Piriformis Regional Pain: Causes and a Four-Step Recovery Plan

So pain in the piriformis can be created by multiple different things. Consider, number one, the highest probability that it is is going to be a low back disc. The second highest probability is probably going to be that it's going to be a pinched nerve in the low back or a quote-unquote radiculopathy. One of the lowest things on the list is going to be the piriformis as a syndrome as the primary generator of your problem. I don't know the exact percentages, but I can guess based upon what my clinical experience has been. Because I've seen a lot of people with pain in the area of the buttocks. Again, is it piriformis syndrome?

That's a whole different story, but it's probably what many of you will deem as piriformis syndrome. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey everyone, it's your host, Sebastian Gonzales with the Restoring Human Movement podcast. Thanks for joining the movement, movement. This is your first time, welcome. This show is intended to be of lightheartedness and just educating the public as well as ourselves as clinicians to improve our ability to get better patient outcome.

I mean, everyone likes to see their patients happy, and all patients like to not really feel like crap. I mean, they want to see you, but they don't want to see you. So, this is intended for patients and clinicians alike. So, the conversation is going to be friendly enough and light enough to where everybody should get some good information from it. This episode is going to be on piriformis regional pain or piriformis syndrome or piriformis tightness or whatever you want to call it, as you heard in the intro. So, we are going to cover quite a bit into that and what could be creating the issues down in that area.

Now, the format is about 45 minutes to an hour-long format. This is going to be a solo podcast with just me today, but there is interviews that I do along the way. If you're a clinician and you want to go back and look in the archives for all the amazing interviews and content back there, please do. At this point, we're doing once every two-week release. We were once every week, but I need to give myself a little bit of a break. But also, too, I'm finding that not everyone is able to go back and listen to all the episodes. So, there's some good gems back there, and there's some critical information that everybody should get through.

And I don't want to keep giving out information if the best stuff is not being digested first. So, please go back there. I've learned a lot as a clinician through interviewing people and being part of this podcast. And so, I want you guys to have the same journey with me. Hopefully, you can. And we're all just trying to get better. So, as always, I do my best to share a little personal story about myself before we start into the show, just so you guys can get to know me and hopefully like me as a host because who likes to follow Conan when you like Oprah? You know, you just kind of like your host.

So, hopefully, you guys resonate well with me, and I try to keep it real. And we'll get right into the content about Puriformis Regional Pain right after the short story. Now, I am 5'7 and about 160 pounds. I'm not a heavy person, but I'm not very skinny either. And so, I don't know how many of you out there around. I think I'm under average American man's size. What is it? Like six foot is – where are the normal – where's the average six-feeter, by the way? I have no idea where these average six-feeter are. But it seems like everything's made for people who are freaking six feet or so. So, you can't find anything shorts-wise, pants-wise.

Well, you can find pants. But you can't find shorts that are really going to work well for somebody who, you know, has an athletic body and who's shorter. So, I have to go and search and search and search for these shorts. And finally, I find some, and they work. But it's – I know they made stores that are for tall and – tall and slim, is it? Or big and tall or whatever. Well, they make short and stocky. I'm pretty sure short and stocky is a thing. And plus, by the way, if you go through a men's aisle and try to find, like, a sale on a 31 or 32 size pants or shorts, you won't. And also, you won't find an average of about 10 to 11 size shoes either.

Like, these are the normal sizes. So, I'm surprised they don't make different seam lengths for people and actually different width for people who are more athletic. Let's say it like that. So, I'm pushing for a short and stocky clothing brand. Everybody, please get with me on that. Now, we're going to get into the content. Now, this podcast is going to be on Puriformis regional pain. I'm going to say regional quite a bit because there's a lot of reasons for your Puriformis tightness or pain or sciatica or a lot of people will deem sciatica as hip pain in the back. And actually, I guess I should clarify that on that first.

Sciatica is technically pain in the leg on the backside below the knee. So, that's classic sciatica. I know that it's been kind of thrown around a little bit loosely as in, like, kind of like people will say the back of the hip region is their sciatic region. The sciatic nerve does pass through there, but it doesn't mean you have sciatica. And so, just be a little aware that when you go through and read stuff that people might write clinically on sciatica, they're talking about stuff below the leg. So, that's point number one there. But I want to encourage you to listen to this podcast that if you're suffering from pain in this area, behind in your buttocks area, and even in the low back and a little bit in the thigh and your hip flexors tight and your hamstrings tight and you're having issues with IT band tightness along the way, all this stuff tends to cluster together.

