Dealing with a Pain in the Butt?
Let's find a solution for your Piriformis and SI pain.
I personally dealt with Right-sided SIJ pain on and off again for several years.
It was a nagging cluster of SI pain (Sacroiliac Joint pain), Piriformis pain, and lower back pain that flared up when I would walk or sit for long periods.
I tried all the traditional physical therapy treatments, but nothing seemed to make a lasting difference.
Fast forward to today- I haven’t had the slightest bit of this pain in well over a year! - Ever since I started appreciating the body’s asymmetries and understanding how to treat this from a more global approach.
So let’s break it down.
For most of us, our pelvis tends to be “more forward” on one or both sides. (Forward meaning the pelvis is relatively flexed, or anteriorly tilted) And even when a pelvis is tipped forward on BOTH sides, we still see one side more than the other, typically the Left.
Why is this?
This goes back to the fact that our body is inherently asymmetrical. The Right and Left sides of the body are not mirror images of one another. We have a liver on the right side, a heart on the left, a larger right diaphragm… just to name a few.
And this is reflected in all of our body systems.
Neurologically our brain is not the same on both sides. Each side has dominant roles- an example being our left brain housing our language centers.
This asymmetry is explained in-depth through the Postural Restoration Institute, and if you’re a provider, I highly recommend taking a course.
Now because of these asymmetries, we tend to see a pelvis that is more forward on the left, compared to the right. (and to clarify, this is not a movement that is happening solely at the SIJ, but it’s a rotational component happening at the spine, SIJ, and hip.)
These asymmetries can often be seen, but when you work with a Postural Restoration Provider they will perform objective tests to confirm the position of the pelvis, because it’s always better to TEST NOT GUESS!
Now we could talk for hours about WHY we see a pelvis that is typically more forward on the Left, but let’s save that for another day.
Let’s get into how we can help your “pain in the butt!”
When we have a pelvis that’s more forward on the Left, this causes compression in the Left SI region, shortening of the Left Piriformis muscle, and overall shortening of the back of the Left hip soft tissue structures.
In this same presentation, we will ALSO see Right side distraction of the SIJ, lengthening of the Right Piriformis muscle, and overall lengthening of the back of the Right hip soft tissue structures.
Now imagine you have Right-sided Piriformis pain- can you see how all the half pigeon poses and figure-4 stretches in the world won’t fix this problem?
And sure, deep stretching CAN temporarily relieve symptoms, due to its effect on the nervous system, but much to our dismay, it typically comes back in a few hours… am I right?
Now traditionally it would make sense to think we need to strengthen the Right Piriformis to encourage “shortening” and “force closure” of the Right SIJ.
And this isn’t wrong, BUT to effectively do this…
We have to make sure we’re addressing the POSITION of the pelvis first.
Because of the asymmetrical position of the pelvis, the muscles are at poor length/tension relationships and are not positioned to function optimally.
Addressing positioning first will lead to more lasting outcomes.
So in the case of our pelvis being more forward on the Left, we need to help shift into our left hip, getting our Left pelvis BACK, and our Right pelvis FORWARD. Essentially finding the opposite position of what we’re used to.
One of my all-time favorite Postural Restoration techniques to address this:
Left Sidelying Resisted Right Glute Max
In this technique, you’re shifting your Right knee forward, as you “scoop” your knee up into the resistance of the band (We go over this technique in PRI: Pelvis Repositioning 2.0 inside of the Loa Movement membership)
Okay, so you try this and you feel like you can’t “shift your Right knee forward” – it’s almost like your left hip is stopping this movement?
Now what?
For many of us, we’ve been in this position where our Left pelvis is more forward for long enough that our soft tissue structures on the back our Left hip have shortened.
We have a tight posterior hip capsule that won’t allow us to move into this new pelvic position.
If this is you, you need to inhibit the Left Posterior Hip Capsule BEFORE you attempt to better position the pelvis.
Think of it like you need to make space for the movement FIRST.
This Left Hip Capsule Inhibition from Postural Restoration helps you make space in the back of the left hip:
In this technique, you’re breathing and finding length in the back of the Left hip (this technique is also included in the class I mentioned above!)
So now that you’ve made space in the back of the Left hip, go back to the first technique and see how it feels!
You may be able to shift into your left hip easier, and better sense the Right Glute Max, due to improved pelvic position.
The Right Glute Max muscle functions as the critical “glue” to maintaining this new pelvic position. And maintaining this position equals happier SI joints and Piriformis muscles!
If you want more on this topic, check out the Body & Breath class titled PRI: Pelvis Repositioning 2.0 (unlocks Sunday 9/8)
We will walk through the education explained here using a pelvis model, and then I’ll lead you through these techniques!
Want to take class with me for 2 weeks free?