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What is…Piriformis Syndrome?

Posted by on Jan 11, 2015

It is, literally, a real pain in the butt!

Because I train runners, dancers and sedentary people alike, I see this syndrome frequently.

It occurs when the piriformis muscle, one of the deep rotators of the hip, becomes irritated. Hip pain and sciatic pain, running down the back of the leg will result. In this way, the symptoms of PS can mimic lumbar spine issues. PS can happen:

1) through external rotation overuse in sport or work-related movement,

2) because the opposing muscles such as hip flexors/internal rotators are working hard as in running, cycling, or certain types of dance or aerobic activity, or

3) because it indicates a sacroiliac imbalance.

It can also be triggered by tightness in opposing, or antagonist muscles. Being seated for extended periods can shorten and tighten hip flexors. If you have tight quads or psoas (another hip flexor), or you pronate excessively, you can be vulnerable to Piriformis Syndrome.

If your gluteus maximus (major butt muscle, responsible for hip extension) is weak, piriformis can become overactive, leading to Piriformis Syndrome.

This video provides a good graphic explanation.

http://www.spine-health.com/video/piriformis-syndrome-video

Here are some good stretches to alleviate discomfort. These can be performed dynamically, with a series of five to ten 4-6 second holds, or more statically, for one or two 20-30 second holds. Applied heat or cold often helps as well.

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Additional stretches will be included later, including rolling on a foam roller or Original Worm, and the yoga pose Pigeon.

Since we always want to get to the root cause of an issue, always consider your activities or customary behavior to provide clues. I recommend a consultation to identify factors or rule out lumbar and sacroiliac issues if you suspect PS.

Thank you, MV, for posing for these photos.

Not all exercises are suitable for everyone and this or any other exercise program may result in injury. Any use of this exercise program assumes the risk of injury resulting from performing the exercise and using the equipment suggested. To reduce the risk of injury in your case, CONSULT YOUR DOCTOR BEFORE BEGINNING THIS EXERCISE PROGRAM. The advice and instruction presented are in no way intended as a substitute for medical counseling. Jennifer Westerfeld and Westerfeld Fitness disclaim any liabilities or loss in connection with the exercise and advice herein.

Feel free to post questions and comments below, or contact me via email: jenni.westerfeld@gmail.com for a personal consultation or fitness plan.

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Flexibility: the Base of the Pyramid Part II: Upper Body

Posted by on Oct 22, 2014

This post has good information and stretches for anyone, not just riders!

Now you have had a chance to explore some lower body stretches. hopefully, you have found some areas that needed to elongate and relax, and you are noticing some changes in your leg position or your ability to be straighter in your seat. If you are not a rider, perhaps the benefits are manifesting in other activities.

Let’s look at the upper body next. Many of us work at a desk or spend quite a bit of time seated. Gravity works against us, and gradually we slump forward and our heads slide out ahead of our chests.

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Now our center of gravity is ahead of our movement…riders, we are on our forehands! Ideally, whether riding or elsewhere, the ear should be directly above the shoulder which should be above the elbow above the hip, then knee and ankle if standing.

The farther forward the head slides, the more it “weighs” as our shoulders and posterior neck muscles have to hang on to it. This causes those muscles to become tight and overused. Likewise as our chests drop, the pectoral muscles shorten. When our upper body collapses forward on itself, it is difficult to engage our trunk muscles and follow the movement of the horse.It send our center of gravity forward and may make it more difficult to balance the horse onto his hindquarters.

How can we retrain our upper bodies? First we need to lengthen what has become short and tight. Later, I will show you how to strengthen the muscles that keep our heads and torsos in the most anatomically efficient and balanced position. Do these in the order presented, as one mobilization leads to the next.
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Let’s start by mobilizing the thoracic spine; the segment spanning the rib cage.

One of the best ways to do this is with a foam roller. (They are available online at a number of sources. You can cut them in two, if you want to share one or keep one at work.)

