Whether your friend has hurt your feelings or you’re upset over a lovers tiff, swearing could help to ease your pain, according to new research published in the European Journal of Social Psychology.
Carried out by Dr Michael Philipp, a lecturer at Massey University’s School of Psychology, New Zealand, along with Laura Lombardo from the University of Queensland, Australia, the work looks at the effect of swearing on “short-term social distress,” which could be anything from an argument with your partner to being excluded from a social situation.
Although previous studies have looked at common methods for relieving both physical and social pain, fir example with paracetamol, none have so far looked at whether swearing aloud could also help relieve social distress in the same way that it has previously been shown to ease physical distress.
To test this idea, the study looked at Pain Overlap Theory, which suggests that physical and social/emotional pain share the same underlying processing system, and anything affecting physical pain will also have similar effects on social pain.
For the research 70 participants were split into two groups, and tested for feelings of social pain and sensitivity to physical pain.
During the study participants had to write either about an inclusive social situation, or a distressing one, to induce the corresponding emotions. They were then were randomly assigned to either swear aloud or say a non-swear word aloud.
The results showed that those participants who were socially distressed experienced less social pain and less sensitivity to physical pain than those who didn’t swear.
“Previous research suggests that social stressors, like rejection and ostracism, not only feel painful but also increase people’s sensitivity to physical pain,” explained Dr Phillip. He also added that swearing can help ease both social and physical pain by reducing its intensity, by distracting the person in pain.
However, Dr Phillip also pointed out that swearing may not have the same effect if used on an everyday basis or in a situation which is only mildly irritating or stressful, when the use of profanity may lose its impact.
He also added that swearing is not a quick answer for those experiencing serious emotional pain and stress such as grief or abuse, when clinical care may be needed.
Previous research on swearing has also found that cursing aloud can make you stronger. In a small-scale study published early last month, a team of researchers found that participants who completed a test of anaerobic power — a short, intense period on an exercise bike — and isometric handgrip test — produced more power and had a stronger grip if they swore while completing the exercises.
Be honest, you don’t know how your car works, do you? And despite spending most of the working day lashed to a QWERTY, if someone asked you how update their modem, you wouldn’t where to start (or what the modem even is).
And that’s fine. Other people do that stuff so you don’t have to. But the same can’t be said for your workout. You need to be okay with the specifics – do you honestly know what that dead lift is doing to your muscles? Or more importantly, the damage you could be doing to yourself if you’re getting it wrong.
Thankfully, experts are on hand. We’ve enlisted the help of Tim Walker, founder London’s Evolve Fitness to settle the form debate on five key exercises, once and for all.
First up, a pre-lift check list.
Breathing. Oxygen creates energy in the muscles, so don’t hold your breath.
Technical understanding. Understand which muscles you are about to engage, know the movement you’re about to make, and be deliberate with that movement.
Mental participation. Make sure you’re in the moment, and don’t think about what’s next. Connect your mind to your muscles, and aim for a full range of motion.
Load selection. Challenge yourself, but be realistic, your body will thank you in the long run. Go too heavy and you’ll fail to get a range of motion, too light and you won’t stimulate the muscle enough force growth.
1.Bicep Curls
The most common mistake: “Leaning back during the curl and bringing your elbows forward (rather than keeping them at your side).”
The damage it might be doing: You can incur bicep tendon injuries (tears, impingements and dislocations etc.) but the main reason you need to get your form right is so that the exercise actually has an effect. “Leaning too far backwards means that you’re not putting enough pressure on the bicep – you’re using your weight as momentum during the curl, rather than lifting only with the bicep muscles. And by lifting your elbows forwards, you’re shifting the focus of the exercise away from the bicep (you’ll be lifting with your shoulders and using the momentum from your body again), thus you won’t get the development you want.
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How to fix it: “Focus on holding your posture more tightly; pull your shoulder blades back and down, and lift your chest up, lean forward slightly and keep your weight in your heels. Contract your abs at all times, too. To keep your elbow position, focus on keeping your elbows in line with your ears, and be forceful with that contraction in your abs when pulling the weight up.”
