(UPDATED 6/15) A physical therapist finally diagnosed that my knee, hamstring and piriformis problems are all stemming from a combination of a weak glute med (GM) plus a weak toe/arch on my left foot. Since the GM seems to be the key muscle for causing/curing all kinds of running injuries, I thought I'd document what I've learned on my journey, plus some magic-bullet stretches for piriformis syndrome.
First, a great glute med primer: how to tell if you need to strengthen it, plus how to correct it. This image shows what's happening to your body when the GM isn't strong. When your hips tilt, it makes all of your muscles work at unnatural angles. Over time, this one wonky tilt can create tons of problems for your back, knees, hips, hamstrings, etc.
To test for this, the PT had me stand in front of a mirror in bare feet and do a 1-legged squat. The key is to ensure your knees are directly in line with your ankles and not turning in, and your toes/inner feet shouldn't come off the ground. If your knees turn in, you likely need GM work. In my case (and a friend of mine who also has a foot problem) our inner feet/toes aren't strong... so the arches cave in and make the knees turn in. So it's possible that a foot issue can be a root cause, or compound the problems caused by a weak GM.
UPDATE: I also saw a neurokinetic specialist (who can identify what muscles aren't working/firing properly, which causes muscle imbalances that can lead to injury.) He tested my glutes and glute med, neither one of which were firing properly. So this confirmed that it was my GM, not just my bum toe, that was causing problems. The other cause for hamstring pain that I discovered was tight hip flexors... if you've sat at a desk for 20 years, your hip flexors may be shortened, which leads to the hamstrings tightening up to compensate. Work on stretching hip flexors and getting a massage therapist to dig into your iliacus.)
The best exercise for addressing both GM and inner foot strength is to put a resistance band around your thighs right above your knee and get into a chair squat position. You can either do this against the wall or hold onto something in front of you. With feet hip-width apart, press your knees outward without allowing your big toes to come off the ground. When you move them back in, be sure not to allow them to drift inwards... always keep in line with ankles or outward. This can be very hard to do; in my case, there's not a whole lot of outward movement. I'm trying to do 3x10-15 reps daily as it's the best way I've found to try to retrain my body into getting my knees over my ankles while activating my toes/arches. And this is going to eventually get me running again injury-free! Here's an image of this movement, but caveat: this gal is lying down, which creates a very isolated exercise which isn't ideal. Compound exercises (like the standing squat) are much better for athletes.
Another good exercise is the side step with resistance band. It's best to do this in front of a mirror so you can ensure your feet are pointed forward, your knees are in line with your ankles and not turning in, and you're not rocking side to side when you step. It should be a very deliberate, strong stepping movement.
The last dedicated GM exercise is the clamshell circuit. Unfortunately I can't find images for all four exercises in the circuit, but here is the first. The key to doing this properly is a 90 degree angle at your knee and your hip, and (most importantly) stack your hips directly on top of each other. Focus on your GM while doing these. After 10 reps, elevate your feet about 6" (feet and knees still together.) Bottom knee stays on the ground while your top knee raises up 10x. Essentially the image to your left but with your feet raised. After 10 reps, keep your same body position but when you've raised your top knee, extend your leg into a kick... then retract it to touch feet again, and lower your knee. I skipped the fourth exercise but it's too hard to explain. Needless to say, after this circuit your GM should be burning.
Other exercises in my circuit include:
- 1-legged squats (knees in line with ankles, activated toes/arches)
- Step-ups, approaching the step (maybe 1 ft high) from the side to get the lateral muscles working
- Stability ball hamstring curl
- Single leg glute bridge
And of course, foam roller and stretches daily. Speaking of stretches, here's a magic bullet exercise for piriformis syndrome. I am doing this daily and my piriformis pain is GONE. Yep, it's been plaguing me for several months now and it's now gone. Now if I can find the magic bullet for my hamstring I'll be good to go!
(UPDATE: After strengthening glutes and GM, plus working on stretching my hip flexors, hamstring pain is gone!)