Alignment and Injuries,  Teaching Ashtanga

The Demon, The Yogi and the Piriformis Injury

by Shanna Small

Lets get this straight right now. I am not a doctor. This is my own chilling tale of dealing with the demon in my right leg. Use these words at your own risk.

I think I have piriformis syndrome or maybe a demon in my right leg. When I looked up “demon in the right leg” on WebMD, I didn’t get what I was looking for but this is what it said about piriformis syndrome:

Piriformis Syndrome Signs and Symptoms

Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running. Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica, however, are not due to piriformis syndrome.

I used to have these symptoms on most days but I have learned how to manage it and almost get rid of it. Again, I am no doctor. Maybe I just have an angry right leg but I hope that something in this article can be of assistance to you and your injury.

As a yoga teacher, I am surrounded by people who have great knowledge of the body. I have had great discussions  with anatomy experts, senior yoga teachers, doctors, physical therapists, chiropractors and massage therapists.  Some of the advice worked and some didn’t.

Shanna Small. Picture by Wanda Koch
Shanna Small. Picture by Wanda Koch

What Did Not Work For Me

Bending My  Knees-this eventually led to death and destruction and is the opposite of some of the best advice I was given which I will share with you later. Bending my knees made the muscles vulnerable. I am not a doctor but I believe that it relaxed the muscles and allowed whatever movement I did to go directly to the injury. Kind of like a lax rope, there was no strength. When force was applied, it went right to the weak spot. My injury got progressively worse until I had to take almost two weeks off  because the pain just would not subside. If you have a theory on why this did not work. Comment below.

Excessive Amounts of Hip Stretches-This led to the biggest set back I ever had. It was as if my hips and back seized up and I could barely move. The muscles got super inflamed. What is excessive? I used to do my yoga practice during the day and stretch at night. I had to cut the night time stretches out altogether. I used to do Yin Yoga and Deep stretch, which are stretch classes where you hold poses from 2-5 minutes. I no longer do those. Excessive movement aggravates the muscle and leads to inflammation and pain.

I still do plenty of hip work. As a first and second series Ashtanga practitioner, I still do all the leg behind the head and lotus variations that are needed to complete my practice but I don’t dilly dally in those poses. Five breaths and I am out of there.

Ignoring Pain-Lets see if I can describe this in a way that makes sense. I do feel the injury. It is there as a mild kind of pulling situation in certain poses. Until it goes away completely, this sensation will be present but I don’t push past that feeling. ego - word in letterpress type

Excessive Amounts of Pressure and Direct Manipulation of the Injury Site-I used to ball and foam role but I stopped because I noticed inflammation a few days later. When lounging at home or sleeping, I avoid my right leg like the plague. Even as I type this, I detect a subtle lean of my body to the left. Direct pressure makes me inflamed.

Beware of Assists on That Leg-Unless you know that the teacher is a master who knows how to work with this type of thing. If you have any doubt, don’t let them do it.

 Heat is a friend and a foe-Heat is great for opening muscles but is highly deceptive. When I practice hot yoga and I get super heated, I pretty much don’t feel my injury. On days when I am feeling particularly stupid, I will ignore all the stuff listed below  that I know I am supposed to do and give into the insane feeling that hot room is giving me that my injury is actually gone. In about 24-48 hours, the pain comes back times 2 and I usually experience a massive set back. If you are like me and you love practicing in heated rooms, you should be even more vigilant about doing all the stuff mentioned below. As long as you do, the heat will actually help with the healing.

What Worked For Me: Stabilization & Inflammation Management

Contracting  The Thighs For Dear Life-seriously you may look like the tin man or slightly constipated as you practice but this is what took me from invalid status to about 90% healed. Why does this work? Here is my theory. When you do as Baptiste teachers often say which is  “hug the muscle to the bone”, it creates a muscular tourniquet if you will.  As you move, the muscles are not just “flapping in the wind” the way they do when your knees are bent or there is no tension.  The tension is evenly distributed across the whole leg and it is not going directly to the weak spot. It helps to immobilize the injury and stabilize it. If you have another theory on why this works, I would love to hear it in the comment section below. sundail

 Bandhas-this is not the first thing I will share from Kino Macgregor. I think she is psychic.  The big king daddy injury that started this madness happened shortly before she came to town.  By the time she did her workshop, I had made it through my acute phase into the slightly annoying phase. Kino is an amazing story teller. So at some random moment, amoungst her many stories, she started to talk about bandhas and the piriformis.  She said that when you practice with bandhas, the injury will go away. She was absolutely right.  I recommitted to my bandhas and it went away.  Why is it back? I lost my commitment to it and went back to doing the same crap that got me there in the first place but that is another story.