2. Bench Press
The most common mistake: “Elbow position. Most people have their elbows in line with their shoulders. It’s hampering your progress because it doesn’t target the chest. You’re looking for synergistic movement in the chest, shoulders and triceps.”
The damage it might be doing: The most common injuries are a Glenoid Labrum tear (front of upper arm), rotator cuff tears and shoulder impingement syndrome. Bench pressing is the kind of exercise that you want to keep increasing in weight, because the feeling of nailing that new three-rep max is unbeatable. But it only takes one lift with poor form for something to go wrong, so always think ‘form first, weight second’.
How you should be doing it: “I often ask my clients to lower their arms 20/25 degrees, so they are just above the nipple, and I always find it useful to keep my knuckles pointing to the ceiling, and my wrists straight.”
3. Deadlift
The most common mistake: “Rounding of the back, rather than keeping a natural arch.”
The damage it might be doing: “A slipped disc in the lower back is the main danger here.” You can also incur sprains and strains (different things), but if there’s any sharp pain at any point, you should stop.
How to fix it: “Try locking the upper body posture by keeping the chest high and arms long (aka fully extended, not bent). Keep your weight into your heels (make sure they don’t leave the ground, and you’re not feeling your full weight in your toes) concentrate on pressing through the legs and keep your core area strong by engaging your stomach muscles.”
4. Squat
The most common mistake: “For squats, there are several: bending forward too much, not squatting deep enough and allowing the knees to turn inwards.”
The damage it might be doing: “That mistake is damaging your body/hampering your progress because� Bending forward too much will put too much pressure on your back, and lead to the same kind of damage as an incorrect deadlift. If you’re not going deep enough you won’t be engaging the hamstrings and glutes as much as you could; if you’re aiming to build the muscles and boost metabolism you’ll be missing the mark. If you allow the knees to turn inwards you’re risking damage to the ligaments such as ACL.”
How to fix it: “For bending forward; this is commonly due to a general tightness in the chest and lats (latissimus dorsi muscles) and/or hip flexors, which is very common among office workers who spend a lot of time sitting. Fix it by stretching these muscles more regularly. For those not going deep enough, you need to man-up and understand the principles if fight-or-flight. Most people fear that when they go down deeper they won’t get back up, but you need to attack the movement with confidence and good technique. The worst that can happen is that the safety catches will stop the bar and you crawl out. For the knees, the best thing is to engage your brain. Think about what you are doing and what your knees are doing, you want your them to be in line with your second and third toes at all times.”
5. Single Arm Rows
The most common mistake: Rounding of the back, rotating too much as you pull the weight, and failing to achieve a full range of motion, i.e. not pulling the weight all the way into the body.
The damage it might be doing: “Rounding the back isn’t particularly dangerous, but it’ll prevent the most optimal development of your back. Over rotation when pulling the weight will mean you’re not working the back muscles as well as you could be, hampering your strength development. The same goes for not having a full range of motion; if you’re not pulling the weight all the way into your body, you’re not getting a full contraction of the muscles, which means you won’t be adequately stimulating them.”
How to fix it: “Stick your butt out and check your position in a mirror – your upper back should be flat, with a gentle/natural arch in your lower back. For over rotation, by more rigid in both your thinking and your positioning. When you hold the position more forcefully you will engage your abs and obliques better. This is one of my favourite back exercises – when done properly – it works and engages your core as well as the back.”
Tim Walker is the founder of Evolve Fitness,13-15 Bouverie Street, London, EC4Y 8DP
Bathing suit season is here, and for many of us that means no longer being able to hide those extra pounds beneath a chunky sweater. Fortunately, there are some small and easily implemented lifestyle adjustments that can quickly shrink your waistline.
Here are 10 ways to slim down for swimsuit season. The best part? None involve the gym.
Plan ahead: Making meals ahead of time can save you calories in the long run. Try cooking up large-batch dinners over the weekend and simply reheat throughout the week. Lisa Lillien, author of the “Hungry Girl” Website, featuring advice on guilt-free eating, suggests emphasizing lean proteins and veggies. Commit time on the weekend to meal prep and all you have to do is throw the ingredients in the pan during the week.
