ollieyoga

Athletically: I saw the doctor two days ago and the physical therapist yesterday. The conclusion: no hip injury, and it is probably not my back. Rather it appears that I have a piriformis strain along with weak/tight gluteus medius muscles.

I've talked about these things in my previous posts: pain in the butt, june injury report, tight butt, late May, yoga's role in injury recovery.

I've been given a physical therapy routine to follow twice a day, and each routine takes about 20 minutes. Some are basic stretches, some are hip hikes, and some are basic exercise moves.

(these photos show the hip hike move)

The odd thing is that these exercises look very easy, but are hard for me at this time! I've also recieved some yoga pose suggestions.

Symptoms: pain in the hip/butt area, especially when standing too long in one place. Short (3-5 mile) walks on flat ground at a gentle but non-strolling pace (13-14 minutes per mile) were usually painless. Slower walking, uphill walking both hurt, and too much faster walking eventually hurt.

Besides the exercises, I was told to stay on anti-inflamatories for several weeks, even if I started to feel good.

I got some good advice from other yogis.
From Yoga Journal: (part of an article by Julie Gudmestad)

Finding Stability

While the piriformis and the other deep hip rotators are best known for the problems they create when they're tight, they do need to be strong to perform important functions in yoga poses. They help to stabilize the pelvis and knees when you bear weight on the legs, especially in standing poses. To experience this, stand with your legs wide, preparing for Virabhadrasana II (Warrior Pose II). Turn your right foot out 90 degrees and your left foot slightly in. Notice that even though the right foot is turned out, there is a tendency for the knee to turn in.

This internal rotation of the femur is due to the pull of the internal rotators of the hip, including the adductors (a large muscle group of the inner thigh) and the medial hamstrings on the back of the inner thigh. If the foot and shin rotate out while the femur rotates relatively in, the knee twists, putting a potentially damaging strain on its ligaments. A contraction of the external rotators is needed to bring the knee into alignment with the foot to protect the integrity of the knee joint.

To refine and strengthen this action, try practicing Warrior II with your back to a wall. Stand close enough so your right buttock touches the wall but your feet do not. Turn your right foot out so the foot is parallel to the wall, and turn your left foot in slightly more than perpendicular to the wall. Now come down into the pose, bending your right knee and keeping your left leg straight and strong. Place a yoga block or firmly rolled towel between your right knee and the wall, and press your right knee into this prop. It is the deep hip rotators that are putting pressure on the block—and at the same time aligning your knee perfectly with your foot.

As you press the right knee toward the wall, make sure that you don't let the left thigh buckle away from it. In fact, if you'd like to increase the challenge, place a second block or rolled sticky mat between the wall and the center of your left femur; hold it in place by firmly pressing your left leg back while continuing to press the right knee into its prop. You will feel a strong action in the back of both hips as the piriformis and its friends externally rotate both legs. A similar action should occur in Parsvakonasana (Extended Side Angle Pose) to the right: Keep the right knee pressing into the right arm while maintaining a straight line through the left leg.

The knee is also at risk of being twisted in some straight-leg standing poses, and a strong contraction of the deep hip rotators is required to align the femur, knee, and foot. While in Trikonasana (Triangle Pose) to the right, turn your head and look at your right knee. Chances are, it's slightly internally rotated.

Now feel the firmness in your right buttock as you externally rotate the thigh to align the knee with the foot. (Notice that this action also creates a beautiful arch in your foot.) Even more challenging, maintain this alignment as you bend your knee and prepare to transition to Ardha Chandrasana (Half Moon Pose). In this transition, the rotators must act strongly to prevent the knee from angling in toward the big toe, and they must continue to contract as the knee straightens fully in the pose.

Building Strength

Let's look at one more straight-leg standing pose, Tadasana (Mountain Pose). Many people tend to stand with their feet pointing out slightly. Sometimes this may be caused by short and tight rotators that externally rotate the whole leg. If that is the case, the knees will also be pointing out, and you need to spend more time stretching the backs of your hips.

However, it's also fairly common for the feet to point out while the knees point in, an alignment that can contribute to pronation of the feet (collapsed arches), knee problems, and low back pain. Weak rotators can be the culprit behind this pathological alignment. If the external rotators aren't strong enough, the internal rotators (which include the gluteus medius and tensor fascia lata on the outer hip as well as the adductors) will pull the femur into internal rotation. In an attempt to align the femur, the outer hamstring, which is also an external rotator, takes over for the deep hip rotators. Unfortunately, the outer hamstring inserts into the lower leg, and so, instead of aligning the shin and thigh, it turns the lower leg out even more deeply, exacerbating the misalignment. [...]

And a yogi on the yoga.com (Purnayoga) message boards helped also; he recommended "half moon" done as above (with a block and against a wall) as well as to do Supta Padangusthasana like this:

"The toes of the down leg point toward the ceiling and the toes (and kneecap) of the lifted leg point to the back wall of the studio (approximately). The alignment of the up leg should always have the toes and kneecap pointing to the back wall (unless you are very very supple and then they point to the floor just above the ear)."

Photo from:

http://www.yogajournal.com/poses/483_1.cfm

The therapeutic for Piriformis strains as you mention is typically (based on my school of training) Ardha Chandrasana at the wall, with a block and the standing leg over-rotated externally.

Are you familiar with the basic pose in the middle of the room?
That would be a good baseline for us to work from. Assuming you are...

The difference in the therapeutic is the wall for support, the block for stability and the external rotation of the standing leg. Achieve the later by pivoting on the heal of the standing leg and bringing the toes closer to the baseboard (wall used for support). Both sides are executed in the same way for balancing the body. I'd do them twice a day - morning and night.

You can also try Parsva Supta Padangusthasana with a belt but the toes on the extended leg should be closer to the floor then the heel, unlike the true pose where the outer edge of that foot is parallel to the floor.

Though here's the thing, the glute medius handles hip abduction so while you are releasing the piriformis you may be putting load on the Glute in question. This is why hoola hoop movement might be tough on you. So it's a bit problematic to give one thing that might "do it" for you.

PS: my yoga teacher continues to cost me money. I went and bought some bike shorts (ok, 1 bike short liner and one pair of the baggy style). Now, I went and got a second bike (one suitable for commuting and soft-bike-path riding). Sheesh.