Just know you're not alone. This is a really common thing. Really common thing. And I'll be sharing some stories today of people that I've worked with with this just to give you an idea of what things that people have tried and things that work and don't work and so on. And hopefully, you get some good, easy tips out of this. But more so, just understand that there is a solution. And a lot of times, a solution does not require you to have surgery or take medication or do injections. Now, those treatments are out there. I'm not saying they're not merited and needed in some situations. But I'll be honest with you.

Over the past 10, 11 years of practice, I think I've only had to refer one person out for a low back surgery for pain in this area. And I had to refer one person for a local injection there. Everybody else has fared very well with different timelines and different goals that they have. Most people have returned to full activity, everything they want to do as long as they follow the plan of attack. Other people have come in and out of care a little bit and they get better and then they kind of do what they want to do for, you know, a couple months. And they end up coming back and, you know, they get really frustrated that it keeps coming back.

And I try to level with them. I say, dude, look, I'll be honest with you. You're only doing part of the solution. And so there is more to it. Lately, I've been saying there's about four steps of recovery that people need to be aware of. Step number one is reducing the pain or the symptom or what we call modification of pain. Modification of pain can happen very, a lot of different ways. You've probably encountered many of them. You've done maybe injections or medication or massage, rest, stretching, things like that. Like many things can reduce pain. Even something as simple as, like, do you ever wonder, like, you think about human nature when someone, like, say when you kick something, you kind of rub your foot.

I'm sure that, you know, just generally rubbing an area or just kind of grabbing an area has an analgesic effect. Like it makes you feel better. It dulls pain. There's nothing wrong with that. And we encourage people to use the ones that work for them. We coach people into ones that work for them. We like to use movement and positions as ways to reduce pain more than just numbing it. But there's a time and place for all those things. So that's step one. Step one is reducing pain. However, reducing pain doesn't do anything to stop it from coming back. And I know a lot of people will not care much about, like, I just want to get rid of this pain.

And I just, I'm okay with not ever playing baseball ever again. I just don't want to feel like this again. Okay, that's a good thought process when you're in pain. Because I've been there too. I've had shoulder blade pain last week. That was, I did it doing pull-ups. And the next day it was so painful to look down in the opposite direction that it's, I was thinking, I just don't want to feel this anymore. You know, and I got treatment for it. It actually went away in a couple days with good treatment. And the next time that gentleman came in and he wanted to do some pull-ups, I said, you can do them.

I don't think I'll be doing them today. And still, since last week, I've not done pull-ups yet. So that's what I would be, that's kind of what I'm avoiding. Now, if we kind of substitute the pull-up for baseball, baseball is more important to me than pull-ups. But if you're willing to sacrifice some of your activities and passions to not feel it anymore, you'll probably be okay. People who don't generally have a lot of demand out of their body, like they're not asking for extreme things like being a powerlifter or bodybuilding or being a sprinter, baseball player, soccer player, you know, Olympian.

But they also, all of these activities come with some risk. And generally, if you're a baseball player, you might have some shoulder issues. But, you know, soccer players probably won't have shoulder issues. They all come with different risk. But they also come with a lot of rewards, such as I love playing baseball. So I'm willing to take that risk. It's not a big risk, but, you know, generally we can say that if you're swimming in the ocean, you're a higher risk of getting attacked by a shark than you would if you're on land, right? And so with that, when you're talking about step one, we're talking about decreasing pain, you can decrease pain very quickly with people.

And I'll give the general broad overview of a timeline. Usually within under three weeks, if you have, you should have a significant reduction. Like you're like, wow, this is way better if you find the right pain modification activity or treatment for you. If you don't, it's not going to work. Logically, let's just say logically, if you found the right thing, it's going to work. And if you don't really demand much more out of your body and you're just doing normal stuff throughout the day, you might be okay in regards to it won't come back quickly. But an example is we had a gentleman who had a shoulder issue and he was able to reduce pain within a week.

It was great. And then he had not been using it for a while. He had not been using the shoulder for about six months. And then he hucked a football. And then he's like, yeah, my shoulder pain came back. Yeah, but you haven't, your shoulder's kind of deconditioned. We haven't done anything to protect the shoulder. And you went out for a rapid shoulder movement with a football. So nothing wrong with throwing a football again, but if you're asking to throw a football again, you better take the care to do steps two and three and four. Step two is building support systems. And if we're talking about piriformis or buttox region pain, usually building support system for the hip locally is important, but more so at the spine.

