Running Injuries and Butt pain/Piriformis Syndrome?

//Running Injuries and Butt pain/Piriformis Syndrome?

Not a day goes by that Ido not see a runner with severe butt pain.  Often the condition is misdiagnosed as either Sciatica, Piriformis Syndrome or Bursitis.  It is not that it is never one of these but much more often than not it is Gluteus Medius muscle strain.  In runners Gluteus Medius muscle strain is far more prevalent than any of the other conditions.  The Gluteus medius is one of three Gluteal muscles that work to stabilize your hip joint and sacroiliac joint.  The Gluteus medius is crucial during the landing phase of gait.  When your foot strikes the ground and you are putting all of your weight on one leg the Gluteus Medius on that side contracts to stabilize the hip and give you balance and support.  The problem?  Your foot impacts the ground up to 2000x per mile.  That is 2000 Gluteus Medius contractions per mile!  Try doing 2000 biceps curls and see what your biceps feels like!

I saw a women today who was suffering from “Sciatica”.  She explained how she has been to all of the “top” orthopods and sports doctors.  She told me the grim details of her encounters with physical therapists who tried to”strengthen” her hips.  I heard tales of Chiropractors who “cracked her back”.  She also had heard that shoes caused her problem so she started running barefoot.  Not only did that not work but now she had Achilles tendonitis too!  Why couldn’t all of these doctors and therapists help her?  Because they were all playing the game blindfolded.  In the dark.  They were all operating under the wrong diagnosis.  She had Gluteus Medius strain not Sciatica!

We directed the therapy at her Gluteus using mostly ultrasound and myofascial release.  I instructed her on proper stretching (how much and how often…how long to hold the stretch and how many times to do it a day).  I introduced her to her new best friend, Mr. Foam Roller.  As I demonstrated how to properly use the foam roller she came to have a love-hate relationship with Mr. Roller (“it hurts so good”!).  She emailed me tonight to let me know that her butt was feeling better for the first time in months!  I promised her it would be 100% better in a couple of weeks and she would be running again…..far.  She asked why the other doctors and therapists did not know what she had.  I explained, “They simply do not understand running injuries because they are not runners.  I run far and I run often.  I have had every running injury there is.  I have treated runners with every running injury there is for 12 years.  When you do the same thing over and over again for 12 years you get good at it.  I’m good at it”. 

It is not arrogance that makes me so confident.  It is my desire to help people, runners especially.  I do not want to be “average”.  I want to be excellent.  I have strived to learn as much as I can about running and running injuries to better serve my patients and the San Diego Running community.  Unfortunately it is true that most doctors and therapists are fine with mediocrity and being average.  For this reason they misdiagnose and mistreat runners and patients.  Sad but true.

By | 2011-06-08T03:09:43+00:00 June 8th, 2011|Running Injuries|9 Comments

About the Author:

Dr. Runco is a U.S. Navy and Gulf War Veteran. He began private practice in 2000 primarily treating and fixing running injuries. He has been a professor of Anatomy, Physiology, and Biomechanics at various colleges and continues to teach continuing education in the fields of rehabilitation, custom orthotics and athletic taping. He is also a member of the American College of Sports Medicine, National Strength and Conditioning Association and is a Certified Strength and Conditioning Specialist. He has completed over 15 Marathons in 15 states and has run 11 50 mile Ultramarathons.


  1. Robert October 24, 2012 at 4:09 am - Reply

    I believe I am suffering from Sciatica and I would appreciate a list of stretching exercises that would help me reduce the discomfort I am experiencing.

    • Dr. Runco November 16, 2012 at 4:50 pm - Reply

      stretching can actually irritate sciatica Robert. Sciatica is a pinched nerve in your lumbar spine. There are far more effective treatments for Sciatica. If you live in the San Diego area call my office at 619-265-2222 to schedule an appointment. If not follow the directions below:
      Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $67 (normally a cost of $125) and by calling my office at 619-265-2222 ext. 2 after 12 noon Pacific Time today, Brittaney can schedule a 45 minute phone appointment. These are very successful because prior to the phone consult you,
      1. Provide me with a detailed history regarding when and how the pain started.
      2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
      3. Anything you did on your own that may have helped or hurt
      4. A list of any special tests including X-rays, MRI’s, blood tests etc
      5. Any information you have or feel I may need to know. Example: How you said you have sciatica…..was it diagnosed by anyone or an educated guess on your part?
      6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
      After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

