S B Coaches College
Tip of the Month
April 2006

Are you experiencing pain in your hip that may shoot down to your foot?  You may be suffering from fat wallet syndrome.  This syndrome is clinically known as Piriformis Syndrome (PS). 

PS is a rare nerve condition in the hip, causing pain and occasionally loss of feeling in the back of the thigh, often to the bottom of the foot. It involves compression of the sciatic nerve at the hip by the piriformis muscle.   The piriformis muscle rotates the hip, allowing the thigh, foot, and knee to point outward. The piriformis muscle travels from the pelvis to the outer hip. The sciatic nerve usually passes the hip between this muscle and other muscles of the hip. Occasionally (15% to 20% of the time) the nerve travels directly through the muscle, causing pressure on the nerve.

Tightness of the piriformis muscle and hip abductor muscles can also cause deep buttock pain without the sciatic pain down the leg as well. Oftentimes, healthcare providers will also refer to this as PS despite the classic nerve symptoms being present as well.

PS is caused by sitting on a large wallet in your rear pocket.  This places your hips “off-line” which is going to alter length-tension relationships of the muscles around the hips.  The piriformis may become over used in situations where the glutes are not receiving enough neural drive to perform the actions they were intended for, namely hip extension and external rotation of the femur.  The piriformis works with the glutes to accomplish the latter movement.  The glutes may become inhibited for overactive hip flexors.  The hip flexors become overactive when they have been trained to be too short and tight, such as when people sit for prolonged periods of time consistently.  As a result the glutes are not activated and the synergists to the glutes: hamstrings, adductor magnus, and piriformis have to work harder than they were intended to.

Treatment and prevention of PS include:

1. Performing dynamic flexibility prior to training sessions and games, primarily targeting the hips. 
2. Glute Medius and Maximus activation prior to training sessions.
3. Statically stretch hip flexors.
4. Statically stretch piriformis and hip abductors (see 2 below)

 PS can be a nagging problem that can adversely effect your training sessions.  Be sure to take the right steps included above to prevent this type of problem before it happens.

Seated Knee Hug

·  Sit on floor with one leg pulled into chest – hold for 30 seconds

Figure 4 Stretch

·  Lie Back on floor with one leg at 90-degrees

·  Pull from shin and behind knee until a stretch is felt

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