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Piriformis Myofacial Release causing knee strain

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  • Piriformis Myofacial Release causing knee strain

    http://www.youtube.com/watch?v=HWfnA...ayer_embedded#!

    This stretch is a staple in my arsenal for lower back and hip mobility. Over the past few weeks I have been getting a really bad pain in the outer side of my knee around the LCL/MCL when doing this stretch. It got to the point where I couldn't even go through the range of motion because my LCL, MCL, or ACL (couldn't figure out what one) felt like it was going to snap.

    I talked to some people through PM and decided to stop doing that stretch, ice, wrap, and let the knee chill out for the past 2 weeks. I have been up and down with the healing process and find that after my workouts the knee feels flawless. When I am cold the knee feels unstable and I am scared to do anything like jumping or sprinting.

    Today my girlfriend told me that I'm dumb and the pain when doing that stretch isn't coming from a knee issue, rather she hypothesized it is coming from a tight hip that is pulling into my knee. I stretched out my groin / aductor region in my left leg and 30 seconds later was able to do the piriformis stretch with no pain.

    I had pulled my left groin about 6 months prior to this and didn't notice how tight it got.

    I am now confused and wondering if anyone has experienced anything like this? Is my knee fine and I just need to stretch my hip? Or could my knee have slight tears because of my hip?

    after writting this I realize without an MRI or xray we have no idea what is really wrong. I am going to continue to ice, and wrap it, while stretching out my hips.

    Pretty much I just contributed a random story to the message boards. lmao.


    As of now I am not expecting or seeking any imediate advice as I think I have it figured out lol. Any opinion sharing from vets would be appreciated.
    Last edited by syssstem; 11-09-2011, 04:19 AM.

  • #2
    We can narrow the ligament question down to LCL - the others are not located on the "outer side" of the knee (MCL is "inner side" and ACL is inside the joint) - and from watching the video I would venture a guess that you either overstressed it doing the stretch because the way he demonstrates it puts a LOT of pressure on the LCL. If you have any knee instability combined with hip tightness during the stretch you will definitely stress the ligament. I would seriously doubt that you tore anything, unless you felt/heard something tear during the self treatment.


    First thing I would suggest is stop doing that stretch the way it is shown in the video until the knee stops hurting. You can still do the ball technique without putting your foot on your opposite knee, and you will still get a benefit from it. There is also a different way you can stretch the piriformis that puts less stress on the outside of the knee - I will see if I can find a picture for you when I get in to the clinic this afternoon.

    TrueNutrition.com discount code: AAL229 saves you 5%

    Feel free to PM me with injury questions - I'll get back to you soon as I can.

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    • #3
      I'll leave this one to PTAaron, but I might also wonder if your Tensor Fasciae Latae and lateral quad aren't tight, too, and the pain is possibly the beginning of IT Band syndrome.

      Ssssssssssssystem, when you had this pain in your knee that "felt like it was going to snap," was there was a intense pain when you bent your knee to 30 degrees of knee flexion (roughly) but no pain (relatively) if you bent your knee beyond that?...

      -S
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      • #4
        Originally posted by homonunculus View Post
        I'll leave this one to PTAaron, but I might also wonder if your Tensor Fasciae Latae and lateral quad aren't tight, too, and the pain is possibly the beginning of IT Band syndrome.

        Ssssssssssssystem, when you had this pain in your knee that "felt like it was going to snap," was there was a intense pain when you bent your knee to 30 degrees of knee flexion (roughly) but no pain (relatively) if you bent your knee beyond that?...

        -S
        That was my other thought as well... I was rushing out the door to do cardio (yay cardio) when I saw the question, glad you mentioned it.

        TrueNutrition.com discount code: AAL229 saves you 5%

        Feel free to PM me with injury questions - I'll get back to you soon as I can.

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        • #5
          Originally posted by PTAaron View Post
          We can narrow the ligament question down to LCL - the others are not located on the "outer side" of the knee (MCL is "inner side" and ACL is inside the joint) - and from watching the video I would venture a guess that you either overstressed it doing the stretch because the way he demonstrates it puts a LOT of pressure on the LCL. If you have any knee instability combined with hip tightness during the stretch you will definitely stress the ligament. I would seriously doubt that you tore anything, unless you felt/heard something tear during the self treatment.


          First thing I would suggest is stop doing that stretch the way it is shown in the video until the knee stops hurting. You can still do the ball technique without putting your foot on your opposite knee, and you will still get a benefit from it. There is also a different way you can stretch the piriformis that puts less stress on the outside of the knee - I will see if I can find a picture for you when I get in to the clinic this afternoon.
          Thanks for the detailed reply! In re: to the narrowing of the ligament. The reason I can't narrow it is I honestly cant figure out where the discomfort is coming from. I know it logically makes sense that it is the LCL, but the actualy discomfort feels like it is on the inside of my knee. If the ACL is actually INSIDE the joint I feel as if it might be the ACL. Before I figured out the hip tightness I would put an ice pack behind my knee and this would also make the pain go away temporarily.

          in re: to feeling and hearing something pop, I did hear some pops and cracks but I thought this was normal. My right knee pops and cracks a little getting into the position but I have no pain in that knee. I also have a 100% functioning hip on that side.

          I am looking forward to seeing this picture of an alternative way to stretch the piriformis.

          I am going to read / reply to scotts post now.

          Thanks!

          Comment


          • #6
            Originally posted by homonunculus View Post
            I'll leave this one to PTAaron, but I might also wonder if your Tensor Fasciae Latae and lateral quad aren't tight, too, and the pain is possibly the beginning of IT Band syndrome.

