Exercises

for
Common
Injuries
PLANTAR FASCIITIS,
IT BAND SYNDROME AND
PIRIFORMIS SYNDROME

INTERNATIONAL SPORTS
SCIENCES ASSOCIATION
 C ontents
Contents
Pain in the Buttocks when Sitting? Use these Tips

Exercises for IT Band Syndrome

How to Deal with your Client’s Plantar Fasciitis

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 P ain in the B uttoc k s w hen S ittin g
?
BY LINDSAY KENT

Pain in the Buttocks

when Sitting?

Use
traveling down the back of the leg and branching
into smaller nerves that end in the feet. Much of
the pain as described above that many of your

these
clients’ experience is from the interaction between
the piriformis muscle and the sciatic nerve.

When people have symptoms of piriformis syndrome,

sometimes they assume it to be a herniated disc.

Tips
But, an alternative cause, proposed by Freiberg
and Vinke and developed by Robinson who coined
the term “piriformis syndrome,” is compression of
the sciatic nerve from a tight piriformis muscle.

How Does Piriformis

Syndrome Happen?
Reciprocal inhibition is a common phenomenon
that happens when muscles on one side of a joint
If you (or your client) has ever had sensations like
contract and opposing (muscles on the other side
sharp pain, numbness, or tingling in your lower
of the joint) relax. This allows movement to take
back and buttocks (glute) region that travels down
place. So, tight hip flexors will cause the glute
the back of your leg, you’re not alone. And, a
max to become inhibited, or “silent.” This doesn’t
muscle called the piriformis could be to blame.
mean movement at the joint can’t occur. Instead,
another muscle must pick up the slack and in this
This small muscle plays a big role in keeping
instance it’s the piriformis. Since the piriformis is
lower body movements smooth and balanced,
small and not intended to do all this work, it can
particularly during extension, abduction, and
get overactive and spasm easily in these cases.
external hip rotation. And, when you know how it
When this happens, it can compress the sciatic
affects movement and pain, you can help clients
nerve, leading to pain, numbness, and tingling
avoid what’s called avoiding piriformis syndrome.
sensations. Because it’s an overactive muscle,
Simple mobility and flexibility exercises can help
spasming from too much work, it just needs a
alleviate the symptoms and stay pain free.
break. By doing hip flexor and piriformis flexibility
What is Piriformis Syndrome? exercises, these symptoms of tightness and pain
subside, restoring normal movement and function.
The piriformis is a small, flat, band-like muscle
that originates on the anterior surface of the The pain from piriformis syndrome can occur
sacrum and connects the most inferior part of during many movements since this muscle is
the vertebrae to the upper part of your leg. A so integral in lower body mechanics. But when
simple reference point for this muscle is the back it’s over-activated, and nerve compression is
of the hip, because it sits on top of the hip joint. happening, you or your client might feel pain just
sitting at a desk, in the car, or even while standing.
The sciatic nerve, on the other hand, runs
alongside or through the piriformis muscle, Clients who are extremely active and prone to
developing this condition include soccer players,

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 P ain in the B uttoc k s w hen S ittin g
track and field athletes, runners, and
triathletes. This is due to the constant lifting
and rotation of the thigh away from the body.
Including piriformis syndrome stretches into
their exercise programming is essential.

Special Considerations with Clients

According to Harvard Health, it is also

important to have a full health history on
your clients, as other medical issues will also
accelerate the pain associated with piriformis
syndrome. Some of these conditions include:

• Previous Injury

• Abnormal development of
sciatic nerve or muscle

• Postural deviations

• Leg length discrepancy

• Unusually vigorous exercise

• Excessive bouts of sitting

• Previous foot issues

Prevention and Pain Management

Piriformis syndrome doesn’t have to sideline

your clients’ goals and successes. Simple
mobility exercises will help keep this tiny
muscle from tightening and causing pain and
dysfunction. Keeping the body’s strength work
balanced will help to avoid overcompensation
issues, and including strengthening work
specifically on the hip adductors is essential.

Check (and share!) out this great resource of

the best ways to deal with pain in the buttocks-
piriformis syndrome. And, if you want to be an
expert at working with clients who have these
types of symptoms (and so, so much more) then
you should be a Corrective Exercise Specialist.
Get this advanced certification and bring even
more value to the clients you work with.

