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Deep Gluteal/Piriformis Pain

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  • Deep Gluteal/Piriformis Pain

    Hi Docs,

    Over the past couple weeks, I seem to have developed some pain deep in my right glute that is most present while deadlifting, particularly once I get the bar to my knees. I primarily pull sumo and my e1RM is around 575 if that matters. I hate self diagnosing things (because how could I be certain?) but it seems like it could possibly be some sort of piriformis strain/dysfunction. Last week was a planned low stress week and the pain had actually somewhat subsided, but yesterday I was back to normal developmental deadlift training and the pain, while minorly present as more of a discomfort on my top sets ([email protected] and [email protected]) worsened substantially by the time I got to my backoff sets. The pain was still most intense in that piriformis/mid glute area, but actually started to radiate proximally to the right side of my sacrum and out to my entire glute, as well as partially down my leg for the first time. Walking was somewhat difficult. This morning, the radiating pain has seemed to have subsided and I'm back to that deep mid glute pain.

    Any advice on rehabbing this? Since the most painful portion of the deadlift is knee to lockout, I don't know if any variations would be particularly helpful. I'm planning on not altering ROM or loading much and just reducing my deadlift volume again - since that seemed to help a bit during my low stress week - and seeing if I could maybe make up some of that lost volume with supplemental isolation work provided this doesn't cause pain. Just (stubbornly) trying to avoid detraining as much as possible since my end of year goal is to pull 6+ plates and I've been building some good momentum towards that over the last couple blocks.

  • #2
    Many of us have experienced similar symptoms (myself included, years ago), and have coached trainees through the rehab process for this.

    I can definitely understand the frustration with these things cropping up when it feels like you're making good momentum, and wanting to mitigate detraining as much as possible. However, in most cases there isn't really a good alternative to simply pulling back on loading to get things calmed down, and working back up again. Continuing to try to hit top loads as a way to mitigate temporary strength loss is likely to just keep the area more sensitive and make the whole process take longer than it needs to (I speak from personal experience here).

    Given that hitting top sets left you in significant pain afterwards, altering loading to the area will be the main recommendation we have. The details of this rehab process (and our general recommendations for this sort of thing) are discussed here, if you're looking for how/where to get started. If you'd like further specific guidance or individualized rehab coaching, a consult with our team would be your best bet.
    IG / YT

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    • #3
      Thanks for the response, Austin. I have read Pain in Training: What Do? multiple times and recommend it to others whenever I can! A recommendation based on your personal experience working through this specific issue yourself and with clients was exactly what I was hoping for, though. I wasn’t sure how conservative to be with this, and you’ve likely saved me from some unnecessary pain and setbacks. I’ll modify my loading to something more tolerable and work on building my way back.

      Just out of curiosity/to manage my expectations - in your experience, does this sort of thing typically resolve itself in a few weeks like a lot of acute injuries, or can it take a bit more time? Or is it impossible to say?

      Edit: I re-read PIT:WD? last night and noticed that radiculopathy was included with tendinopathy as symptoms that may take a few months to fully bounce back from. I've only ever really dealt with acute, non-specific pain before so I must've missed that the previous times I've consulted it. Since I experienced a some radiating pain on Monday, I guess I'll have to adjust my expectations and be patient. Thanks again for your help!
      Last edited by Nate B; 04-14-2021, 01:57 PM.

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