As you see, the idea is to drape yourself over the roller and allow your spine to bend back into extension. Support the back of your head, letting it drop back as much as is comfortable., and keep your knees bent. Start with the lowest part of your ribcage, spend a few seconds there, then move to the next section up toward your head. Keep working your way up to your shoulders, taking your time and allowing the release of your paraspinal muscles (the ones that run along each side of your spine). This can be painful at first, but try to breathe deeply and slowly. If you do it daily, you will be amazed at how quickly your back adapts, and soon it will not be uncomfortable. If it really is hard to handle, try a towel or other padding until it becomes tolerable. Each pass up the spine should take 20-30 seconds. Once or twice daily should reap results.

 Pectorals/ shoulder rotators:

Now that your upper spine is free to move, you can stretch your chest and front of the shoulders. The two stretches below will allow you to bring your chest up and forward, and roll your shoulders back. In the first stretch, it is important to extend your whole hand and fingers back. Do not grip or clutch. Turn slightly away from the outstretched arm to increase the stretch. You may feel some tingling through your arm -the nerves may be getting a lengthening, too! The bent arm version focusses more on the pectoral muscles specifically, but both are useful. Short holds of 5-10 seconds, about 6-8 per arm.

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Neck:

Lastly, the neck may require some stretching. The upper trapezius muscle runs from the base of the skull, fanning out to attach to both the cervical (neck) spine and the back of the clavicle, becomes overdeveloped to counteract the weight of the forward-sliding head. If the shoulder or upper arm is weak, the “traps” are only too happy to take their jobs, too. Now you may really need to stretch them. This will help sternocleidomastoid (SCM) as well as the scalenes. With rounded shoulders and forward head, SCM becomes vertical and short, rather than long and obliquely oriented.

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Anchor your hand under a bench or chair seat so you keep the shoulder attachments away from your head. Slowly and lightly pull your head away from the anchored side. You may need to rotate or bend your neck to find the angles that work best. Be gentle, and hold 5-6 seconds repeating 6-8 times. You may find one side of the neck is tighter than the other.

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There are plenty of other stretches for the shoulder and upper back. For now, we will stick to these as they address some of the most common issues people face. With practice, you will be able to assume a more upright position, taking in more oxygen, and staying balanced in the center of your saddle. Soon, we will start some exercises to help maintain the good posture.

Thank you, MV, for posing for these photos.

Not all exercises are suitable for everyone and this or any other exercise program may result in injury. Any use of this exercise program assumes the risk of injury resulting from performing the exercise and using the equipment suggested. To reduce the risk of injury in your case, CONSULT YOUR DOCTOR BEFORE BEGINNING THIS EXERCISE PROGRAM. The advice and instruction presented are in no way intended as a substitute for medical counseling. Jennifer Westerfeld and Westerfeld Fitness disclaim any liabilities or loss in connection with the exercise and advice herein.

Feel free to post questions and comments below, or contact me via email: jenni.westerfeld@gmail.com for a personal consultation or fitness plan.

 

 

 

 

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Ann

Posted by on Oct 17, 2014

 

I’ve worked with Jenni for about 3 years now and am continually amazed at the changes that we’ve achieved together. I’ve been able to lose 30+ pounds with her steady support and unflagging optimism about my ability to achieve my goals; with never a judgment when I fall off the wagon and have the occasional éclair or that extra Mexican Martini!

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Her knowledge about exercise physiology and nutrition have created a well balanced program that positively impacts my health everyday. When I started working with Jenni 3 years ago I was motivated by  worsening arthritis in my knees, my weight and my overall out-of-shapeness.

 

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The Tuesday and Friday training sessions with her quickly became a touchstone for a more complete overhaul of my health habits that have included a much healthier diet, regular workouts on my own, weight control     (an on-going project!) and the less tangible but equally important belief in my power to imagine a change and work to create it.

 

IMG_5259It’s truly not an exaggeration to say that our work together has changed my life and I now view my health in light of manna-a blessing that is never finished and and that I participate in daily. Thank you, Thank you, Thank you!