References

1. Ask Dr. Rob about piriformis syndrome - Harvard

Health. (n.d.). Retrieved August 20, 2018, from
https://www.health.harvard.edu/diseases-and-
conditions/ask-dr-rob-about-piriformis-syndrome

2. Carro, L. P., Hernando, M. F., Cerezal, L., Navarro, I. S.,

Fernandez, A. A., & Castillo, A. O. (2016). Deep gluteal
space problems: piriformis syndrome, ischiofemoral
impingement and sciatic nerve release. Muscles,
Ligaments and Tendons Journal, 6(3), 384–396.
https://doi.org/10.11138/mltj/2016.6.3.384

3. Hopayian, K., Song, F., Riera, R., & Sambandan, S.

(2010). The clinical features of the piriformis syndrome:
a systematic review. European Spine Journal, 19(12),
2095–2109. https://doi.org/10.1007/s00586-010-1504-9

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 THE BEST IT BAND EXERCISES FOR PREVENTING, CORRECTING, AND MANAGING INJURY
The Best Not all of your clients know what the iliotibial band (IT band) is, but
they’ll quickly find out if they end up with an IT band injury. This

IT Band
important piece of connective tissue runs down the side of each
leg and can cause knee pain. Further, repetitive movement when
muscle imbalances are present can result in an overuse injury.

Exercises Work with all of your clients to strengthen the hip and glute muscles
that help prevent injuries (including IT band syndrome). Specifically,
for Preventing, cyclists and runners can benefit from IT band exercises.

Correcting, and What is an IT Band?

Managing Injury The IT band, or iliotibial band, runs from the hip to the knee on the
outside of each leg. Rather than a muscle, it is fascia. This means it has
lower blood supply, can’t be strengthened, and doesn’t have the same
elastic properties as muscle. The best way to prevent problems in this
area, including the knee and hip, is to perform strength and flexibility
exercises on the muscles around the joints it affects: the hip and knee.

ITB Syndrome

IT band syndrome is pretty common. It occurs when there is

instability around the knee joint and results in sharp pain on the
outside of the knee. Many runners know what this feels like, but
ITB syndrome is also common in cyclists and other athletes.

The outer knee pain of ITB syndrome is often sharp when

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 THE BEST IT BAND EXERCISES FOR PREVENTING, CORRECTING, AND MANAGING INJURY
The Best IT Band Exercises to
Strengthen Hip and Gluteal Muscles
Strengthening these muscles is the key to both preventing
IT band syndrome and correcting it. If your client is already
struggling with pain from this injury they may need to
back off the exercise that is causing it, like running, but
in the meantime work on the right strength exercises.
And if the client hasn’t experienced any IT-related pain,
add in these exercises to make sure they won’t.

The Clamshell

Lie on your side with knees bent at a right angle. Lift

the top knee up while keeping the feet together. It
will look like your legs are opening like a clamshell.
This is a small, specific movement that targets the
glute. You can also add a resistance band around the
knees for more tension. Repeat on the other side.

The Bridge

Lie on your back with your knees up as if you were

going to start doing crunches. With or without
a resistance band around the legs just over the
knees, lift the hips up and squeeze the glutes.

The Single-Leg Squat

Perform regular squats but on just one leg. Extend

the other leg forward during the squat and repeat on
the other side. Good form is important with squats
to avoid putting pressure on the knees. The hips and
butt should go back and the knees should not extend
over the toes. Keep the chest and head upright.

The Lateral Band Walk

Use a resistance band around the ankles for this

exercise. With good tension and knees slightly bent,
take several steps to one side and then back the other
way. You can also do a variation of this exercise with
the band around the thighs and with the knees bent a
you first start an activity and then lessens
little bit more. Steps will be bigger in this variation.
as the muscles all get warmed up.
What About Foam Rolling?
However, with time and without doing anything
to correct it that pain will get worse and will People often mistakenly think they should foam roll the
persist until a workout becomes impossible. IT band. This activity doesn’t worsen negative symptoms,
but it does little to improve it. Keep in mind, fascia doesn’t
The causes of IT band syndrome are general overuse,
have the same elastic properties as muscle tissue so
but only because of specific muscle weaknesses.
it won’t respond as readily. Instead, you can have your
When the gluteal muscles and muscles around the
client benefit from foam roll activities on the piriformis
hip are too weak, they cause the IT band to pull the
or adductors. These muscles affect the hip and tend to
knee out of alignment, hence the pain and injury.
get overactive and tight, further pulling hip alignment in a
less than ideal way. After the client completes the self-
Preventing IT Band Injury
myofascial release, you can have them also stretch the
Because weak muscles and overuse cause ITB syndrome, same areas to further improve proper range of motion.
there are two ways to prevent or manage this injury:
Teach all your clients who are very active in one
• Rest particular sport, like running, to roll correctly.
• Strengthening muscles of the hip
ITB syndrome can become serious, and athletes who
No athlete wants to rest, and if your client does enough ignore the pain and push through it will soon regret
work to build strength in the muscles connected to the IT it. Educate your clients, help them learn the right
band, one shouldn’t have to. However, when injury and strengthening exercises, and insist that they rest if
pain are severe, you may need to make your client sit out necessary. Learn more about this type of training
some workouts for a while as you work on strength. with the Corrective Exercise Specialist program.

