How To Run Without Piriformis Syndrome Pain

Piriformis syndrome is a common chronic injury among runners. It’s frustrating to suffer from piriformis syndrome because there is no clear way to treat it. Before I got diagnosed with piriformis syndrome in 2012, I used to run almost every day at the gym (doing high-intensity interval training). I was in my first year of university and I didn’t know anything about injury prevention, rehab or muscular imbalances. I still remember waking up on a cold winter day, not able to walk to class.

Most people who first experience this deep gluteal pain don’t know what piriformis syndrome is (including myself). I personally struggled for two years wondering what the pain in my glutes was before finally getting diagnosed with ‘piriformis syndrome’… And even then, it’s not like I knew exactly what to do. I didn’t receive any clear guidance on how to fix it…

Related: how to heal piriformis syndrome if you’ve tried everything else

I spent years trying to figure out how to heal myself. I certainly stopped running but I still made a lot of mistakes which held me back for years. Now, I’ve been pain-free for more than 3 years and I still follow the exact steps that helped me recover. It’s important to stick to what works and not go back to the old ways that created the problem in the first place.

How Running Irritates The Piriformis Muscle

Running is a high impact form of activity that places more tension on the hip, knees, and ankle joints. Injuries occur when present dysfunctions or postural malalignment are combined with high-intensity exercise and added load. Let me explain…

Let’s say you have pronated feet (flat feet) and you’re engaging in walking or even running… The feet are the base of support and will transfer that force up the kinetic chain… the knees will rotate inwards altering the way you walk which will also affect the hips. This change in posture will affect the muscles attached to these joints, creating weakness in some muscles (for example, the gluteus maximus), and tightness in other muscles (i.e. The tensor fasciae latae).

When we add load or intensity that the body cannot handle well (because the joints and muscles are out of alignment and can’t do their job properly as they were designed to), the process of compensation kicks in… Some muscles will start firing up abnormally to help the body get the job done.

These muscles are called synergists and are different from prime movers, which are muscles designed to perform big movements. They become overactive, tight and highly sensitive to triggers. The piriformis muscle is a good example of one of these muscles…

The piriformis muscle is a synergist to the Gluteus Maximus and helps externally rotate the hip. Which means, it is meant to help the gluteus maximus (not take over its main job). The piriformis is also responsible for stabilizing and supporting the pelvis but… It’s not meant to drive big movements.

When the gluteus maximus and the gluteus medius are weak and cannot fire up quickly to handle the load placed on the hips, the piriformis dominates and start to kick in to do their work. And this is important to understand when running.

How To Start Running Without Triggering Piriformis Syndrome Pain

If you love running, piriformis syndrome can be extremely frustrating. Any high-impact activity such as jumping, gym bootcamps, and running can irritate the piriformis and make working out very frustrating (especially if you love high impact workouts).

I used to think that my gym days were over and that I would never be able to workout like I used to. I’ve always been passionate about health and fitness and I was extremely terrified of the idea that I would have to let go of that which I loved so much. But I’m thankful I didn’t let that limiting belief take over. And I hope you don’t lose hope either.

If you are in pain right now and feel this way, I want you to know that you CAN get back to running, lifting weights and do whatever you love to do. The road to recovery can be long and frustrating if you’re not mindful about not repeating mistakes or you’re not willing to fix the underlying root cause of the pain…

… It took me about 7 years to fully heal from this nagging pain, but that was mainly because I was so stubborn and didn’t want to listen to my body and look deeper. And one of those mistakes was… I would quickly jump into a high impact workout as soon as I started feeling better.

Recommended Program: Piriformis Control Program.