Drink more: Water, that is. Staying hydrated is important for your overall body function and can prevent you from feeling hungry. Sometimes the body confuses dehydration with the sensation of hunger. This problem comes with an easy solution — drink more water. Bring a travel water bottle with you when you’re on the go so you can remember to stay hydrated.
Limit or avoid alcohol: Cutting out alcohol is one of the quickest ways to lose weight. Alcohol triggers a process in the body similar to sugar. It can set off the same insulin resistance that can cause weight gain. For six days of the week, cut out alcohol.
Snack on healthy foods: Keep a variety of healthy snacks around to satisfy cravings. Protein bars and nuts are great snacks that will satisfy your hunger and prevent you from making poor food decisions at meal times. Fresh fruit and veggies are another great snack option.
Banish stress: Maintaining a healthy diet isn’t about never indulging. It’s about eating healthy foods the majority of the time and treating yourself on occasion. Don’t stress out if you veer off course. Instead, do what you can to get back on track. Stress can actually be a source of weight gain, so try to focus on the positive.
Careful with carbs: Processed white carbs are a no-no. They spike blood sugar levels and cause the pancreas to produce insulin, which causes the accumulation of fat. Instead, opt for refined carbs like brown rice and oats.
Start with soup: According to research from Penn State University, soup is a great diet food. The combination of liquids and solids helps make you feel full faster. Eat it before a meal and you may be able to decrease your overall calorie intake by up to 20 percent.
Consider your coffee: Black coffee isn’t a diet buster — it’s the milk and sugar that go in it. A latte from your favorite coffee shop can be a hidden source of fat and calories. Try swapping your usual espresso for a plain black or green tea.
Stop multitasking: A recent study in the American Journal of Clinical Nutrition found that multitasking while you eat will leave you feeling unsatisfied. Instead, slow down and enjoy your time savoring your meal without the distractions.
Spice it up: According to a recent study led by David Heber, a professor of medicine and director of the Center for Human Nutrition at the University of California-Los Angeles, capsaicin — the compound found in chili peppers — speeds metabolism and helps burn calories. Participants in the study were given a capsaicin supplement or a placebo for four weeks. The group who received capsaicin burned more fat for several hours after the meal for a total of 100 to 200 more calories a day. Spicy foods may also make you feel fuller more quickly than bland foods.
A compound in a plant found throughout Southeast Asia is a more powerful anti-HIV compound than the drug AZT that’s used to treat the condition, says a study published in the Journal of Natural Compounds.
Patentiflorin A, a chemical derived from the willow-leaved Justicia, stood out in a screening of more than 4,500 plant extracts by a team of scientists from the University of Illinois at Chicago, Hong Kong Baptist University, and the Vietnam Academy of Science and Technology to see if they had any effect against the HIV virus.
AZT is an anti-viral drug that doesn’t cure HIV, but reduces the amount of the virus in the body and reduces the risk of developing AIDS. It was the first drug approved by the FDA to treat HIV infection in 1987. Today, it is still the cornerstone of HIV treatment, although it is combined with other drugs to increase effectiveness and reduce side effects.
For the current study, Lijun Rong, professor of microbiology and immunology in the UIC College of Medicine, and his colleagues zeroed in on patentiflorin A because of its ability to inhibit an enzyme needed for HIV to incorporate its genetic code into a cell’s DNA.
AZT inhibits this enzyme, called reverse transcriptase. In studies of human cells infected with the HIV virus, patentiflorin A was significantly better at inhibiting the enzyme than AZT.
“Patentiflorin A was able to inhibit the action of reverse transcriptase much more effectively than AZT, and was able to do this both in the earliest stages of HIV infection when the virus enters macrophage cells, and alter infection when it is present in T cells of the immune system,” said Rong.
Patentiflorin A was also was effective against known drug-resistant strains of the HIV virus, making it a very promising candidate for further development into a new HIV drug.
“Patentiflorin A represents a novel anti-HIV agent that can be added to the current anti-HIV drug cocktail regimens to increase suppression of the virus and prevention of AIDS,” Rong said.
The researchers were also able to synthesize patentiflorin A. “If we can make the drug in the lab, we don’t need to establish farms to grow and harvest the plant, which requires significant financial investment, not to mention it has an environmental impact,” Rong said.
