Síndrome del piramidal y su efecto en los corredores

Una contractura puede generar un dolor más intenso del habitual si afecta a algún nervio cercano. Esto es lo que sucede con las contracturas o las sobrecargas del músculo piramidal o piriforme; lo que genera el síndrome del piramidal. Las personas que se dedican a correr son las más afectadas por esta enfermedad.  

El músculo piramidal se ubica en la parte profunda del glúteo, en la pelvis. Su función es realizar la rotación externa de la pierna, por lo que al sobrecargarse se genera el síndrome del piramidal.

La contractura o sobrecarga oprime al nervio ciático que pasa por debajo del músculo, y produce el dolor tan característico. Esto acorta la longitud del músculo y aumenta su volumen, lo que provoca una compresión sobre el nervio ciático. 

 El síndrome del piramidal puede afectar a cualquiera que adopte una mala postura o una biomecánica deficiente. Sin embargo, tiene mayor impacto en los corredores. Una mala posición a la hora de entrenar puede provocar una contractura. 

Causas del síndrome del piramidal 

  • Se puede producir por un espasmo muscular
  • Por una carrera más larga de la cuenta 
  • Una sobrecarga de entrenamiento 
  • El engrosamiento del músculo producido por una mala biomecánica, que va sobrecargando el músculo con el tiempo.

En el caso de los corredores, el origen del síndrome del piramidal está en la aplicación de una mala mecánica de carrera. Un corredor de fondo genera un número importante de impactos durante la carrera. Puede ocurrir que la musculatura estabilizadora de la cintura pélvica, el glúteo medio, o el piramidal, no estén bien trabajados. También hay que revisar si está asumiendo una carga mayor a la que puede soportar. 

Además, este síndrome se puede derivar de una mala biomecánica de la pisada. Por ejemplo; si no sabemos que somos pronadores y no corremos con un calzado adecuado, tenemos mayor probabilidad de desarrollarlo. Hay que tomar en cuenta que si la pisada no es correcta, puede que necesites mayor estabilidad y pongas la pierna en rotación externa. 

Sintomatología y diagnóstico del síndrome piramidal

Cuando el paciente no conoce los síntomas, puede crear dudas de si hay una protrusión [discal] o una hernia. Se puede confundir con la ciática o un problema lumbar. 

El síndrome piramidal es una patología generalmente más leve, provocada en muchas ocasiones por la compresión del músculo o por una contractura. Hasta la mala postura a la hora de sentarnos nos afecta. 

Los síntomas del síndrome del piramidal son: tumefacción, molestias y dolor en el glúteo. Además, produce un reflejo por el seguimiento del nervio ciático que baja por mitad del glúteo y suele llegar hasta la zona posterior del muslo. 

¿Cómo se diagnostica?

El diagnóstico del síndrome piramidal es por exploración, por dolor a la palpación. Esto implica una limitación de la rotación interna y puede ir acompañado de mayor dolor en maniobras de rotación interna, flexión y aproximación de cadera.

Aunque se trate de una dolencia que pueda detectar un fisioterapeuta con práctica, es función del médico realizar el diagnóstico. En algunas ocasiones implica la realización de pruebas radiológicas para descartar otras patologías. El síndrome se puede detectar con radiografías y, sobre todo, al realizar un análisis biomecánico con un podólogo. 

En ese caso, la solución pasa por una readaptación de la musculatura, de cintura pélvica, de los estabilizadores de cadera, rodilla y tobillo. Hay que aplicar un protocolo de ejercicios adaptados para cada persona y sus características. Por lo que una vez más les recomiendo asistir a un especialista del área. La salud es muy importante y cada profesional está capacitado para darles la ayuda que necesitan. 

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