I'm not shocked by your obvious poor grasp of anatomical and physiological principles. Nor am I shocked that you possess nor demonstrate no knowledge of medical or physical medicine research. I find it most troubling that you propagate your lack of knowledge through insults and then purport to know the answers.

Facts: true pirifirormis syndrome is exquisitely rare. However, If the sciatic nerve were traversing through the piriformis, pinching it would create distal numbness not pain. This is the feeling you get when sitting on the toilet too long. The ischial bursa is a contained fluid filled sac that has no ability to pinch the sciatic nerve. The spine is well known to create referred pain- pain that is present not local to the site of the problem. For diagnostic principles, it is expected that the spine is ruled out before ruling in either the hip or SI joint. MRIs and other visual diagnostics reveal very little information about pathoanatomics of the spine or nearby joints as arthritis is normal. This is also true for wearing of the intervertebral discs. Bottom line- assess the spine first. Now, as for your other uneducated assertion that I'm a chiropractor, that is also untrue. I'm a PT who knows more than a Neanderthal with a google search.

I think the use of a cortisone shot less than two weeks out from competition would be (or at least runs a big risk of being) an impermissible PED. As I understand, it is allowed out of competition only and must clear the system before competition. Somebody who knows more particulars here -- please chime in. With a shot in my knee, I still was still feeling weird effects (e.g., cramping) weeks later. Anyway, please do research on it if you decide you want to pursue a shot.

Is there a reason you don't think it could be ischial bursitis? I mean he is tender where the bursa is and an ultrasound seems to show it. He also doesn't talk about pain that sounds to be radiating but has said pain in the buttock. Pain in the buttock could be localized or radiating. If he didn't have localizing tenderness I would agree could be his spine. As for the piriformis in 20 years I have not seen a case. Maybe because I am not looking for it but I think it is rare. Nor I have ever ordered an ultrasound looking for ischial bursitis I have always found it clinically. Ironically a few days after this post one of my pt's (a 92 year old man) was admitted because he fell (on his butt) and won't sit or stand. No localizing weakness or radiating pain. Xrays ruled out fracture of hip, pelvis and spine. I examine the guy and pronounced tenderness over the ischial bursa. I get help with my job from all sorts of places.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Interesting that you found the assumption of chiropractics was an insult.

Also interesting that you went strongly on the defensive as a PT when I recommended he visit a PT

I suggested you may be a chiropractor which you took as an insult that was representative of my intellect, then you called me a Neanderthal. I think this conversation is done.

How did you make out?

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

It was a really tough day, wind was brutal. Very choppy swim, and very tough on the bike with a big headwind all the way back into town.

I ended up getting a cortisone shot on Tuesday last week. My glute hurt at about halfway through the bike, but was ok on the run. Finished with an 11.03, and most importantly felt strong on the run most of the way (except for a bad patch through about 22km-28km. Ended up bringing the last 10k of the run home pretty strong passing quite a few who were struggling.

All things considered given I didn't ride/run really for two weeks leading in to the race I'm pretty happy with my first IM.

Congrats on getting the job done. Would be interesting to get some feedback down the road once the cortisone shot has run its course.

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late answer - but piriformis spasm responds well to specific stretches, PNF stretches guided by physio, triggerpoint therapy, massage, trigger point ball massage, grid roller.....

Awesome. I am always amazed by how well one can do if in the last few weeks you cannot do much. The lesson for me is if in the last 4-6 weeks before a race something hurts play it safe don't push it.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

And yet I see people the day before races warming up like it is the race, sigh... but yes, less can be more before the race. One piece I actually want to write up down the road is a comparison of two pros training 10 days out from Kona

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Congratulations, nicely done. 11 hours is a stout time any day, but even more so on a day with tough conditions and an injury.

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Any run that doesn't include pooping in someone's front yard is a win.

I'd read that. However, the caveat must be made that everyone is individual and what works (or doesn't work) for a pro might not work for everyone.

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Any run that doesn't include pooping in someone's front yard is a win.

I already have my reasearch done, one of many pieces I am dragging my feet on. The cliff's note version is that they probably do less than most people assume. I think that is important to show to athletes to let them relax instead of trying to kill it 10 days out. It may not be a problem for STers but for other it can be.

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Agree. I think many (myself included) would be shocked at the (small) amount the top performers do leading into a race.

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Any run that doesn't include pooping in someone's front yard is a win.

I'm not what I'd call a top performer, but my experience is that even with the no running/riding for two weeks before the IM, I'd expect that it cost me about 5-10 min on the run. I still ride my target power in the bike that I was planning on prior the the injury. So in future, all I'll be doing in the last couple of weeks is the minimum required to maintain my level. Any niggles whatsoever and I'll be resting.