Other advances are being made in the battle against HIV. Last year, scientists at the Oregon National Primate Research Center found that giving infant monkeys human antibodies within 24 hours of being exposed to a virus similar to HIV totally cleared them of the virus within two weeks. Current HIV treatments keep the virus in check, but once a person stops taking anti-HIV drugs, the virus returns.
Summer’s officially just a week away, and millions of Americans are facing high odds of suffering from sunburn in coming months.
If you catch too many rays and wind up looking like a lobster, head straight to your kitchen. No kidding. Here are some surprising home remedies to soothe the burn that are as good as — or better than — commercially available skin creams and lotions:
Cucumbers: These vegetables are rich in vitamin C and caffeic acid, both of which help to soothe irritated skin and reduce swelling. Cukes also have compounds with analgesic properties to numb pain. You can slice cold cucumbers and apply them to burned areas. Better yet, make a paste by mashing or blending a couple of cucumbers and apply it chilled.
Lettuce: The greens have painkilling compounds that can take the sting out of sunburn. Boil the leaves in water, then strain and chill the liquid. Apply the fluid with cotton balls.
Potatoes: These tubers have been used throughout history to ease burns, bites, scrapes, and other skin problems. Blend one or two until they get pasty — you may have to add a splash of water — then chill the paste and apply via cotton balls.
Honey: This remedy for burns goes back to ancient Egyptian times. Honey reduces inflammation, provides nutrients to the damaged tissue and seals in moisture. It also has antiseptic properties. Just spread some of the sweet stuff where it hurts.
Apple cider vinegar: A common home remedy for a variety of problems from poison ivy to acid reflux to allergies, the cider also works on sunburn. You may want to dilute it a little since one of the active ingredients, acetic acid, may sting when applied. Use cotton balls or soak a washcloth in the solution for more coverage.
Coconut oil: You can use this for both protection — it has a sun protection factor (SPF) somewhere between 5 and 10 — and relief if you just stay out too long without any other sunscreen. Apply it directly to sunburned areas and you can feel its soothing effects as its medium-chain fats are absorbed into your skin and work their healing magic.
Oatmeal: Regular rolled oats will do just fine as the oatmeal’s polysaccharides will help to heal your skin. Put about 2 cups into a clean tube sock and add it to a tub of tepid water. Let it soak a few minutes, then climb in. Squeeze out the sock every few minutes, which will turn the water cloudy. When you’re done, air dry or pat yourself off gently with a soft towel.
Yogurt: Yogurt contains probiotics and proteins that will help to heal your skin. Make sure the yogurt is plain with no flavoring and also that it has live, active cultures. Spread it around the burned areas, let it sit for about five minutes, then rinse it off with tepid water.
Witch hazel: The tannins from the plant’s liquid extract reduce inflammation, kill bacteria and repair damaged skin. Use cotton balls or a clean cloth to dab it on sore areas. Reapply as needed.
Aloe vera: The gel from the fleshy leaves of this plant is rich in glyconutrients that soothe and heal all kinds of skin problems, including burns. Slice open a leaf and the gel will ooze out. Apply it directly to sunburned areas.
When suffering from sunburn, also be sure to drink plenty of water, because you’re probably dehydrated too. And try to avoid harsh soaps that will wash away the natural oils of your skin and further dry it out.
Of course, the best sunburn remedy is prevention. That means staying out of the sun during peak hours, typically between 10 a.m. and 2 p.m. And dermatologists strongly recommend wearing a hat, covering exposed areas with clothing and using sunscreen with a SPF of 15 or higher.
Look for sunscreen labeled “full spectrum” to make sure it screens out both UVA and UVB rays. But beware that a lot of sunscreens have toxic chemicals. Your best bet is to check out the Environmental Working Group’s Skin Deep database online to find the safest products.
Chiropractor, Dr. Alexander Jimenez gives insight into the relevant anatomy and functional biomechanics of the piriformis muscle, highlights the role it plays in musculoskeletal dysfunction and looks at management options in cases of muscle dysfunction.