            Ssssssssssssystem, when you had this pain in your knee that "felt like it was going to snap," was there was a intense pain when you bent your knee to 30 degrees of knee flexion (roughly) but no pain (relatively) if you bent your knee beyond that?...

            -S
            Scott, I had no idea what the hell a tensor fasciae latea or lateral quad was prior to reading this response. I am using this picture for the TFL.

            http://ce-preview.bmjknowledge.com/m...-2_default.jpg

            What is a lateral quad? Is it just the main part of your quad? If it is, I stretch that all the time it is not tight.

            First I would like to say that I think my Tensor Fasciae Latae is TIGHT AS HELL!!!! I spent the last year gaining about 100 pounds on my 18inch box squat. I went back to normal medium stance deep squats a few weeks ago and literally FELL FORWARD on my ramping sets because my hips were soooooooo tight and not used of the depth.

            When I do the ball rolling I am trying to really focus on ringing out the areas of my upper glute, and side of my hip. This region was what I thought defranco was calling the piriformis. Is the piriformis deep in the middle of the glute? If it is, I think I am actually wanting to stretch my gluteus medius, my IT band and my TFL with that same ball rolling tactic.


            second, when I am standing up with all my weight on my left leg and bend my knee to 30 degree flexion, there is no pain, however, something inside my knee clicks like a tendon is popping out of place or something of that nature. If I go all the way down there is still no pain.

            last, I am speculating the root of this issue lies within tight adductors in my left hip due to the injury I had last year. I just did a heavy 3rm deep squat for the first time in months. Something in my left inn theigh / hamstring area took way more of the load than before I gained 100 pounds to my box squat and I might have even over strained it.


            edit:

            are you familiar with defrancos agile 8?
            http://www.elitefitness.com/forum/we...-a-631289.html

            this is the staple of my pre workout warmup. the stretch I forgot to do during my box squat progression was #8, the static hip flexor stretch. When I do it now, I feel extremely tight in my left hip.

            as for static stretching later in the day, I usually just do the basics for the quads, hams, glutes, and calves.

            for my piriformis I do this : http://www.healingmassage.ca/piriformis_stretch.gif

            I also feel that stretch in my IT band, but do stuff like this from time to time http://www.rice.edu/~jenky/images/ITband1.GIF

            2nd edit:

            I have been looking at anatomy charts for like 2 hours. Refering to these pictures and found this video explaining some hip pysiology:
            http://www.youtube.com/watch?NR=1&v=XU9hJuFnSwE
            http://www.deeptissue.com/learn/hip/adductors.jpg
            http://muscleventures.com/video/imag...tretch-004.jpg

            The first time I hurt my hip I think I hurt my pectineus or adductor brevis. No clue how to tell the difference between the two. I took a month or two off squats then I switched to 18 inch narrow box squats because they didn't hurt this muscle.

            Later down the road my knee started hurting because I think the tight hip was pulling on it funny?

            Now today I pulled something in my adductor magnus, longus, or gracillis. My first hip injury was higher up closer to my pubic bone where the green circle is in that one pic. The first injury was 8/10 bad and I couldn't squat. This one feels halfway down my innerthigh but potentially my hamstring. It is 4/10 bad, and I should be able to squat next week or the one after.

            I want to sort this whole tight hip shit out! I am confused where to begin and why this keeps happening.

            also I want to try and uncover a connection between the tight left hip and the sore left knee. I want to see if they are from the same issue or if they are two separate problems.
            Last edited by syssstem; 11-10-2011, 12:45 AM.

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            • #7
              Sorry for the delay man, like I said in the PMs - was slammed at work yesterday, and today was no better. I had planned to have our student demonstrate some stretches and shoot a video to post up for you - but I never got any down time except at lunch when he was out.

              Anyway... even though it doesn't sound like you need it now - this is the piriformis stretch I recommend to people:
              http://informahealthcare.com/na101/h...f0004g.tif.gif - basically pulling your knee to the opposite shoulder, puts a lot less stress on the knee.

              The reason I went into the ligament detail was just to try to get some clarification about where specifically the pain was - but that doesn't seem like it was necessary as it seems this probably isn't the problem.

              From the sounds of all of your additional information - you are already doing a lot of good stretches... that agile 8 routine looks fantastic. Are you just doing that as a warmup or doing that every day? With all of the stretching you are doing, I would question if maybe you needed your form tweaked/critiqued to make sure you are doing things right if you are still experiencing tightness - not meant as an insult in any way... just an observation that if you are doing that much stretching and are still tight - something is amiss.

              As far as the hip being related to the knee: MOST knee problems that we see that don't have a traumatic cause can be traced back to tightness and/or weakness in the hip region causing abnormal biomechanics during a movement. Tight IT band/TFL, tight piriformis, weak glute medius (most common problem), and weak adductors are probably the biggest things we see - even in people that are otherwise very strong. I'm not talking about weak like a kitten - but weak relative to the rest of the muscles.

              I don't think I really provided anything useful here ... my suggestions would be stretching properly - which you are already doing, and specific strengthening which would require some testing to know where it is needed.

              TrueNutrition.com discount code: AAL229 saves you 5%

              Feel free to PM me with injury questions - I'll get back to you soon as I can.

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              • #8
                This site has some decent stretches...
                http://www.nismat.org/ptcor/itb_stretch

                TrueNutrition.com discount code: AAL229 saves you 5%

                Feel free to PM me with injury questions - I'll get back to you soon as I can.

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