And usually we're looking at spinal endurance or reactive posture. Okay, I'll explain the two in turn. And so spinal endurance is important for you guys to understand because we're not talking about strength. Like strength has no effect or a really big relationship on what your piriformis area will feel like, nor even having back pain or back stiffness. Strength is basically moving something heavy. Okay, we don't need you to do weighted sit-ups. We need you to have endurance to be able to hold the position and build some robustness. And so what does that look like? Well, maybe instead of doing a weighted sit-up, we have you do something like a, say, like a little tiny baby curl, like where the ribcaids barely go to the floor, and just hold it for like 20 seconds and breathe deep and then take a five-second break and then go again and then go again and then go again.

Go again. Right? And so you might only be able to sustain like five weighted sit-ups, but with the one that I mentioned, you'll probably get to about a minute and a half, two minutes, and you'll just be smoked. The difference between the two is obviously they're both challenging in their own way, but one builds strength because it's higher weight with lower reps. And then we have endurance, which is longer time. Granted, we allow people to take the break in the middle. That's more to reduce risk or having failure points, but it's not a big break. So it still challenges the endurance of the area to be able to get to the effect that we need.

Again, so the stabilizing area, especially the spine, is spinal endurance. Now, do we need endurance only with this crunch? No. We need it for multiple different areas. And so we need the front wall, side wall, back wall. What might the side wall look like? What might look like a side plank? What might the back wall look like? I think a bird dog is a really easy one to do. And then also we need top and bottom of the cylinder. And so we can classify this whole supportive system of at least the spine kind of like a keg of beer, like a big old keg of beer. This keg of beer has front wall, side wall, back wall.

It's a different analogy because it's a cylinder. So it has a hoop, but also the top and bottom. And it has the ability to modulate pressure. So top and bottom is your pelvic floor muscles. You might deem it as the kegel, but there's much more than that. And there's also the diaphragm, the thoracic diaphragm, which basically is your quote unquote breathing muscle, but it has other features as well. It actually moves voluntarily as well as kind of repetitively through breath. So you don't have to really think much of it. But you can use the diaphragm in a voluntary way to create some pressure in the area.

Now, the stabilization system I'm talking about for in regards to pressure and breathing is going to be internal pressure. Think of that beer keg analogy now. The sidewalls are great, you know, but the internal pressure really makes it firm. They're all equally important and they all help each other to support the area, to build some endurance in the area so that your spine has a chance to allow the hip to move well, to allow the piriformis to not hurt. In regards to reactive posture is usually we're building stabilization. We're not just basically having you sit there and not challenge you in any way.

The world comes with a lot of other challenges. People push you, you move doors and so on. And so a lot of people will have piriformis pain when they get in and out of a car. They'll have it when they bend forward, when they kind of twist and turn and pick up stuff from Costco. And this is an example of the world, loads of the world, twists and forces of the world, making your body get challenged and have to react and stay stable. So by training that in a training environment, then you'll get a really good benefit of the next part, which is going to be building strength throughout the hip. Before I hit that third one, I guess I should regress back because it's a lot of technical stuff there.

Number one is decrease pain or modulate pain. Step number two is build support system. Step three is build strength. And step four is going to be just do movement, movement variability we call it. Before I go into step three as well, I guess I should, we should tangent into what is piriformis syndrome because I think that's going to be something that's, or piriformis regional pain, what can create it. And I probably should have started the podcast like that. But either way, I think that we're about 15 minutes in here. I think we'll be okay. So pain in the area of the piriformis can be created by multiple different things.

And don't worry, I'll come back to the four-step thing in a little bit here. So pain in the piriformis can be created by multiple different things. Consider number one, the highest probability that it is, is going to be a low back disc. The second highest probability is probably going to be that it's going to be a pinched nerve in the low back or a quote-unquote radiculopathy. One of the lowest things on the list is going to be the piriformis as a syndrome, as the primary generator of your problem. I don't know the exact percentages, but I can guess based upon what my clinical experience has been.

Because I've seen a lot of people with pain in the area of the buttocks. Again, is it piriformis syndrome? That's a whole different story. But it's probably what many of you will deem as piriformis syndrome. Or you've been told that, or Dr. Google told you that you had that. I would disagree. You know, most people don't have piriformis syndrome. If you are someone that has it, you're in a very unique situation, and you should go play the lottery because you are beating the odds. I'd say in my clinical practice or my clinical experience of 11 years, I've only found one, maybe two, at least one true piriformis syndrome.

