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STAND
AND DELIVER
by Julie Gudmestad
Published in Yoga Journal, January/February 2002
"Do
you know where your piriformis is?" Over the years I've
gotten a variety of responses to this question: sometimes a blank
stare, sometimes a laugh. Once in a blue moon, someone correctly
points to the back of the hip.
If
the location of the piriformis is a mystery to most yoga students,
its action and its function in yoga poses are even more mysterious.
Most students have no idea of the important work it performs.
Unfortunately, the piriformis is best known for the problems it
causes, including sciatica. But this obscure muscle is crucial
in stabilizing the pelvis and knees.
Before
we examine the action of the piriformis, let's clarify its
whereabouts. It's located deep in the buttock, underneath
the better-known gluteus maximus. The piriformis is part of a
group of six muscles called the deep external hip rotators. These
six muscles all originate at various locations on the back of
the pelvis and cross the back of the hip to insert on the greater
trochanter, a protuberance on the outer upper femur (thighbone)
about six to eight inches below your waist. The position of the
rotators, reaching from the back of the pelvis to the outer thigh,
gives them excellent leverage to externally rotate the hips –
in other words, to turn the legs outward.
Perhaps
you've made the acquaintance of your rotators during a massage,
when deep work on the back of a buttock brought your awareness
to tight and tender muscles. That tenderness, which can range
from minor soreness to sharp pain, may be due to overworked, strained,
or chronically tight rotators. In such cases, massage, gentle
stretching, and a reconditioning exercise program will help solve
the problem. Poses that can help stretch a chronically tight piriformis
include preparations for Eka Pada Rajakapotasana (One-Legged Pigeon
Pose), the leg position of Gomukhasana (Cow Face Pose), and Ardha
Matsyendrasana (Half Lord of the Fishes Pose).
However,
the piriformis and its brother rotators sometimes get blamed for
problems they didn't cause. The buttock is a common area
for referred pain from lower back problems, including arthritis,
disc injuries, and sacroiliac problems. So it's very important
that any persistent hip pain be thoroughly evaluated by your health-care
providers before you decide on a course of treatment.
Finding
stability
While the piriformis and the other deep hip rotators
are best known for the problems they create when they're
tight, they do need to be strong to perform important functions
in yoga poses. They help to stabilize the pelvis and knees when
you bear weight on the legs, especially in standing poses. To
experience this, stand with your legs wide, preparing for Virabhadrasana
II (Warrior Pose II). Turn your right foot out 90 degrees and
your left foot slightly in. Notice that even though the right
foot is turned out, there is a tendency for the knee to turn in.
This internal rotation of the femur is due to the pull of the
internal rotators of the hip, including the adductors (a large
muscle group of the inner thigh) and the medial hamstrings on
the back of the inner thigh. If the foot and shin rotate out while
the femur rotates relatively in, the knee twists, putting a potentially
damaging strain on its ligaments. A contraction of the external
rotators is needed to bring the knee into alignment with the foot
to protect the integrity of the knee joint.
To
refine and strengthen this action, try practicing Warrior II with
your back to a wall. Stand close enough so your right buttock
touches the wall but your feet do not. Turn your right foot out
so the foot is parallel to the wall, and turn your left foot in
slightly more than perpendicular to the wall. Now come down into
the pose, bending your right knee and keeping your left leg straight
and strong. Place a yoga block or firmly rolled towel between
your right knee and the wall, and press your right knee into this
prop. It is the deep hip rotators that are putting pressure on
the block – and at the same time aligning your knee perfectly
with your foot.
As
you press the right knee toward the wall, make sure that you don't
let the left thigh buckle away from it. In fact, if you'd
like to increase the challenge, place a second block or rolled
sticky mat between the wall and the center of your left femur;
hold it in place by firmly pressing your left leg back while continuing
to press the right knee into its prop. You will feel a strong
action in the back of both hips as the piriformis and its friends
externally rotate both legs. A similar action should occur in
Parsvakonasana (Extended Side Angle Pose) to the right: Keep the
right knee pressing into the right arm while maintaining a straight
line through the left leg.
The
knee is also at risk of being twisted in some straight-leg standing
poses, and a strong contraction of the deep hip rotators is required
to align the femur, knee, and foot. While in Trikonasana (Triangle
Pose) to the right, turn your head and look at your right knee.
Chances are, it's slightly internally rotated. Now feel
the firmness in your right buttock as you externally rotate the
thigh to align the knee with the foot. (Notice that this action
also creates a beautiful arch in your foot.) Even more challenging,
maintain this alignment as you bend your knee and prepare to transition
to Ardha Chandrasana (Half Moon Pose). In this transition, the
rotators must act strongly to prevent the knee from angling in
toward the big toe, and they must continue to contract as the
knee straightens fully in the pose.
Building
strength
Let's look at one more straight-leg standing pose, Tadasana
(Mountain Pose). Many people tend to stand with their feet pointing
out slightly. Sometimes this may be caused by short and tight
rotators that externally rotate the whole leg. If that is the
case, the knees will also be pointing out, and you need to spend
more time stretching the backs of your hips. However, it's
also fairly common for the feet to point out while the knees point
in, an alignment that can contribute to pronation of the feet
(collapsed arches), knee problems, and low back pain. Weak rotators
can be the culprit behind this pathological alignment. If the
external rotators aren't strong enough, the internal rotators
(which include the gluteus medius and tensor fascia lata on the
outer hip as well as the adductors) will pull the femur into internal
rotation. In an attempt to align the femur, the outer hamstring,
which is also an external rotator, takes over for the deep hip
rotators. Unfortunately, the outer hamstring inserts into the
lower leg, and so, instead of aligning the shin and thigh, it
turns the lower leg out even more deeply, exacerbating the misalignment.
If
you are dealing with pronated feet, knee problems, or lower back
pain, be sure to take a few moments to stand in front of a mirror
and look at your leg alignment. If your kneecap points over or
even inside your big toe, weakness in your external rotators may
be contributing to your problems. While work with your foot muscles
and the use of orthotics may help support your leg from below,
you may also need to increase support from above, at the hip,
by making your buttocks firm and rotating the thigh outward so
the knee is centered over the foot. Don't overdo the action
by gripping the buttocks onto the tailbone, pushing the pelvis
forward, or rolling onto the outer edges of your feet. Use a moderate
action, just enough to achieve knee alignment while staying balanced
on your feet.
Don't
be surprised if you feel soreness in your buttock muscles within
a day or two after working carefully on your standing pose alignment.
Just be sure to take time to stretch the muscles after you've
worked them. Remember, a sore muscle is a worked muscled, and
a worked muscle is getting stronger, adding to the stability of
your feet, knees, and hips.
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