Brian Schiff’s Blog

So, have you ever experienced pain in the buttock that radiates down into the thigh? Maybe even felt some numbness and tingling? Recently, I was contacted by an experienced marathoner who has been plagued by pain in the buttock and posterior thigh.  He self diagnosed himself as having piriformis syndrome after doing some research on the Internet.  So. what is piriformis syndrome?

Some experts debate whether it truly exists, but essentially, it involves the piriformis, a small pear shaped muscle in that helps externally rotate (turn out) the hip and the sciatic nerve which runs down the entire back of the leg and is responsible for sensation and motor movement patterns of many of the muscles in the lower leg.

It is suggested that in this syndrome the sciatic nerve essentially becomes compressed or irritated by a tight piriformis muscle.  The sciatic nerve travels above, below or even through the piriformis muscle itself based on anatomical studies.

Some have even suggested that prolonged sitting with the hips turned out or sitting on a wallet can contribute to this problem.  I even remember being told in PT school that it is more common in truck drivers.  With that said, I think I can count on one, if not both hands the number of patients I have seen in 15 years that I truly believe had piriformis syndrome.

Now back to my runner.  He began having pain in his left buttock and hamstring in late December after seeing a trigger point specialist who suggested he had a tight piriformis and did some deep tissue work on it.  A short time afterward, he began having symptoms.  He saw a physical therapist for 2-3 sessions and was given some stretches to do.  Meanwhile, he began getting deep tissue massage focused on the area in January and February.

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I am always looking to try and learn new things.  There seems to be so much buzz around soft tissue mobilization and release on the blogs and web these days.  The longer I practice and treat soft tissue injuries, the more convinced I become of the importance of releasing trigger points and myofascial restrictions.

One of the therapists who works alongside of me every day recently attended a Graston® training course.  For those unfamiliar, this is a form of instrument assisted soft tissue mobilization (IASTM) utilizing convex and concave instruments to resolve fascial restrictions that are often present and a source of pain/tightness.

I volunteered to have her work on my IT band immediately when she returned from the course.

Click here to see a short video clip

While I have utilized foam rolling, the Stick, deep tissue massage and most forms of stretching, this was a first for me.  I must admit, the instruments Liz used seem to find every single tender and gritty spot in my IT Band. Yes, there was some mild discomfort at times.  But, the treatment lasted 3 minutes or so and I felt much less tightness and soreness the very next day.

Many people see good results in as few as 3-4 sessions, but results vary.  Consider IASTM another tool to place in your collective tool box.  It is a great adjunct to stretching, strengthening and corrective exercise. There are other methods out there (SASTM and Gua sha to name a few) but I am not addressing them here today.

If you have specific questions or want more info on GT, visit the link below:

Graston® Frequently Asked Questions

If you are an endurance athlete or someone who has been struggling with chronic soft tissue pain or tendinitis, and have not yet tried this, I might suggest looking into this as it may be a missing link in your rehab plan. If you have personal experiences with the GT, I would love to hear about them.

In most gyms and training circles, people are performing bench press or push-up exercises.  There is no doubt in my mind that repetitive heavy full range bench press causes many of the labral and cuff injuries among males I have seen over the years These injuries are often the attritional type – developing over many months and years.

What about push-ups?  Is the force development pattern the same?  Are they safer?  Honestly, I believe in keeping the elbow at a point at which it does not drop below the plane of the body (bench press) or move above the body (push-up).  Essentially that means keeping to a 90 degree angle or less.  Why?  Well, regardless of load, I feel the real risk is not so much in the motion itself but the very repetitive manner in which it occurs with external loads, often lending itself to acquired anterior shoulder laxity, strain on the proximal biceps anchor (think SLAP lesions) and secondary shoulder impingement.  The picture below hurts my shoulders just looking at it, and over time this technique will hurt your shoulders too.

But, I say all that to set up today’s post.  In a recent article in the February edition of the Journal of Strength & Conditioning Research, David Suprak et al. looked at the effect of position on the % of body mass supported during traditional and modified push-ups.

The study looked at 4 static positions in 28 males (about 34 years old) who were highly trained and members of the special forces or SWAT team (the up and down position for regular and modified push-ups) to determine the change in body mass (BM) supported by the upper body in different ranges of motion.  The down positions studied were at approximately 90 degrees (the lowest depth I safely recommend) and all holds were performed for 6 seconds.

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In my last post, I shared some practical plyometric drills with you to help teach proper landing mechanics in an effort to reduce ACL injuries.  Yesterday, I presented my comprehensive approach to knee training at our ACL Symposium in Cary, NC.

One of the fundamental errors I see coaches and athletes make is abandoning their pre-season training efforts during the in-season.  While athletes need to spend the majority of the in-season focusing on sports skills, they must also maintain the neuromuscular training adaptations acquired in the off-season and pre-season.

In my mind, the phrase “use it or lose it” is applicable for the neuromuscular training effects we see with balance, strength, agility and plyometric training.  This is especially true for our high risk female athletes like soccer and basketball players who suffer knee sprains, ACL tears and patellofemoral pain at disproportionate rates.

I often hear coaches say, ” I don’t have time to get workouts done and still accomplish what needs to be done at practice.”  While, time management may be difficult, I think coaches could probably squeeze in a single training session lasting 15-20 minutes if they simply knew how important it was to the overall health and performance capacity of their team.

With that said, I like to offer simple, yet effective exercises that can be done on a court or field with the whole team simultaneously without the need for expensive equipment.  Exercises should focus on activating the glutes (including the medius and minimus) as well as training the hamstrings more since most female athletes tend to be quad dominant.

These exercises are just as effective for males too.  So, in the video below I will reveal some exercises I prefer to do to increase strength and reduce injury risk.  Perform 2-3 sets of 8-15 reps focusing on strict form throughout.

With the new year, millions of people have made a resolution to lose weight.  Along with that, comes the idea they will flatten their midsection.  If you are like me, you share a certain disgust for the infomercials marketing the “next” latest and greatest abdominal machine.

For years, people have sought out how to build the perfect six pack.  Obviously, nutrition is probably the single biggest factor in achieving a sculpted midsection. But, beyond that people often wonder what exercises to do to target the upper and lower abs as well as the obliques.  Is this really possible?

Well, I thought I would share the results of a recent study in the Journal of Strength & Conditioning Research. The authors wanted to look at the use of other training tools versus just a body weight only exercise. In the study, they looked at surface EMG activity for the upper rectus abdominus (URA), lower rectus abdominus (LRA), external obliques (EO), internal obliques (IO), transverse abdominus (TA) and rectus femoris (RF) with the following exercises:

• Abdominal floor crunch
• Supine V-up
• Prone V-up on slide board
• Probe V-up on stability ball
• Probe V-up on TRX
• Prone V-up on power wheel

Crunch

Prone V-up with power wheel

In short the major results are as follows:

1. The most muscle activity overall occurred with the power wheel
2. There was no significant difference for activation of the EO, URA and LRA
3. RF was much less active only during the abdominal crunch

Practical applications include:

• There is no realistic way to isolate portions of the abdominal muscles, but keep in mind one limitation may be that the study looked at MVC (contraction at only one point in the motion)
• The RF is NOT a spinal stabilizer but rather a hip flexor and therefore it can cause an anterior pelvic tilt if overly active which can be viewed as potentially harmful
• Focus on training the core globally as an integrated segment of the kinetic chain to maximize activation and understand how the hips affect completion of the movements

I hope this post stimulates your thinking with respect to abdominal training.  If you do use training tools, simply stop for a moment to consider the desired training outcome, as well as the impact the body position and  muscle firing patterns have on the exercise itself.