I've seen hundreds, maybe thousands of people with piriformis pain, but only one or maybe two, I'm not sure about the second one, with piriformis syndrome. A lot of these people have had images of their hip. They've had ultrasounds. They've had injections to the area. And still, they did not have piriformis syndrome. The area of the piriformis on the image did not show anything significant to lead us to believe that they had piriformis syndrome. Now, did they have abnormalities of the hip? Did they have some impingement? Did they have some tendinitis? Yeah, they did. But did they have true evidence of piriformis syndrome?

They did not. And a lot of these people got better when treating them as a low back disc or a radiculopathy. Now, what does that look like? Well, there's a lot of things you can do at home, and it does encompass the things that I, part of the things I mentioned. And the cool thing with having, no matter what is creating your piriformis regional pain, a lot of the stuff, it will, after usually pain modulation or step one, a lot of stuff becomes kind of one thing. There's little tweaks on everything, because everybody's programming is not going to be the same. It's going to be a little variation, but not a large variation.

Most people are going to need spinal endurance. Most people are going to need hip strength. Most people need to generally move a little bit more. So those things kind of are the same, but the way to reduce low back disc pain and low back nerve pain are just slightly different. Okay? I won't get into those too much today, but just know that at least I'll tell you what we do in my office is that we have the patient do movement. We like to have them do things like cobras and, you know, lay on their side and do frog's pose and do 90-90 feet into a chair position. These work very well. A lot of people kind of already know these positions feel good.

They know that bending backwards, laying on their belly, but extending their elbows and their chest in the air generally feels good to them. And I had a gentleman one time that he had gluteal region pain, piriformis regional pain. And so I showed him what I wanted him to do, and he's like, damn it. And I said, what? And he's like, I was doing that. And I said, how many times did you do it? And he's like, ah, like 10 times in the morning. I said, dude, you're really close. Just do a little more. And so he did a little bit more. He got better in about a week and a half, two weeks. So sometimes people already kind of know what makes them feel better.

They just don't know how to apply it, okay? And that's why it's valuable to have someone kind of lay out a roadmap for you. Now, I'm trying to recall if there's been people that I've had to send out for a surgery for these or not. I don't recall. There was a couple troubling cases I definitely had. But we've been able to manage pretty much all of the low back, disc herniation, and pinched nerve people of the low back when they have referred pain to the piriformis of the buttocks area. Granted, everybody's a little bit different. Usually the younger you are and the less incidents that you've had, the less duration you've had, the problem, the easier it is.

As we get older, it's not that our old age makes it so it's an issue, but it's the fact that we've been around this planet for a long time that makes it a little bit of an issue. Our body's gotten used to being in certain positions. We have certain habits. We're kind of stuck in our ways. A lot of times we have to modify activity for people. And generally, I think when we get a little older, rather than in our 20s and 30s, we kind of have more obligations throughout the day. So it's hard to get time to yourself. But this does not mean that you can't get better. But there are complications that come along with unsuccessful treatment that people have.

If you've been through multiple different therapists and chiropractors and doctors and routines that you might have seen, or by the way, no offense to those professions because there's plenty of people who do amazing work. But if you've been through those, for whatever reason you failed care or you failed to get better by whatever means you picked, the harder it is to dig yourself out of a hole. And I can tell you from my personal experience and when I was dealing with low back pain, I asked a friend if he would accept some money and just treat me as a patient. And he didn't want the money, but he said, sure, I'll help you out.

And he did. And then I hired a strength coach to help me get back to doing what I needed to do or what I wanted to do, which was lift weights at that time. And I know him well, too. I paid him thousands of dollars to help me out. And he came twice a week and he kind of looked at me and he said, you know all this, though. Why do you need me? I said, because I'm scared to do it. I'm just not doing it. If you're not here, I'm not doing it. And it's just nice and comforting knowing that someone's watching. And so I always recommend that people just go out and get help. And make sure you find someone who knows what they're doing and resonates well with you.

But make sure you go find someone who can help you. There's no substitute for one-on-one. There's great things to do at home, but there's no substitute for one-on-one. And I remember what I mentioned earlier about kind of just only going through step one and not playing baseball again. That's kind of what I was doing when I went through that back issue, which, by the way, it could. Same thing as piriformis regional pain. It's the same kind of thing. We manage people a very similar way. And you guys will probably have a very similar experience, at least resonating probably well with the mentality I'm talking about, is someone asked me.