The piriformis muscle (PM) is well-known in the fraternity of sports medicine as a significant muscle in the posterior hip. It is a muscle that has a role in controlling hip joint rotation and abduction, and it is also a muscle made famous due to its �inversion of action� in rotation. Furthermore, the PM also grabs attention due to its role in the contentious �piriformis syndrome�, a condition implicated as a potential source of pain and dysfunction, not only in the general population but in athletes as well.
Relevant Anatomy
The name piriformis was first coined by Belgian Anatomist Adrian Spigelius in the early 17th century. Its name is derived from the Latin word �pirum� meaning �pear� and �forma� meaning �shape� � ie a pear shaped muscle (see Figure 1)(1).
The PM originates on the anterior surface of the sacrum and is anchored to it by three fleshy attachments between the first, second, third and fourth anterior sacral foramina(2). Occasionally its origin may be so broad that it joins the capsule of the sacroiliac joint above and with the sacrotuberous and/or sacrospinous�ligament below(3,4).
PM is a thick and bulky muscle, and as it passes out of the pelvis through the greater sciatic foramen, it divides the foramen into the suprapiriform and infra-piriform foramina(5). As it courses antero-laterally through the greater sciatic foramen, it tapers out to form a tendon that is attached to the superior-medial surface of the greater trochanter, commonly blending with the common tendon of the obturator internus and gemelli muscles(6).
The nerves and blood vessels in the suprapiriform foramen are the superior gluteal nerve and vessels, and in the infra- piriforma fossa are the inferior gluteal nerves and vessels and the sciatic nerve (SN)(5). Due to its large volume in the greater sciatic foramen, it has the potential to compress the numerous vessels and nerves that exit the pelvis.
PM is closely associated with the other short hip rotators that lie inferior such as the superior gemellus, obturator internus, inferior gemellus and obturator externus(2). The primary difference between the PM and other short rotators is the relationship to the SN. The PM passes posterior to the�nerve whereas the other otators pass anterior (see figure 2).
Variants
A few anatomical variants have been found with the PM:
1. Additional medial attachments to the first and fifth sacral vertebrae and to the coccyx(7).
2. The tendon may fuse with the gluteus medius or minimus above, or superior gemellus below(7).
3. In less than 20% of cases it is divided into two distinct portions through which part or all of the sciatic nerve may pass(7).
4. It may blend with the posterior hip joint capsule as a conjoined tendon with the obturator internus(8).
5. The distal attachment of the PM has shown to vary in dimensions and position on the supero-medial surface of the greater trochanter. It can span a distance of between 25-64% of the anterior-posterior length on the greater trochanter, with 57% attaching more anterior and 43% more posterior(9).
6. Pine et al (2011) studied the insertion point extensively and found that four types of insertion existed and these were classified based on the relationship to the obturator internus(10). The variability in position and breadth of the distal attachment of the PM muscle may influence the validity of the concept known as �inversion of action� (see below).
The other hotly debated issue is the relationship between the PM and the SN. The conclusion is that there are several anatomical variations of the PM and its SN relationship. The sub-types of this variation include(11-13):
Type 1 (A below). Typical pear shape muscle with the nerve running anteriorly and inferiorly to this (in 70%-85% of cases).
Type 2 (B below). The PM is divided into two parts with the common peroneal nerve running between the two parts and the tibial nerve running anterior and below (found in 10-20% of cases).
Type 3 (C below). The peroneal portion loops over the top of the muscle and the tibial portion is below (found in 2-3% of cases).
Type 4 (D below). Undivided nerve passing through the PM (occurs in about 1% of cases).
It is also believed that two other very uncommon variations occur (see E and F below).
Type A is the most common variation, showing the SN passing below the PM
Functional Considerations
The primary functional roles of the PM are;
1. Hip external rotation(15).
2. Abductor at 90 degrees of hip flexion(15).
3. In weight-bearing, the PM restrains the femoral internal rotation during stance phase of walking and running(2).
4. Assists the short hip rotators in compressing the hip joint and stabilising the joint(6).
5. As it can exert an oblique force on the sacrum, it may produce a strong rotary shearing force on the sacroiliac joint (SIJ). This would displace the ipsilateral base of the sacrum anteriorly (forward) and the apex of the sacrum posteriorly(16).