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Mindy

Posted by on Oct 15, 2014

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Just before my father’s death from lung cancer on Sunday, January 15, 2012, I asked if he had any special advice for me. He looked me over head to toe and said, “Lose some weight.” Not the kind of advice I expected!

 Soon after, I ran into Jenni at Central Market, and she asked when I planned to come see her. She had donated a gift certificate to a silent auction I organized for Austin Animal Center, and a friend bought it and gave it to me. Remembering Dad’s “advice” for my life, I promised to come soon.  I finally made good on that promise in late February 2012.  Challenge accepted, old man.

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Before…

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I believe that I probably weighed over 140 pounds, but I refused to go near a scale. I told Jenni during our introductory session that I wanted to lose weight and get in shape. When Philip and I married in 1987, I weighed 108 and I had a 19” waist and stood 5’3”, so 110 seemed like a good goal. I have no idea what my measurements were; Jenni measured my waist and hips. (To this day I don’t know what those measurements were.)

She promised to guide me but she emphasized that the ball was now and always would be in my court. The very first thing she had me do was to start jotting down every single morsel that crossed my lips. Being ever so slightly OCD, I plunged in with a vengeance.At that point, I thought I ate pretty well. I tried to be mostly vegetarian, and I prefer chicken and eggs over other meats and proteins. I love beans, I enjoy salad – I thought I had it made. I told Jenni that there was one absolute: I would not give up tequila. She advised me that I would not need to give up anything except for processed food and refined sugar.

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Mindy with fellow client Merlin

Slowly, Jenni helped me shape my diet and trained my sense of portions and combinations. For instance, before, I would have toast with jelly for breakfast, a sandwich and chips for lunch, and chicken with potatoes, salad, and a roll for supper. Jenni simply pointed out that I needed some sort of protein with breakfast, and I could lose the jelly (organic nut butter – problem solved); I could have an open-face sandwich with no chips for lunch (celery is crunchy – problem solved), and chicken with just a couple of red potatoes and salad for dinner (no roll – problem solved). I learned what to eat when, too, and less of it. Apparently, the sound of my whining was music to Jenni’s ears.

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With fellow client Paula at yoga

Soon, I had lost five pounds, which motivated me immensely.  Then, on April 23, 2012, I Zumba’d onto my left foot and promptly tore my left peroneus longus tendon. I wore a boot for just over eight weeks, and went to physical therapy for three months. Still, by managing my diet with Jenni’s help, I continued to lose weight, although more slowly. I also discovered that I could stretch farther in yoga, and I could get into poses more fluidly. I slept better. The aches and pains that I attributed to being over 50 were vanishing as my strength and diet improved. Some work-outs were brutal and others plain fun but the weights were increasing and the movement patterns turned more complex.

I struggled often. That year was tough. I would think about Dad and get very sad. Dealing with his estate and our family business caused unimaginable stress. My leg and ankle hurt like crazy for months. I became irritable and snappy. But through it all, Jenni stood by, patient, tolerant, and very forgiving.  I improved my diet. I kept coming to see her. I talked with her about every problem, including personal situations that weren’t really diet or exercise related, and she helped me strategize ways to cope with everything and other potential issues, like holiday parties and family dinners (hint: eat a small salad with lots of veggies and some sort of protein before you go). Amazingly, after about six months I found that instead of devouring a whole basket of chips and Bob Armstrong dip, along with an entire entrée and two margaritas, I wanted only 3 or 4 chips, a couple of spoonfuls of Bob Armstrong dip, about half my entrée, and only one margarita. I became a cheap date again!

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Mindy inspired her mother and her daughters to start working out!

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From the first time I stepped on Jenni’s old-fashioned scale, I refused to watch as she fiddled with the weights. She teased me about it all the time, but she honored my request that she not announce my weight unless I made it to a five-pound interval. Sometimes, when I dreaded climbing on that scale, I would hear to my delight that I had lost well. Sometimes, when I thought I would impress Jenny, I would find that I had somehow gained back a pound. Finally, in April 2013, Jenni weighed me and said the magic words, “Turn around.” I had done it. The scale showed that I weighed just under 110 pounds!

