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Piriformis Thread...Again
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Hello All

First time poster. I've been struggling with sciatic like pains from my right hip down to my right foot since October. The leg feels very 'heavy' and sitting/driving are no fun at all and can quickly increase my foot pain (burn/tingle). I've had a spinal MRI that was clean and looked great. I injured it playing hockey, feeling a very sharp stabbing pain in my right glute when I attempted to push off with the skate. I'm currently able to bike upto 30min at a moderate pace and swim 20min at a moderate pace with only minor increases in symptoms. No running currently. My sciatic type symptoms are pretty well constant during the day with the intensity fluctuating from low to moderate. Lying on my stomach or my side with a pillow is the most comfortable position. I have tried a number of modalities to get this under control and get back to my tri's. Here is what I've tried thus far:

Stretching (2xdaily)
Tennis ball (daily)
Foam roller (daily)
Strength training (clam, leg lift, single leg balance) - doing single leg balance daily now (I am working with my 3rd PT currently)
Rest
Acupuncture (2x weekly - 6 weeks)
Dry Needling (2x weekly - 6 weeks)
Chiro (only a couple of times)
Ice
Heat
ART
Massage
Neural Flossing (2xdaily)
Aleve/Advil

After 6 months I feel very little improvement thus far. I've started to investigate injections and surgical release options but I'm really not wanted either of these. Does this every get better? I'd be happy just to get rid of the daily sciatic pain throughout my leg but I really want to get a couple of races in this year. Any insight would be appreciated.

Thanks
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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1. What do you do for a job?

2.What work are you doing on your hip flexors?

If you have a sitting job/drive every day for more than 20 minutes your hip flexors are in bad shape.

If you hip flexors become matted down, you will get problems with the glute complex including the glute maximus and the lateral stabiliser the medius.

The reason your piriformis has become inflamed is because you have overloaded it, likely due to inactivation of the glute medius.
You need to

1) sort the hip flexors out through self massage/myofasical release, none of this ridiculous stretching.

2) switch the glute medius back on. Don't bother with clam shells etc. you need to do 1-legged squats with a horizontal pelvis and knee tracking straight.
Once you can get low enough that your quad is parallel with the ground you need to add weight, on your back as a barbell and start the process again.
Very slow, keep the knee tracking straight.

Stop stretching the piriformis, it only makes it madder.

However, you CAN do the 4-sign exercise - youtube it.

Also, stop all sitting if you can, all driving that you don't need to do. You HAVE to switch that glute medius back on or you will go round in circles.

Contact me on here if you want any more info.
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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Sorry man, tough crap I feel ya. 2 discectomies here, but mine were due to disc blowouts. However, during the trauma it didn't stop my posterior chain from going into total lock down. My sacrotuberous ligaments locked down and felt like bone, same for piriformis. Our society in general lives a life destined for hip dysfunction via all manner of weakness and tightness. We were not meant to be at a desk or in a car/airplane all day:( Keep fighting it!
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Re: Piriformis Thread...Again [TriByran] [ In reply to ]
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Hey TriBryan

Thanks for suggestions. To answer your questions:

1. I'm in IT (I do have a sit/stand desk though and try to stand majority of the day). I even try and get up during meetings when I can
2. Hip Flexors - I've been getting dry needling and acupuncture in my TFL (which were crazy tight and sensitive). I've also tried some kneeling lunge style hip flexor stretching as well as tennis ball self massage on the TFL. This has reduced my TFL pain but I haven't noticed much sciatic symptom relief yet.