This was around December or so. So our baseball season was about to start. And they said, hey, are you going to play baseball this year? And I remember back, you know, about how my back hurt after playing baseball when I was 15 and how the swing was just murder on my back. And I said, I don't know. And I realized at that moment that I was doing what I tell people not to do. I had not tested my body. I did not build resiliency throughout my body. I didn't go through steps two, three, and four. I went through step one. Actually, I went through steps one and two. I didn't go through steps three and four yet.

That's why I hired the strength coach. And I was avoiding it. I eventually went back to play. I played fine. I've been playing three years since. No problems whatsoever. The first time swinging the bat was I was very hesitant, you know, almost sweating type of hesitant, but perfectly fine. You know, no flare-ups, no regressions, everything like that. Now, with your piriformis, can you return to things like running? Can you return to things like hiking and lifting and being active at whatever age? Yeah, probably. I would gamble and say yes. I mean, if I'm going to go to Vegas with the odds of can you return back to an activity that you think you're too old for right now, at some point in time after the right amount of building resiliency and going through the steps, yeah, I'm pretty sure I would be a millionaire, billionaire in Vegas banking on those odds.

I mean, people gamble on less odds and have more hope than they do on something like this. And I think it's because a lot of us feel like we're broken. It's a normal thing to think that you're broken, that you, you know, that you're getting old. I've been there at 35. I felt the same way. I thought, is this what old age feels like? Is this what it's going to be like? You know, and I was able to climb my way out and I'm fine now. You know, I'm sitting here today. So, it's normal to feel that, but you should really challenge yourself about what your reality is or what reality is versus what your beliefs are.

And so, when you go through these and you have some easy wins, such as in step one and step two, you can find some super easy wins. Like I mentioned, like the people earlier, within about a week and a half, they generally feel really good. You know, it's empowering. It's good. Now, I've spoken about low backs a little bit. Now, you might be wondering, well, what the heck? I came on this for piriformis. Yeah, you did. They function very similarly. I had a lady who she had, I remember she was a, she was a fun one. I've known her for years. I treated her for things in the past and she ended up coming back eventually.

And she had buttocks pain and it was the point where she couldn't walk. She couldn't drive. She couldn't drive here from her work about 10 minutes away. She had been through so many different people and I had seen her once the year prior about it. And it was so severe that I referred her for an MRI and I said, look, I want you to go see this orthopedic surgeon that I know. I just want his opinion. And what I was looking for just was to see, is there anything that was glaring that we need to address? You know, like the spine's unstable or, you know, there's a big tear or there's cancer or something weird, you know?

And he said, he basically told her that, yeah, you're going to need surgery. And she's like, well, I don't want to do that. And he's like, well, you're going to need it. So you just come back when you're ready. And she didn't like that answer. And she actually didn't, she assumed that I wanted her to have surgery. And when we finally talked a year later, because she was still just riddled with pain, just going through this for about a year. She, I said, why didn't you come back and tell me about it? And she's like, well, I thought you wanted me to have surgery. I'm like, why did you think that?

And she's like, could you send me to him? And he wanted me to have surgery. I'm like, no, I just wanted an opinion. I wanted to see if there's anything else. But I didn't need you to have surgery. And she's like, oh, okay, let's do it. And so we started messing with it a little bit. I struck out for about a month with her, to be honest. And eventually, I did find something that worked. And it was interesting to see what she had described. She was a very challenging case to me, by the way. She's in the extreme version of cases. So it was interesting what she described. She kept saying, she kept pointing at her hip, you know, in the backside.

She said, it's right there. I said, what's right there? She's like, my pain is right there. That's what I need. I need it popped. And I said, you want me to adjust you there? And she said, yeah, yeah, I think that'll work. And I'm like, I really don't, I really don't think that's what it is. And she said, no, I can feel it right there. I know it's right there because it feels right there. And I said, okay, so what do you want me to do? And she's like, well, I think, can we do some tissue work on it? And can we adjust it? And I said, okay, look, here's what we're going to do. I'll do what you want.

Let's do it for two weeks. Every treatment should be allowed a couple weeks to prove that it's right or wrong. Let's do it. And if that doesn't work, can we do what I think we need to do? And she said, yeah. So we did that. It did not get better. It hurt like hell to press into the area. And she didn't get better. She never really felt better walking out. There was no immediate change. But, you know, that was part of the plan just to see if it worked. And it didn't work. And finally, we found something that worked. What worked for her was doing press-ups, doing those Cobras that I just mentioned.