As the PM is the most posterior of the hip external rotators due to its attachment on the anterior surface of the sacrum, it has the greatest leverage to exert a rotation effect on the hip joint. It is often seen clinically that the PM appears to be tight and hypertonic, while the other short hip�rotators that are closer to the axis of rotation become inhibited and hypotonic.
Inversion Of Action
The most contentious issue related to the function of the PM is its �reversal-of- function role� or �inversion of action� role. Many authors have suggested that as the hip approaches angles of 60-90 degrees and greater, the tendon of the PM shifts superiorly on the greater trochanter. As a result, its line of pull renders it ineffective as a hip external rotator; however it does contribute to internal hip rotation. Therefore it reverses its rotation role at high hip flexion angles(15,17,18).
The function of the PM at varying joint angles is an important consideration for the clinician who is evaluating and treating �piriformis syndrome�. Often it has been advocated to stretch the hip into flexion, adduction and external rotation to stretch the PM over the glutes by utilising the �reversal of function� concept.
However, more recent anatomical dissection studies have shown that the attachment of the PM onto the greater trochanter can be variable and in some instances it may insert in a position whereby it is unable to reverse its function, for example in a more posteriorly placed attachment(19). Therefore, stretching the PM into external rotation when the hip is flexed beyond 90 degrees � based upon reversal of function � would be ineffective as a treatment or misleading as an examination technique(19)
MSK Dysfunction & PM Syndrome
Many decades ago, the role that the PM played in creating sciatic-like symptoms was first suggested by Yeoman (1928) when it was considered that some cases of sciatica may originate outside the spine(20). This was supported soon after when Freiberg and Vinkle (1934) successfully cured sciatica by surgically dividing the PM(21). Based on cadaver dissections Beaton and Anson (1938) gave the hypothesis that the spasm of the PM could be responsible for the irritation of the SN(12).
The term �piriformis syndrome� was first coined by Robinson in 1947(22) and was applied to sciatica thought to be caused by an abnormality in the PM (usually traumatic in origin) with emphasis on ruling out more common causes of sciatica such as nerve root impingement from a disc protrusion. It soon became an accepted clinical entity � but with no consensus about the exact clinical signs and diagnostic tests to differentiate it from other sources of sciatica(23,24).
Piriformis syndrome can be defined as a clinical entity whereby the interaction�between the PM and SN may irritate the SN and produce posterior hip pain with distal referral down the posterior thigh, imitating �true sciatica�. Isolating the dysfunction to this region usually follows exclusion of the more common causes of buttock pain and sciatica.
More specifically, complaints of buttock pain with distal referral of symptoms are not unique to the PM. Similar symptoms are prevalent with the more clinically evident lower back pain syndromes and pelvic dysfunctions. Thus, a thorough evaluation of these regions must be performed to exclude underlying pathology(4). It has been suggested that piriformis syndrome� is responsible for 5-6% of cases of sciatica(25,26). In the majority of cases, it occurs in middle-aged patients (mean age 38 yr)(27) and is more prevalent in women(28).
Pathogenesis Of Piriformis Syndrome (PS)
PS may be caused by or relate to three primary causative factors;
1. Referred pain due to myofascial trigger points (see Figure 4)(2,28-30). Examples include tight and shortened muscle fibres precipitated by muscle overuse such as squat and lunge movements in external rotation, or�direct trauma(16). This increases the girth of the PM during contraction, and this may the source of the compression/entrapment.
2. Entrapment of the nerve against the greater sciatic foramen as it passes through the infrapiriform fossa, or within a variant PM(29,31).
3. SIJ dysfunction causing PM spasm(29,32).
Janvokic (2013) has presented a number of causative factors in PS(29);
1. Gluteal trauma in the sacroiliac or gluteal areas.
2. Anatomical variations.
3. Myofascial trigger points.
4. Hypertrophy of the PM or spasm of the PM.
5. Secondary to spinal surgery such as laminectomy.
6. Space occupying lesions such as neoplasm, bursitis, abscess, myositis. 7. Intragluteal injections.
8. Femoral nailing.
Symptoms
Typical symptoms reported in piriformis syndrome include:
A tight or cramping sensation in the buttock and/or hamstring(33).