Bandhas bring about stabilization because they force you to contract your muscles. You cannot do Uddiyana Bandha and Mula Bandha and not contract something.

Pushing the Backs of the Legs Into the Floor-below are some great videos by Kino Macgregor and David Garrigues that describe this. I do this for all seated forward folds. Again, stabilization.

http://www.youtube.com/watch?v=iFUduxyYdWY

http://www.youtube.com/watch?v=VOxrxnCfzvs

Pushing Down Through the Feet and Out Through the Pinky Toe– This does the same thing as pushing the back of the legs into the floor and is a technique used for standing poses.  Warrior

Moving Slow-In order to focus on engagement and stability, you have to move slow. If you continue to speed through your practice, I guarantee you that your injury will not go away. Do not move fully into any pose until you have down the stability practices I have mentioned. If you do even one pose without using these techniques, you will have a setback.

mueller
Mueller Ice Pack

Ice- I love these ice packs by Mueller. They stay cold for a long time, don’t leak and don’t have condensation. Cold gets rid of inflammation. However, make sure to lightly sit on the bag and to not do it for more then 10 or 15 minutes at a time or you may put to much direct pressure to the site.

A yoga teacher who knows how to give stabilizing assists-with the right stabilizing assist, it is possible to ground the leg so much that the pose bypasses the injury. This is a skill that most yoga teachers have no clue about. Also, if you do a lot of guided classes, you are less likely to get this type of assist because it requires more time.  There are two ways, that I know of, to do stabilizing assists. One  requires the teacher to engage the leg into the hip joint by applying force in the direction of the pelvis that allows them to then move the leg into position. Another one, requires the student to commonly push  into the teacher’s hand, chest or thigh which again stabilizes by providing tension and it allows the teacher to take the student deeper into the pose.   You can also combine these techniques as well. This link to a David Keil video is an example. 

The most amazing version of this assist I get is in Krounchasana pictured below. Without an assist I cannot even straighten my leg even much pull it to my head. When my teacher gives me a grounding assist, my back straightens, it goes straight and to my head and it feels amazing. A good teacher can provide assist that can help heal the injury. If you are unsure of the teachers ability, then don’ t let them assist you on this leg.

Shareen doing Krounchasana
Shareen doing Krounchasana

Good Food and Clean Living-There are many articles on line about anti inflammatory diets. I won’t go into detail here but I will say they all include eradicating sugars, refined carbs and processed foods and advocate a plant based diet.

Heat But Not To Much-Heat allows the muscles to open up which makes them more malleable. I talked about the dangers of heat above so be safe with it. Don’t practice when the room is cold or the muscles are cold. I sometimes even do more sun salutes and hold the poses during the warm up longer then what is required to make sure I am nicely heated. Traditional Ashtanga classes are usually not heated any higher then 80-85 degrees which is fine but honestly, I won’t go any lower then that for any type of yoga.  Hot Vinyasa, which I also practice, is between 90-105 degrees, which I am fine with but I would never do my Ashtanga practice in a room that hot because the Vinyasa Krama of Ashtanga would cause me to overheat.

Sports Medicine Dudes, Chiropractors & Other Therapists-In Charlotte, we are super lucky to have some amazing doctors, physical therapists and massage therapists who deal with athletes and yogis and actually help them to get back to the circus freak practices they enjoy. Many doctors do not understand yoga or extreme athletes and give advice that is not suited for us. It is important to find someone who understands what it is that you are trying to do. Look for  people who work with yogis and professional athletes because they know that their job is to get you back into playing condition. Also, doctors who are also athletes themselves are more likely to understand your obsession with using your body to do amazing things. I have had great success with electric pulse therapy(I don’t know the technical name for this), dry needling and the Graston method.  Do a search on the internet in your area, call the doctor and ask questions. When my bank account has a few more zeros and recovers from the holidays, I will definitely go back to my sports medicine dude. If you live in Charlotte, try these dudes.

Nevin Markel

Ryan Danner

Josh Wilson

Please note that this is direct pressure, so if you go to the doctor or therapists to much, it can also lead to inflammation. Even though he would have made much more money if I came all the time, my therapist dude cautioned me against this. Macro shot of white asprin on white.