  2. Bernice May 12, 2013 at 10:41 am - Reply

    I am a runner & have had buttock pain on & off for more than 30 years!! The only way it goes is if I stop running for months at a time but at 60 yrs I relly don’t want that down time anymore!! It has become worse since I now spend so much time on the computer so sitting down! I have since purchased an inflatable ring to take thepressure off while sitting! I am doing the exercises I have been instructed to do eg running man 3×20 & crab walk 5x10m x2 a day! I am still running but very little & only on the flat!! Everything is painful! I feel that due to my age 60yrs they really don’t see it as important to get me back to running competitively!! Even with the pain I am still topping in my age group & came 4th woman in a 6km trail run & 11th over all this was against men & woman half my age! I have been told not to rest completely so am very confused!! I live in Australia so a consultation with you is out of the question! Some advice would be most helpful!

    • Dr. Runco May 13, 2013 at 3:03 pm - Reply

      Hi Bernice,
      As you said you live in Australia so it is going to very difficult for me to help you. There are so many different things that could be causing this problem. You are going to have to listen to what i say and research these conditions on your own. Next you will have to find a competent doctor who will help you properly diagnose the condition and then supply the means to correct it. Any of these problems could cause some of the symptoms you provided me.
      1. Hip Arthritis
      2. Anatomical Short leg Syndrome
      3. Piriformis Syndrome
      4. Hip Bursitis (subgluteal, Ischiogluteal or Trochanteric)
      5. Sciatica
      I wish you well in your endeavor to find pain free running. By the way sometimes changing shoes, running form or getting insoles can change the way you run enough to help alleviate SOME of the symptoms. However, I suggest you find an excellent doctor who will use all means necessary including MRI to solve your chronic problem.

  3. Bernice June 19, 2013 at 5:11 am - Reply

    Thanks for taking the time to reply Apparently I am show very little signs of degenerstive changes in the joints of my body & my bone density is that of someone half my age!! I am going to ask for an MRI otherwise they are just stabbing in the dark! I am now unable to run since I raced in the week-end & feel like I have torn the muscle at the attachment site! It is very specific pain over the Ischial spine surely something will show up on a MRI

  4. Nikki October 13, 2014 at 5:38 pm - Reply

    I am new to running and think that I’m suffering from a gluteus minimums or medial strain. I had one before in May that my doctor thought was bercitis, but then the PT diagnosed it as gluteus strain. I basically took off 2 months and now it’s doing great. But of course now the other side is feeling the same. Be asides taking off 2 months and of course stretching what should I be doing? I have new taking ibuprofen and icing some. I am running approx 12 to 16 miles a week at a pace of 10:00. Run less? Run slower? Weight train? Yoga? Elliptical until some pain subsides? Certain stretches? Thanks for any help you can give.


    • Dr. Runco October 13, 2014 at 5:45 pm - Reply

      It is difficult for me to help you through the internet Nikki. Taking 2 months off will heal most running injuries. If it is tightness then stretching and the foam roller would seem appropriate. Neither ice or ibuprofen would be correct for muscle tightness.

  5. Ana August 6, 2015 at 5:11 am - Reply

    aye same problem here! I live in Azores so about as unlikely to get a consultation! I have researched all the likely suspects and am no closer to knowing wich one I have. Streching just makes me feel worse, running with longer strides makes it worse, sitting down on a chair long makes its worse. Resting, shorter strides and running offtrack makes it better. Then again, running offtrack makes everything better except an old ligament strain on my foot. I run semi-barefoot and you can barely hear my footstrike so it’s not a matter of impact, but that doesn’t help on reducing the options either cos most are ligament or muscle related… I’ve heard it might be an imbalance between my aductor and abductor muscles because I also do horse riding… I’ll try correcting that now and see how that goes…

    • Dr. Runco August 6, 2015 at 6:01 am - Reply

      good luck Ana. I wish I could help you. It sounds like a high hamstring problem and not an imbalance between your adductor and abductor muscles

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