Gluteal pain (in 98% of cases)(34).
Calf pain (in 59% of cases)(34).
Aggravation through sitting and squatting(35), especially if the trunk is inclined forward or the leg is crossed over the unaffected leg(36).
Possible peripheral nerve signs such as pain and paraesthesia in the back, groin, buttocks, perineum, back of the thigh (in 82% of cases)(34).
Physical Findings & Examinations
Palpable spasm in and around the PM and obturator internus and external tenderness over the greater sciatic notch (in 59-92% of cases)(34,35). The patient is placed in the Sims position. The piriformis line overlies the superior border of the PM and extends from immediately above the greater trochanter to the cephalic border of the greater sciatic foramen at the sacrum. The line is divided into equal thirds. The fully rendered thumb presses on the point of maximum trigger-point tenderness, which is usually found just lateral to the junction of the middle and last thirds of the line.
Hip flexion with active external rotation or passive internal rotation may exacerbate the symptoms(36).
Positive SLR that is less than 15 degrees the normal side(37).
Positive Freiberg�s sign (in 32-63% of cases)(34,35). This test involves reproducing pain on passive forced internal rotation of the hip in the supine position � thought to result from passive stretching of the PM and pressure on the sciatic nerve at the sacrospinous ligament.
Pacers sign (in 30-74% of cases)(34,35). This test involves reproducing pain and weakness on resisted abduction and external rotation of the thigh in a sitting position.
Pain in a FAIR position(34). This involves the reproduction of pain when the leg is held in flexion, adduction and internal rotation.
An accentuated lumbar lordosis and hip flexor tightness predisposes one to increased compression of the sciatic nerve against the sciatic notch by a shortened piriformis(38).
Electro-diagnostic tests may prove useful (see below).
Investigations
Conventional imaging such as X-ray, CT scan and MRI tend to be ineffective in diagnosing piriformis syndrome.
However, some value may exist in electro- diagnostic testing.
It is beyond the scope of this paper to discuss in detail the process of electro- diagnostic testing; the reader is directed to references for more a more detailed description of how these tests are administered(35,36,39). However the purpose of these tests is to find conduction faults in the SN. Findings such as long-latency potentials (for example the H reflex of the tibial nerve and/or peroneal nerve) may be normal at rest but become delayed in positions where the hip external rotators are tightened(27,36,39).
It is accepted that the tibial division of the SN is usually spared, the inferior gluteal nerve that supplies the gluteus maximus may be affected and the muscle becomes atrophied(40). However testing of the peroneal nerve may provide more conclusive results as is more likely to be the�impinged portion of the SN. The H-wave may become extinct during the painful position of forced adduction-internal rotation of the affected leg(36).
The �Myth� Of Piriformis Syndrome
Stewart 2003 argues that piriformis syndrome is an often over-used term to describe any non-specific gluteal tenderness with radiating leg pain(41). He argues that only in rare cases is the PM implicated in nerve compression of the SN to truly qualify as a piriformis syndrome. He cites only limited evidence and cases where the diagnosis of piriformis syndrome can be made.
1. Compressive damage to the SN by the PM. Stewart cites studies whereby in few isolated studies, the SN was seen to be compressed by the PM in instances such as hypertrophy of the muscle,�usual anatomical anomalies such as a bifid PM, and due to compression by fibrous bands.
2. Trauma and scarring to the PM leading to SN involvement; it is possible that rare cases of true Piriformis Syndrome have been caused by direct heavy trauma to the PM due to a blunt trauma to the muscle. This is termed �post- traumatic PS�.
McCory (2001) supports this argument by stating that it is more likely that (given the anatomical relationship of the PM to the various nerves in the deep gluteal region) the buttock pain represents entrapment of the gluteal nerves, and the hamstring pain entrapment of the posterior cutaneous nerve of the thigh, rather than the SN alone(33). This would explain the clinically observed phenomenon in the absence of distal sciatic neurological signs. Whether the PM is the cause of the compression has not been clearly established. It is possible that the obturator internus/gemelli complex is an alternative cause of neural compression. He suggests using the term �deep gluteal syndrome� rather than piriformis syndrome.