NSAIDS –These should never, never, ever, ever be used on a regular basis. They are bad on your liver and, just like the highly deceptive heated yoga class, they give you a false sense of well being.  I only use them for cases of extreme inflammation where my normal day to day tasks are being hampered. If you have to use them everyday, you are not managing your healing or your yoga practice in a healthy way. Excessive inflammation can usually be curtailed by diet and practicing in an intelligent way. The few times my inflammation got way out of hand, I took time off from my practice, let it diminish and then started back in an intelligent way. If you are eating well, drinking enough water and getting enough sleep, this shouldn’t take more then 2 or 3 days.

 

Anybody else with an angry hamstring? Share your experiences or ask your questions in the comments

Shanna Small has been practicing Ashtanga Yoga and studying the Yoga Sutras since 2001. She has studied in Mysore with Sharath Jois and is the Director of AYS Charlotte, a school for traditional Ashtanga in Charlotte NC. She has written for Yoga International and the Ashtanga Dispatch. Go here for more information on AYS Charlotte. For information on workshops, please e-mail shanna@ashtangayogaproject.com.

20 Comments

  • theyogimaster

    Reciprocal inhibition describes the process of muscles on one side of a joint relaxing to accommodate contraction on the other side of that joint. Joints are controlled by two opposing sets of muscles, extensors and flexors, which must work in synchrony for smooth movement. When a muscle spindle is stretched and the stretch reflex is activated, the opposing muscle group must be inhibited to prevent it from working against the resulting contraction of the homonymous muscle. This inhibition is accomplished by the actions of an inhibitory interneuron in the spinal cord.

    • admin

      Thank you. I know you have told me this many times before but I couldn’t think of the name for the term while I was writing. That is exactly why the stabilization works.

  • sad teacher

    Your article is the first article to give me real hope. I am an Ashtanga yoga teacher who have seriously considered giving up any hope of teaching or even practicing myself. I do my daily practice but asanas such as padottanasana, utthita hasta padangusthasana, (any forward bend – feels like paschimottanasana will never happen again). Any pose stretching my left leg out feels impossible.
    I have been working a lot of strengthening core, and as you wrote – keeping it all tight and engaging the thigh muscles.
    Question – would you suggest avoiding poses such as Krounchasana until the pain has decreased?

    • admin

      Good news. My pain is gone. The method I described does work for me. I would not avoid Krounchasana. Try using a wall. Sit down in front of a wall and put your heel or whole leg on it. Engage your quad. The wall should help you find more engagement and serve as a self assist.

  • jami

    I had the same problem for a year and a half or maybe two years and the pain only recently subsided. Thank you for posting this – I only wish I had read it sooner!!

    As for bending the knees — It did work for me, but ONLY if I also really thought to engage my quads and send pressure out through my feet while keeping the knees slightly bent. Having my legs straight was just too painful and caused more strain. I think what caused the pain to begin with was keeping straight legs without ever engaging my quads. No one was reminding me to do that but I wasn’t doing that it at all … I was over stretching muscles without giving them the proper foundation.

    So I do recommend if you have this problem to bend the knees ever so slightly, especially in poses like uttita hasta padangushtasana and any forward fold. You may be surprised to find out that you can still really engage the muscles while bending the knees slightly.

    The other thing that worked for me was to keep practicing. When I stopped practicing (I let the pain be an excuse) then when I came back to it the pain was actually worse. It was a case where I actually had to work through the pain, being very mindful of it and at the same time not let my ego say, “oh, feeling good today why not stretch as far as possible even though my legs aren’t engaged?” That’s the hard part, because, for me, I can stretch further without engaging my legs as much … but looking good in a pose is not the point.

    Also — yes, the bandhas … until i really started sucking my stomach in, my back was rounded during forward folds which probably pulls on the wrong muscles in the buttocks.

  • jami

    I should also mention that Sharath is the one who told me I should bend my knees … not saying he would tell everyone the same thing, but when I mentioned it, he said “bend the knees, little bit”. at first, i was like, “great, big help” (in a sarcastic tone), but it actually ended up being very helpful (at least for me!) It was hard for my ego to admit that I needed to bend my knees. I felt like a little old lady in some poses … but you know what … so what. It helped the pain go away.

  • jami

    ALSO… bending my knees was not a magic cure. It still took months of practicing with the knees bent to heal completely. So for me … bending the knees slightly while engaging the quads, holding in the bandhas and breathing, keeping my gaze where it should be in forward folds and not letting the back round (even if that meant not touching my chin to my leg), TIME and PATIENCE were what worked. Also not overdoing it and not letting my teachers push me in poses where I knew I might strain my ass again and telling my teachers — “hey, i’m bending my knees in this pose”. For over a year I was walking around with a pain in my ass — not fun!