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 PROTEIN SUPPLEMENTS VS. PROTEIN FOODS!
The Best IT Band Exercises
For Preventing, Correcting, and Managing Injury

Clamshell Bridge
• Lie on one side. You can prop your head up • Lie on your back on the floor.
in your hand. • Bend your knees and keep your feet flat
• Bend your knees to a 90 degree angle. on the floor as if you were going to do
• While keeping the feet together, lift the crunches.
knee on the top leg. • Lift the hips up as high as you can until you
• Make this a small movement, lifting the feel a contraction in the glutes.
knee until you feel a contraction in the glute. • Squeeze the glutes on the top before
• Repeat the same exercise on the other side. slowly lowering hips down to the ground.
• For more of a challenge add a resistance
band around the legs just above the knees.

Lateral Band Walk Single Leg Squat

• Put a resistance band around the legs just • With legs a little further apart than shoulder
above the ankles. width, face forward.
• Knees should be relaxed and just slightly • Lift one leg up and point it forward while
bent. squatting on the other leg.
• Facing forward, take small steps to one • Keep the chest and head upright.
side, squeezing glute and hip muscles with • Move the hips and butt back, as if sitting
each step. down in a chair.
• Repeat the same movement going back in • Don’t let the knees move forward over
the other direction. the toes.
• Also try using a resistance band around the • Lower down slowly and stand back up
thighs, just over the knees. straight, with full hip extension.
• Bend the knees a little more and • Repeat on the other side.
keep the chest and head upright and
facing forward.
• Again, step to the side, squeezing
and contracting with each step.

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 KNOW IT ALL
Know It All
_

ISSA’s Corrective Exercise Certification

_

Everything you need to know to deliver life-changing results for

yourself and your clients by mastering the art and science of
corrective exercise.

issaonline.edu

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 HOW TO DEAL WITH YOUR CLIENT’S PLANTAR FASCIITIS
BY DR. SCOTT HOAR

How to Deal with A client of yours has been having chronic troubles with plantar fasciitis and
Achilles tendonitis for years. Whenever these issues get too bad, she stops

your Client’s running and stops working out. Then she gains weight and is unhappy. After a
few months, her foot starts feeling better and she get’s back to working out.

Plantar Great! Until….guess what, IT STRIKES AGAIN!!!!

Fasciitis
Which is what’s been happening for this particular client for 5 years now.

Don’t let your client (or yourself) fall into this cycle.

Before you treat your client, remember this!

You’re Not A Medical Professional

So Don’t ‘Treat’ Injuries!
It’s important to understand where your professional
expertise is, and where it’s not.

It’s actually a very clear line. Pain. It something hurts. Don’t do it.

Now that doesn’t mean that client can’t work out with you, you just
need to modify the activity. Change the exercise. As well, it really
helps to understand a little bit about the injury. While it’s not your
job to ‘treat’ the injury. You can still take actions to help resolve the
issue and not lose your client to “I need to stop working out so I can
heal from this injury”. That’s what I will provide you with today.