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…and after.

My journey is best summed up in my January 2013 visit to my GP for my annual exam.  I strolled into the exam feeling pretty cocky.  While I had never gotten any caution from him about my weight in the past, I knew it had been steadily increasing for the 22 years I had been seeing him.  I sat in the exam and answered all the usual questions about my habits and health, and he did all the usual tapping, poking, and listening that goes with a check-up. As the session seemed to be winding to a close, I was about to jump through my skin because he had not made any mention of my weight loss (then about 20 pounds). I could stand it no longer, and I blurted out, “Stephen, say something about my weight!”  He blinked, peered at me over his reading glasses, and said very mildly, “Oh, yeah, you lost some weight.” I replied in a somewhat strangled tone, “WHAT?” He chuckled and said, “Yeah, that’s great, but here’s what’s really good: your cholesterol , which was fine before, is down by 75 points. That’s what’s really impressive.” Wow. And that was never even on my radar for improvement.

This whole endeavor has not been only about losing weight or building strength or improving my cholesterol, even though all those things happened. It’s been about making a permanent lifestyle change for the better. Some days the scale shows me I need to cut back; other times, it’s like a pat on the back. I still have carb-attacks; I still drool over doughnuts. I’ve learned tricks that work (staring at a doughnut or cookie or whatever for a while seems to alleviate my craving) and some that don’t (having just a spoonful never seems like enough; for me, it’s better to not have any).  I have most assuredly NOT given up tequila.  I have dragged Jenni into yoga. The journey continues and it’s a whole lot of FUN!

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Paula

Posted by on Oct 14, 2014

 

The 2007 Austin Marathon was my 7th marathon finish, all 26.2 miles.

Paula's 2014 Half Marathon Finish

 

That same year, Merlin and I married. Lucky #7!  Merlin had been training with Jenni for a few years prior, and he’ll write his story.

I was a runner, and gym workouts didn’t appeal to me. I met Jenni through Merlin, and she was interested in running. So we started off the New Year of 2009 as running partners. Waldo the gym dog always joined us on our runs on the Barton Creek Greenbelt and other trails.

 

For me, off-road running was the perfect activity for body, mind and soul: You depend on stabilizer muscles, gripping rocks. You engage your brain, calculating where to step next. And the feeling you get from being outside in nature feeds the spirit.

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Jenni and I even competed in a few races together, and also experimented with barefoot running (see her blog “the Barefoot Journal” )

Then my life changed. A bone density scan revealed “slight osteopenia.” To stave off osteoporosis, I became a paying customer of Jenni’s. To rebuild bone health, she designed a program of weight-bearing exercises. Now, 5 years later, I’m still outrunning osteoporosis!

My life changed again. After about 6 months on this new routine, I was pretty happy with my new toned body. But I asked Jenni why I didn’t have 6-pack abs! She suggested I see a gastroenterologist, it may be inflammation.

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I followed her advice, and I’ll be forever grateful. A simple blood test was positive for celiac disease. CD is an autoimmune response to gluten proteins in wheat, barley and rye. (www.celiac.com ) I was told the “gold standard” test for CD was an endoscopy, where a biopsy of the villi lining the wall of the small intestines is examined for damage. When gluten is in the gut, the immune system in a person with CD attacks the villi, damaging it so much as to cause all sorts of problems. One of those problems is nutritional deficiencies like lack of calcium for strong bones leading to osteoporosis!

With CD there is no such thing as moderation. One has to abstain from gluten forever. This came as a relief to me. I knew what I had to do. It wasn’t difficult. After 2 years off gluten, I had a second endoscopy which showed my villi were regenerating!

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Almost 5 years gluten free, and I don’t miss it. I’m grateful to know what was causing my problems, and I have Jenni to thank for the guidance.

My next life change? I’m working on my 6-pack abs!

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