As for my glute medius engagement that is what my current PT has been trying to do (he noticed this was a weak area for me and that TFL was taking over).
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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Are you riding indoors or outdoors?
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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If you've got sciatic pain without spinal issues then you're piriformis is likely inflamed (enough to press on your sciatic nerve) and as tight as piano wire. Sure, keep stretching, but the foam roller and tennis ball are useless because they don't get deep enough. You only need one thing (and a lot of pain tolerance and dedication): a lacrosse ball. Get it in there hard. The more it hurts, the more you need it. No joke. I've suffered as you have and tried most of the things you did. Some helped. None really cured the problem. Sure, you can pay someone to beat you up, but no one can find your trigger points as good as you. The only limit here is how much time you have. Seriously, it's virtually impossible to over-massage the area, but you should be hitting it hard (20 minutes or more - it's a big area) twice a day every day. It will get worse before it gets better but it will get better. It will take 3 maybe 4 days (and you will doubt what you're doing) before you get relief. Stick on the trigger points and slowly work around and outward. If you feel the muscle start to involuntarily twitch you're on the right track. Keep it up even after you're better - it's a problem that can easily resurface. As with everything hit both sides - you'll be surprised to realize the non-symptomatic side is also tight. Preventative maintenance frequency depends on a lot of things, but shoot for a least once a week. I've found right after workouts to be the best time to hit the area - it hurts more, but when it hurts more is exactly when you need it ..at least that's been my experience. Best of luck to you.
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Re: Piriformis Thread...Again [Sausagetail] [ In reply to ]
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Outdoors...roads
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Re: Piriformis Thread...Again [TriBiker] [ In reply to ]
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I'll see if I can get my hands on a lacrosse ball and try that. Thanks TriBiker
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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take out the ice and advil part. That only delays healing. I was injured bad 2 months ago and now almost 100%

a board member on here made this good video that helped. https://www.youtube.com/watch?v=tFtUgS69rPk

For me it was more atrophy of the muscle... so you need to work it out and perhaps eat more. Every day I put a doubled bike tire tube between my feet and walk sideways, or that thigh clam exercise machine at the gym. What is different from me and you is I could still skate - perhaps you have more damage than piriformis?
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Re: Piriformis Thread...Again [synthetic] [ In reply to ]
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Thanks synthetic

I'm meeting with my GP this week to request a hip MRI. See if anything comes up there. I've stopped taking advil/aleve as it was not doing anything for me. I can feel my legs getting stronger with the physio but the sciatic symptoms just don't want to go away. Even as I stand here typing I can feel discomfort in my glute, heel and toes (right leg). The funny thing is when I wake up in the morning I have almost no sciatic symptoms at all. Once I start moving around and 'getting on with the day' they start to sting.

This is really frustrating injury that plays on your mind.....
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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Brief update.

I asked my GP for a Hip MRI and she instead referred me to a Physiatrist, which is appears to be a kind of sports rehab doctor. So I met him, nice man but and after explaining the history and him looking at my MRI and doing an assessment he basically said, so dude I don't what is wrong with you. I asked about piriformis syndrome and he said it doesn't exist. He told me to stop going to physiotherapy and that some people "just hurt". Needless to say this was not the outcome I had hoped for in meeting him. He also explained that no amount of imaging will do me any good. Although he did leave on a positive note saying this will get better...eventually and that is likely just myofascial pain. Is it all in my head??

The saga continues....
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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Weeks of PT and stretching did nothing for me. I bought some massage balls (actually the Rumble Roller spiked balls but they say lacrosse balls work too) and 90% of the pain was gone within 48 hours, 100% within a week.

I put the massage ball on the bathroom floor and did the traditional piriformis stretch while sitting on the ball. Just rolling around on it I found a very sore transverse band that could only be the piriformis. There are quite a few videos online illustrating this technique.

My symptoms were kind of the opposite of yours though. It was worse when waking up but I was fine as long as I was sitting down. Walking or standing killed me and I was close to buying a cane (carbon fiber or sword).
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Re: Piriformis Thread...Again [Sausagetail] [ In reply to ]
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I've been using a tennis ball and now a lacrosse ball for about 4 months now with minimal or no improvements.