Understand The Injury - The Three

Shock Absorbers of the Feet
Mechanically, something is going awry with the foot and the posterior chain
of the hips, hamstring, calves, heel and the bottom of the foot. Whenever

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 3. Stepping Down During Box Jumps or Plyometrics

HOW TO DEAL WITH YOUR CLIENT’S PLANTAR FASCIITIS

you take a single step with your foot, there are three - The rapid lengthening of the plantar fascia
main joints that act as ‘shock absorbers’. They are: will irritate the tissue, so don’t do it. Opt for
stepping down instead. This is assuming your
1. Toe Extension
client can handle jumping up with no pain
2. Metatarsal-Philangeal (Mid Foot) Extension

3. Ankle Dorsiflexion
Further actions and Education
for you on this topic
These joints are very commonly restricted due to
1. Learn the Short Foot Exercise - Originally described
improper footwear, old ankle injuries and fallen
by Vladimir Janda, this is an exercise that helps you
arches. So now, the plantar fascia cannot lengthen
to awaken the intrinsic muscles of your foot that
the way it’s supposed to and the tissues start getting
have probably gone to sleep from years of padded
beaten up and starts becoming hard and tense.
footwear. In this exercise, we attempt to shorten
Eventually, if it gets bad enough, it could even start
the length of our foot, without pressing the toes
to get a bone spur growing out of the bottom of the
downwards on the ground. Try it. It’s not easy.
heal. We don’t want that. So if you’re dealing with a
client with such an injury, this is what you can do:
2. Consider Recommending A Medical Professional -
Having a few medical professionals that you have
Exercises To Avoid
a rapport with is a huge advantage as a fitness
• Running professional. It will take time to develop your
• Jumping Rope network (chiropractor, physical therapist, podiatrist,
orthopedic, neurologist) but it’s a huge plus to
• Box Jumps or Vertical Jumping be able to send your ‘injured’ clients to a medical
professional that will offer something more than
Exercises to Include ‘rest your foot for 2-4 weeks and stop working
out’ (which no one wants, especially you). Try your
These will be used at the beginning of the workout
best to find a medical professional that are fitness
as a ‘warm up of sorts’. One set of 10 repetitions
or exercise inclined. They’ll understand you and
should be sufficient for most of these.
your client a whole lot more. A really good one
1. Eccentric Calf Raises - Be sure not to perform and you can be sure to coordinate your efforts
the ‘concentric’ aspect of the calf raise. with the client (which looks really great for you).

2. Ankle Dorsiflexion Mobilizations 3. Consider the ‘Cock Up’ Brace - These braces can
be picked up at your local drugstore. The keep the
3. “Heel” and ‘Tippy Toe’ Walking - Have your client plantar fascia lengthened while your client sleeps
walk around with their shoes off and walking with which could decrease their morning stiffness. It’s
the heels raised up for 1 minute. Be sure to not not a complete treatment plan for the injury, but it
allow the ankles to ‘roll out’ or invert during the can provide some relief especially in the morning.
movement. You might have to allow them to hold
onto a support and just walk in place. Repeat with 4. Lacrosse Balling Rolling - While seated on a chair,
the toes elevated and walking on the heels. place a lacrosse ball and roll the bottom of your
foot over the ball. It should help to decrease
4. Toe Flexibility Work some of the tension within the plantar fascia.

5. Calf and Hamstring Stretching - Pick your What I recommend you do with this article is to take
favorite, I’m sure you know plenty of these. action. Look up a medical professional and ask to
have a cup of coffee with him. Get good at the ‘short
Ways to modify other exercises foot exercise’. Read up on the ‘Posterior Chain’. See
in light of Plantar Fasciitis what it feels like to roll your foot on a lacrosse ball.
If you’re going to recommend your client take an
1. Make the Exercises Less Weight Bearing -Perform action, you’d better have some personal experience
seated and kneeling based exercises to reduce stress performing the same thing. Good luck and please
on the plantar fascia. The more you can get your leave a comment to let me know how it goes.
client off their feet, the better off they’ll be. Suggest
something like swimming or biking for cross training. References

2. Lift the Heel - Now I’m not a huge fan of making this Moon, Dong-chul, Kyoung Kim, and Su-kyoung Lee.
a recurring habit, but used sparingly, I don’t see “Immediate Effect of Short-foot Exercise on Dynamic
a problem with it. If you really want to prescribe Balance of Subjects with Excessively Pronated Feet.”
an exercise and your client says it hurts, try a Journal of Physical Therapy Science. The Society of
small heel lift (like a small pad or a flat plate) Physical Therapy Science, Jan. 2014. Web. 20 Sept. 2016.
which will change the length of the plantar fascia
and hopefully provide relief. Remember, if there Garrett, Troy R., and Peter Neibert J. “The Effectiveness
is active pain during an exercise, don’t do it. of a Gastrocnemius–Soleus Stretching Program as a
Therapeutic Treatment of Plantar Fasciitis.” Journal
of Sport Rehabilitation 22.4 (2013): 308-12. Web.

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