You know, that was a really easy win. And amazingly, she just came back to life. She was easily 50% better within about 10 days. She felt so good, in fact, that she still had problems sitting for a long period of time. And so because of that, she opted to not drive in. She would walk in. She'd walk from her house. It was about two miles away to her appointment. She was late often because it was hard to calibrate time. She'd walk in. And I was like, oh, you're all sweaty when you get in here. What are you doing? She's like, I've been walking. I'm like, why are you walking so much? She was like, because walking is the thing that makes me feel the best.

And I was like, well, you know, walking puts more load to the piriformis. So that doesn't make any sense if it was the piriformis. She's like, yeah, it still hurts right there. It hurts when I sit. But she's like, yeah, I feel so good walking that the other day I walked eight miles. And I was like, holy shit. Like, you really do feel good walking, huh? And so she found that the more that she walked, the more her pain reduced. Now, originally walking was painful to her, but it became very therapeutic. And what we ended up doing was, so that was her way of getting through step one. We did press-ups and we did walking, okay?

Now, what did she do in step two? She did side planks. She did those little baby curl-ups. And she did bird dogs, just like I said, okay? Now, getting her out of the weeds completely and making it so she can sit and drive and have no problems, it took a little bit more time because she was a challenging case. Great person, great person to work with, but just challenging as it goes with the body. We eventually deadlifted her with, I think we went about 25, 30 pounds originally with a kettlebell first. We coached that. We coached deadlifting because it teaches her how to pick up objects without triggering her piriformis regional pain.

We did split squats. We did crawling. We did planks. We did carries, farmer's carries, suitcase carries. We did a lot of stuff. And she's back fully to doing triathlons, cycling, running. She lifts weights twice a week. She can deadlift around 90 pounds with a barbell. We don't need her to lift with a barbell necessarily, but that's the highest that I can recall that she did. But she is the biggest proponent of not having surgery now. Like, she'll tell people. She'll tell all of her coworkers about, she's like, you've seen me. You've seen what I looked like. You'll see how, you saw how bad I was.

You saw how crippled I was and how active I was before. Like, she was extremely active. One of the most active ladies at 50 that I can recall runs faster than I do. You know, she's very active. And then she was crippled for about a year and a half. And then she came back and she looks completely normal. She feels normal. She can do anything she wants to do. She has no fear of it returning because she knows she can get rid of it. So, she's a very good case, very good person, and a good example that piriformis regional pain, number one, is not always the piriformis. And honestly, most of the time, it's not.

Like I said in the beginning of this podcast, a large, large, large percentage of the time is a low back disc or a nerve root pressure, not the piriformis. Now, can it feel like there's pain in the piriformis? Yeah, it's normal. Can the hip flexor feel tight? Yes, it's normal. Can the hamstring feel tight? Yes, it's normal. But what happens a lot of times is people chase these things, okay? I call it a muddy water presentation. And I say, look, let's unmuddy the water. You have a cup of water right there. It's full of mud and you shook it. Like, because your body's so angry, you just shook it.

And we can't really even tell what's going on there. Let's just chill it down a little bit by doing step one, which is reducing pain. Let's use some support for the area. And let's do that via step two. And let's just see, is there anything really at the bottom of that cup? Maybe it's a dice. Maybe it's a marble, you know? And the analogy of that analogy for the thing in the bottom of the cup is, is there really anything that we need to do to the hip flexor, piriformis, or hamstring or groin? Because there might not be. And as the mud settles, the spasms will too. And the aches will too. And all the tension you feel throughout your body, honestly, will too.

And a lot of it settles on its own. A lot of the stuff, the reason why it settles is because a lot of that is protective and it's compensation for the main thing causing the problem. Now, if you treat only the hamstring, if you treat the hamstring or the adductor or the hip flexor and it just never unmuddies the water, you've picked the wrong thing. And it's very rare, very rare, that it's actually the muscle that's the primary problem. Again, is it bad? Did you see she worked there? No, it's a good bonus, but it is not the end all problem. Now, this is a hard thing for a lot of people to swallow because they know, they feel the muscle's tight, right?