    What this pain in the ass taught me:
    -ashtanga doesn’t hurt you; your ego hurts you
    -practicing mindfully should be the only way to practice
    -patience means, at first, a lot of waiting in agony and then, forgetting what you were being patient about to begin with and just getting on with it.
    -it helps to be stable on earth before you reach for the stars

  • Rebekah

    Practically my story. I first got the problem while bringing my foot between my hands in sun salutation. I rested it for a while, worked in parallel. It dort of went away until i was doing a demi lotus. Now three years later, it is sort of under control. But i made it worse and awakened a problem in the other leg by stretching the pririformis too much. What works for me. -child’s pose before getting out of bed, gentle massage with heated shiatsu cushion and then gentle stretches. I still run. But demi lotus might forever be impossible for me now.

  • Ra

    So happy I found this article! Just like you I have this radiating pain/discomfort throughout my right glute that sometimes extends down my quad in my side leg. It was diagnosed years ago as restless leg syndrome. Now that I practice yoga regularly and solely the pain is consistent. I have googled, youtubed, seen a chiropractor, and physical therapist and all have assisted of course but the pain is still there and worse following the 80min hot Ashantaga classes I take regularly 5 days a week. I tried implementing more yin practices and that again seemed to be a temporarily solution. Again thank you for posting this! I have a good feeling that these tips will help immensely if not get rid of the problem all together.

  • Melissa Freed

    Thank you for your article, I have had this problem for 6 years and it actually caused me to lose my hip to an unnecessary hip replacement and hence my yoga career ended all too soon in 2013. I get this annoying pain down my leg and in my piriformis area whenever I practice, it is also my right leg. I went to various doctors and was diagnosed with a labral hip tear, I went through with the surgery to repair the tear and the Dr. shaved my femur bone down too much which then resulted in a complete hip replacement. After all was said and done the pain never went away and I truly believe it is the piriformis muscle all this time. After years of not practicing and my heart breaking from not being able to do what I love which is teaching yoga I decided to try teaching again. My focus is different I plan on making the majority of what I teach prenatal and restorative yoga however many of my old students want to return to my regular vinyasa class which would help my yoga business grow tremendously. I started practicing again of course using precautions and being careful with the new hip however the old demon pain in my right leg has returned. I found this article when I googled piriformis injury and yoga and I feel so fortunate to find this my only wish is I found it 6 years ago when all of this started for me! Thank you for this insight this gives me hope! I really loved the article and plan on trying to use the bandhas in my practice and to follow the two tips discussed in the youtube videos that you provided.

    Namaste,
    Melissa Freed
    Morse Yoga

    • Shanna Small

      Thank you for your story. I know many people who have had hip replacements who continue to do Ashtanga and Vinyasa with no problem and at the same level they were performing at before the surgery. Don’t give up!! Find someone who can help!

  • Amy

    I am so happy to have stumbled across this page ! I’ve suffered with my piriformis for about ten years now, and spent a lot of last year in Physio therapy trying to sort it out. All was going well until I began hot yoga classes and all of a sudden the pain is worse than ever. I must have pushed it too far in the hot room without noticing the strain.

    I’m so happy to see that I don’t have to give up yoga because of this as although I’m a noob I’m really enjoying it!

    Thank you for the advice and tips. Here’s hoping some of them can pull me out of this agony right now!

  • Karen

    I had this syndrome last spring and it lasted several months. I continued to do yoga for 25 minutes daily and one class per week. My teacher was very knowledgeable about piriformis tears as she had had them before. I modified my poses, especially forward bends, used heat (still do), and sit on a gel cushion, especially in the car or on a hard chair. It’s eased up quite a lot and I’m aware now not to over stretch.

  • Laurel

    I overstrained my hamstring from doing forward bends without engaging the hamstrings. It’s a bit set back for me, I was only just getting into practicing regularly at least 4 times a week. :/ Your article is really helpful! Am just super insecure about whether to continue (modified) practicing. Some days its fine, some days I feel that aching pull in my buttocks in the morning or a few hours after practice. Yoga is for healing but I am worried about doing further damage really. A bit of a bummer that it takes SO LONG to heal! But it has been a great lesson for my pushy, fast achieving ego…

    • Shanna Small

      If you keep your quads engaged and limit your range of motion to what feels good, you can still practice. It won’t look like your old practice for a while, but you can still practice. Focus on other parts of your body like your arms. Work on arm balances and twisting. Don’t focus on your hamstrings.

  • Trent

    love the article ; i too practice slow – i realize i’ll have to pick it up one day but at this point i need to be mindful 🙂

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