Treatment
When it is believed that a piriformis syndrome exists and the clinician feels that a diagnosis has been made, the treatment will usually depend on the suspected cause. If the PM is tight and in spasm then initially conservative treatment will focus on stretching and massaging the tight muscle to remove the PM as being the source of the pain. If this fails, then the following have been suggested and may be attempted(23,36):
Local anaesthetic block � usually performed by anaesthesiologists who have expertise in pain management and in performing nerve blocks.
Steroid injections into the PM.
Botulinum toxin injections into the PM.
Surgical Neurolysis.
Here, we will focus on therapist-directed interventions such as stretching of the PM and direct trigger point massage. It has always been advocated that PM stretches are done in positions of hip flexion greater than 90 degrees, adduction and external rotation to utilize the �inversion of action� effect of the PM to isolate the stretch to this muscle independent of the other hip external rotators.
However, recent evidence from Waldner (2015) using ultrasound investigation discovered that there was no interaction between hip flexion angle and the thickness of the PM tendon in both internal and lateral hip rotation stretching � suggesting that the PM does not invert its action(19). Furthermore, Pine et al (2011)(9) and Fabrizio et al (2011)(10) in their cadaveric studies found that the PM insertion is a lot more complex and varied than first thought. It is possible that the PM may invert its action only in some subjects but not others.
Therefore, due to the disagreements and confusions over the �inversion of action� concept, it is recommended that the clinician �covers all bases� and performs two variations of a PM stretch � stretches in flexion, adduction and external rotation and stretches in flexion, adduction and internal rotation. Examples of these stretches are given in figures 5-7 below.
Trigger Points & Massage
(see Figure 8)
The best approach to palpate the PM trigger points is in the position suggested by Travel and Simons(2) and this is shown below. In this position, the clinician can feel for the deep PM trigger points and apply a sustained pressure to alleviate the trigger�points � and also apply a flush massage to the muscle in this position.�In this position the large gluteus maximus is relaxed and it is easier to feel the deeper PM.
Summary
The PM is a deep posterior hip muscle that is closely related anatomically to both the sacroiliac joint and the sciatic nerve. It is a hip external rotator at hip flexion angles of neutral to 60 degrees of hip flexion, an abductor when in flexion and also contributes to hip extension.
It has been previously accepted that the PM will �invert its action� or �reverse its function� after 60 degrees of flexion to become a hip internal rotator. However, recent ultrasound and cadaveric studies has found conflicting evidence that this �inversion of action� may in fact not exist.
PM is a muscle that is a dominant hip rotator and stabiliser, and thus has a tendency to shorten and become hypertonic. Therefore, stretching and massage techniques are best utilised to reduce the tone through the muscle. Furthermore, it has also been implicated in compression and irritation of the sciatic nerve � often referred to as piriformis syndrome�.
References
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Eugene, Or. – UTEP’s Emmanuel Korir and Michael Saruni make history by being the first freshman duo from the same school to make the 800m final in meet history at the NCAA Championships on Wednesday night.
Running at their first ever NCAA Championships, All-American duo Korir and Saruni did not disappoint. Korir won the first of three heats in the men’s 800m semifinal with the fastest qualifying time of 1:46.38. Saruni’s time of 1:46.63 was enough to win the final heat of the 800m and the third-fastest qualifying time.
Korir and Saruni will run on Friday’s 800m final set to start at 7:45 p.m. MT.
In a valiant effort running the 4x400m relay, Saruni, Korir, Asa Guevara and James Bias clocked 3:18.65. Saruni and Korir had just 90 minutes to recuperate and compete in the mile relay.
Day two of the NCAA Championship will see Tobi Amusan in the 100m hurdles set to start at 6:25 p.m., Lilian Koech in the 800m set for a 7:10 p.m. start and Winny Koech to close out the night in the 10,000m final running at 8:05 p.m.
You can watch the 2017 NCAA Division I Outdoor Track and Field Championships live on the ESPN family of networks. Both the final day of the men’s championship and women’s championship will be aired in prime time on ESPN.
For live results and breaking news be sure to follow @UTEPTrack on Twitter and uteptrack on Instagram.
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Variants
Trigger Points & Massage