But is it tight or does it feel tight? I think it's a big question. And also, too, consider what types of muscle injuries are possibilities. I'll try to speak logically about this with you guys. Because there's different types of muscle injuries, right? So there's tears. There's large tears, small tears. There's strains, which strains are now in a lot. It's in a category where there's spine-induced, quote-unquote, strains. Or there's reciprocal inhibition or kind of imbalance-induced strains. And the thing about strains is, and there's a lot of strains. Most people are strains. I guess we're going to classify this.

They don't have a positive image. And they don't have a bruise. Meaning they don't have a muscle. They don't really have a muscle fiber disruption. They don't have a tear. So anything that bruises is going to be a tear. And it's going to be a positive MRI. Okay? Now, if you're a strain, well, nerve pressure can create a, quote-unquote, strain in that same category. Because no positive MRI, no appreciable muscle damage, no bruising. Also, too, if your glutes are off, that can create a, quote-unquote, strain. Compensation from a disc or a nerve root can create strains. So, yeah, I agree with you.

There is tension in the area, and it feels like the muscle is the problem. I've been there. I understand with that shoulder blade thing I had recently, I even had one of my, my associate doctor work with it. And I said, she's, I kept saying, I kept saying muscle. I knew it wasn't the muscle. I knew it was something else. And it's really easy to say muscle because it feels like it's a muscle. I get it. But it's not. It's not, you don't want to go to Vegas with those odds because you're going to lose every single time and you'll go bankrupt with it. And you won't get better. Or some people will, but a low percentage will usually.

Now, we should get on to step three and four because I think this is important before we close up here. So, step three is building strength. You have to build strength in the ball and socket joint, which is the hip and the shoulder mainly. It moves that solid beer keg that we mentioned, and it builds, it makes it so your spine and your little muscles of the hip don't have to do so much work. Make the big muscles do the work, all right? The big muscles, like the glute max, they do the work. Let them do the work. And this comes along with kind of what I did with that three-month spurt when I was having someone do weight training with me, okay?

So, I paid someone to help me through step three because it's challenging to do. Step four is you just generally just go out and move. This one's hard for people because they say, well, what do you want me to do? I say, anything, you know, go roll around the ground, go to yoga, go swing a baseball bat, go crawl in the sand, go catch a dog, go chase bunnies, butterflies. You know, it's unchoreographed movement. You know, and the hard thing, I think, for people to understand is with this one is that how is this beneficial? Well, when you've had something, you've probably not done a lot of large movements and a lot of different movements because it's guarded.

And so, those movements are just kind of like dark areas right now. Just let your body experience those movements and it'll start to unlock things. I know that I grew up with video games, you know, and the cool Nintendo video games, not the iPad ones. And you would have to get, like, say, at the end of a level, you have to get a certain amount of points to unlock a feature, you know? When you unlock that feature, it's only because you have certain skill sets or certain things that you've acquired. And so, once you've reduced pain in step one, you've unlocked features of movements. You'll be able to probably bend forward and twist and turn.

When you build stabilization, you'll be able to do it quicker. When you build strength, you'll be able to unlock the mobility you're looking for. But you can't, you know, you use the mobility in the large range of movement through step four. You still have to use it or else you'll lose it. I don't think grandma's wrong on that one. And so, that might look like, you know, you just do, like, I think jujitsu is a great one with this. It's just unchoreographed movement. It just happens. It's reactive, you know? So, I think those are important points. And the big picture is that the piriformis is not the problem, you know?

And if you've only tried the routes where you're looking for things that people do to you or medications or surgeries, you've, it might seem like you've tried a lot of things and you feel like you've tried everything. I mean, you have tried a lot of things probably, but you have not tried everything. And you haven't tried some things that have some really high payoff, really, really high payoff, easy wins all day. And it almost seems like, I know I've talked to you on the phone about this and they say, you know, like, oh, I'm looking for this and I want to feel better. My piriformis hurts and I say, they describe their things and we're like, yeah, so, yeah, we can get some easy wins.

And, you know, things can go really well and you're probably going to feel pretty good in a couple weeks. And I think they think we're bullshitting them. And I started to learn from at least reading a book called The Alchemist that I think when you tell someone something, if it sounds too good to be true, it might be too good to be true. And so I've tried to downplay that a little bit and say, yeah, you'll be about 25% better in a couple weeks. But I really know deep down the side, if I do the job right, if Dawne Costantino does the job right and they do their homework, they're going to be much better than that.