Proper Strengthening Plan

If you love cardio and running, you probably wonder how strengthening exercises can help you improve your endurance. Well, they can. Making sure your joints are supported with strong muscles goes along way into preventing injury and improving performance. Here are key strengthening techniques I recommend:

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  • Assess your core and glute weakness. Assess your posture and how you’re holding yourself standing. Notice if you have any postural dysfunctions like flat feet, knees rotating inwards or outwards, anterior or posterior pelvic tilt. Don’t ignore your shoulders and back as well. A full body assessment is beyond the scope of this article but I have a step-by-step assessment tutorial inside Piriformis Control program.
  • Release the hip flexors with a foam roller. I recommend you release the TFL, PSOAS and Rectus femoris (front quad muscle) 2-3 times a week and up to 4 times if you spend long hours sitting. 
  • Activate your glutes and deep core muscles before you run. When your glutes are firing up properly, the piriformis will not have to kick in to compensate for the weak glutes. (I have a home routine to activate the deep core below).
  • Don’t run if you are in pain. It’s important to focus on low impact strengthening for a little while to restore proper alignment.

5 Exercises To Activate The Deep Core Muscles

Proper Recovery Plan

Recovery is very important in avoiding muscle spasms and allowing your body to rest and recover. Here are some key points to follow to properly recover after running and mistakes to avoid:

  • Avoid stretching or foam rolling the piriformis if it hurts. This will just further irritate the muscle. To release muscle spasms, I prefer to take magnesium, practice mindfulness meditation and get at least 8 hours of sleep. I know it sounds like work, but this worked best for me… You can try this short 12-minute meditation before bed to help relax your nervous system. The nervous system controls the musculoskeletal system, and if you’re stressed, your muscles won’t relax.
  • Focus on foam rolling the hip flexor complex, the hamstrings, the adductors, the TFL and the thoracic spine after your workout or run. This will help restore proper alignment, in addition to releasing trigger points (1), so any tightness isn’t altering your posture. Earlier, I’ve included links to foam rolling tutorials.
  • Use heat therapy to reduce inflammation. Heat therapy (2) in chronic pain is beneficial in increasing blood flow which draws more oxygen and nutrients to areas of your body like the lumbar spine and hips. My favorite tool is the Spoonk mat. I use the mat after my workouts and it just releases all tension and load off my muscles. I prefer this method better because it uses your body’s natural response to generate heat and stimulates the parasympathetic nervous system, responsible for healing and regeneration.

How To Safely Start Running Again

As you’re starting to feel better and the pain is settling down, don’t rush into your old running habits. You want to progressively add load over a period of time while giving your body time to build strength and adapt to that load. Start with short runs 1-2 times a week and monitor your body’s response.

I get that you want to quickly get to where you were but slow and steady progress will allow you to remain consistent without triggering pain. I learned this the hard way.

Find The Sweet Spot.

How long can you run pain-free? Find that sweet spot…whether that’s 5 minutes, 10 minutes or 20 minutes. Once you find it, you need to remain below the sweet spot and slowly add more time under tension so you’re progressing over time. Again, you want to avoid pain-triggers and focus on the recovery plan and re-educating your muscles to move properly before we load the body too much.

Avoid stretching the piriformis before running. I recommend foam rolling (3) your muscles before you engage in activities because self-myofascial techniques not only release tension but also helps warm up your muscles…stretching, on the other hand, works to lengthen the muscles and can work against you if your goal is to improve your performance. Static stretching can inhibit your muscles’ ability to contract properly (because now they are lengthened and cooled down). 

I’ve been able to resume running but I don’t do it often. After being in pain for so long, I think I appreciate being pain-free more than the satisfaction of going for a run. However, I workout almost every day. I lift weights and my workouts are very challenging. I get that a lot of people love to run and you want to find the activity you enjoy to stay active.

Piriformis syndrome should not stop you from enjoying your activities, just make sure you invest the time to find the root cause of the dysfunction and fix it. Quick fixes work for the short-term and they won’t fix the pain for good. If they did, I wouldn’t have spent 7 years in pain.

Start now inside Piriformis Control and find the root cause of the pain.

Related: Why is stretching making the pain worse