrective exercise. Early intervention utilizing the proper progression of corrective exercise and given enough attention the corrective exercises have been shown to help enhance the recovery of the athlete. As a side note: a good movement assessment and screening can help catch any of these issues early and before they progress into anything debilitating a good Coach is going to perform one prior to the start of your training... If they do not perform a movement assessment GET A NEW COACH. ***Disclaimer: Corrective Exercises only work if YOU take the time to do them consistently and correctly, Staying consistent and persistent will ensure that you will RESPOND, EVOLVE, PERFORM 5 5

6 Example Day The above day is part of the initial phase of the Achilles rehab programming The above template can be used as a tracking guide for your workouts For full programming, reference materials, how to videos, and more check out the programming at Check out our free reference videos at The Training Plan Source 6

7 Conclusions The big take a ways are: 1. These injuries have a slow onset if ignored can get debilitating quickly. 2. Utilize a proper progression in your fitness programming to prevent the onset of these overuse injuries. Do not progress your programming too quickly. 3. Early interventions utilizing Corrective Exercise can enhance recover time. 4. Perform Corrective Exercise Often, DO NOT SKIP DAYS! Get the Full Program at TheTrainingPlanSource.com Questions? Please visit TheTrainingPlanSource.com or for performance and endurance questions Coach Scott at: Scott@irepathletics.com and for Injury Management, Weight Loss, and Strength questions Coach Anthony at: Anthony@irepathletics.com Training for another race, trying to improve strength, lose weight, or dealing with a nagging injury? Visit thetrainingplansource.com for all of your training and fitness needs. 7 7

8 References Association, N. S. (2015). Essentials of Strength Training and Conditioning 4th Edition. Human Kinetics. Floyd, R... (2014). Manual of Structural Kinesiology 19th Edition. McGraw-Hill Education. Houglum, P. (2016). Therapeutic Exercise for Musculoskeletal Injuries 4th Edition. Human Kinetics. Magee, D. J. (2002). Orthopedic Physical Assessment, 4e. Saunders. Medicine, N. A. (2013). NASM Essentials Of Corrective Exercise Training: First Edition Revised. Jones & Bartlett Learning. Prentice, W. (2017). Principles of Athletic Training: A competency based approach 16-e. Mcgraw-Hill. Saladin, K. (2014). Anatomy & Physiology: The Unity of Form and Function 7th Edition. McGraw-Hill Education. 8 8