So we're going to start under-promising, over-delivering because if we got the right type of person, right type of case, right type of solution, it's a perfect storm and it likes it. You know, like it's a good, it's a good perfect storm. It's a good situation. Now, if you're wondering how am I going to find someone that does this, I think you just call around and ask. You know, I think if you question them how you question me, or I guess you didn't question me, how, you know, question them what they would do. And if it sounds like they're going to do stuff that you've already done before, why would you do it?

If it's proven that it hasn't worked. Again, the wrong solution to the problem you have will not create a solution or will not create a resolution. The right solution to the problem that you have will be game-changing. Now, if you're looking for more information that I have or that we have, we have a lot of it on the website. It's p2sportscare.com slash products, and you'll see a lot of the online resources that we have. These things have changed a bit over the years, and we used to have very simple ones. It was just a short PDF, like two pages, five exercises, just the high bank-per-buck exercises and suggestions that tend to work with things like piriformis regional pain.

And funny, it changed. It changed. I thought I could deliver better content, more education, and then the exercises as well. And we found that as we made them longer, I made them close to 30 pages, and all of a sudden people didn't want to read it. Even though the exercises and videos and format and program was in there, it was kind of a stall point. So recently we put together a bridge version where the exercises are first. It's a very brief introduction of why these things would work, how they work, why we use them. And then there's kind of like For the Nerds, it kind of goes on the back end of do you want to learn more about why these things work?

Here's all the cool information. Obviously it has disclaimers and so on, and everybody should be seen by somebody in person. But these videos, these things are very, very useful. They're very, very useful. And when I created them, the intention was that there's so many people all over the place who just struggle to find any suggestions at all. They don't find a roadmap. They just don't find any hope. And so I put the highest bang for buck, lowest risk, highest reward, exercise-based suggestions in there that work for people with regional, piriformis regional pain, whether it be from the piriformis itself, whether it be from a low back disc, whether it be from a pinched nerve.

I put the highest bang for buck things in there that work for a lot of people. Again, you should be seen by somebody in person. I don't pretend to suggest that online resources and home care is superior to seeing someone in person. When I had problems, I saw someone in person. I paid for someone to coach me. I believe that there is nothing better than seeing someone who's highly qualified, highly educated, and knows what they're doing in person because it gives them one other ability or one more teaching tool to teach you how to do something. They can't put their hands on you. There's no feedback in online resources.

But I know a lot of people who have gone through YouTube videos and said, well, that completely solved my problem. So I know online resources work. I know videos work. And it works for a lot of people. But if you want the best, best care, you got to go in and see somebody. Yet on the note of, again, on the online resources, I think everybody needs to be met where they're at. Everybody needs to see that there's light at the end of the tunnel. And they need to be able to see that even though they feel like they've tried everything, they have not tried everything. So some people are only willing to do online stuff or do self-help things.

And that's just the way it is. I know from that, from a working out perspective, some people don't want to ask for personal training yet or strength coach yet. Strength coach yet. Oh, man. I'm tripping over my words today. And so the intention is just meet everybody where they're at. The resource is there. Check it out. You're going to love it. If you love it, then you should probably advance on that because it is only step one of a four-step recovery process. Again, I don't pretend to say it's the end-all solution because there's other steps. There is other steps. It's an abridged version. It's there to meet you where you're at.

And it's there to get you to a good point where you feel like you can make some good progress. So go to the website. It's p2sportscare.com slash products. You'll see piriformis in there. It's not too far. You don't have to dig too deep. And we have reviews on there, too. So people have tried it. People have liked it. And if you always want to reach out to us, too, you can. You can come see us. We're in Huntington Beach. We also do virtual sessions for people in certain circumstances. So if you're wondering if we can help you from far away, or if you have any questions, just email us. It's a simple thing.

Info at p2sportscare.com. Again, info at p, the letter to the number, sports is plural, care.com. And if we feel like we've got to send you somewhere close to where you're at and we know somebody there, then that's an easy one as well. So there's no excuses not to get better anymore. There's simple online resources. There's ways you can come in in person. We can refer you to somebody, or we can suggest a telehealth session. So just reach out to us. We'd love to help you out. Thanks, everybody, for listening to the podcast again and spending the last hour or so with me. It's always a pleasure. And I love the podcast.

I love that you guys are getting good information from the podcast. And I love that everybody's reaching out to say their personal experiences with the podcast and, you know, what it's done for their life and what it's done for their knowledge. So thanks for giving back and thanks for sharing. Thanks for being part of the movement. I'll see you guys next time.