Right now, here is my daily routine:

1. Single leg deadlift (2x muscle fatigue/failure)
2. Plank (2x 1min hold)
3. Foam roll (ITB, Hamstring, Glutes, Piriformis, Quads)
4. Lacrosse/Tennis Ball Roll (~5-10min Glute/Piriformis, Psoas)
5. Figure 4 Piriformis Stretch (2x45sec hold)
6. Kneeling Hip Flexor Stretch (2x45sec hold)
7. Neural flossing (20x)

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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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One option is having anesthetic and/or Botox injected into your piriformis. It's both a diagnostic procedure and a treatment. If it provides no relief then you likely don't have piriformis syndrome.
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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I used to have it SO BAD and this stretch routine fixed it. Also read the comments about how many people it helped and additional tips. I'm the guy in the video, btw.

https://www.youtube.com/watch?v=tFtUgS69rPk

----------------------------------------------------------
Zen and the Art of Triathlon. Strava Workout Log
Interviews with Chris McCormack, Helle Frederikson, Angela Naeth, and many more.
http://www.zentriathlon.com
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Re: Piriformis Thread...Again [Keener] [ In reply to ]
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Has your PT been doing ART, (active release technique). It's a technique that friends of mine have had success with.
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Re: Piriformis Thread...Again [Sausagetail] [ In reply to ]
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So I think I may have piriformis. No shooting pain down the leg, but the pain starts in lower back on the right side and shoots to the back of the right hip. Everything I do hurts, especially walking and especially up and down the stairs. It is a dull, aching and shooting pain. I went to a massage therapist who told me to not do anything for at least twelve days. I told her that I wanna go to yoga cuz I read that hip stretches are key. She said absolutely not. Is she right? Google says to stretch. She says not to move. I am going to go crazy if I can't even do yoga since I can't run, walk, cycle or swim properly (pull only).
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Re: Piriformis Thread...Again [IronLady] [ In reply to ]
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Piriformis is possible but I would rule out any spinal involvement first. Get an MRI to confirm all is good with your back.

As for stretching, many practitioners say stretch the piriformis (I.e. Figure 4 stretch) and that did relieve the sharp stabbing pains.

Look up neural flossing as this was also helpful for many folks.
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Re: Piriformis Thread...Again [IronLady] [ In reply to ]
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i went to sports doctor, who had me go to physical therapy, they did ASTYM, gave me stretches, and strengthening exercises, didnt help a bit, so went to chiropractor, finally started gettign bettter, i think it was the deep tissue massage he does, he also does some major back adjustment thing, have no idea what that is supposed to do, but basically i'm like you, everywhere on the internet says you should stretch, doctor and PT say to stretch, but that just does not work, makes it worse for me
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Re: Piriformis Thread...Again [synthetic] [ In reply to ]
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synthetic wrote:
For me it was more atrophy of the muscle... so you need to work it out and perhaps eat more. Every day I put a doubled bike tire tube between my feet and walk sideways, or that thigh clam exercise machine at the gym. What is different from me and you is I could still skate - perhaps you have more damage than piriformis?

i've had foot drop for 7 years now and after a lot of time wasted on tests and surgery have realised that this is my problem as well. The piriformis goes to sleep (or contracts rigid, not sure which). Clams (with or without tension band), affected-side leg lifts -- anything that buzzes the attachment to the femur -- gets it working and function improves dramatically.
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Re: Piriformis Thread...Again [kiki] [ In reply to ]
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This is something I have struggled with, too. TriBryan is on the right track trying to help you identify the reasons why your piriformis became so angry in the first place, but reading through this thread it doesn't sound like you have total clarity on that. It is fairly common for one side/set of your hip flexors to be stronger than the other. If that goes uncorrected for long periods of time, you can end up putting tremendous additional load on one side of your body and issues like what you have been experiencing crop up.

Since you have tried many of the most common protocols without success, you might consider doing a total reset of your hips, beginning with basic body weight and ankle weight leg strengthening exercises over a 6-week period following the protocol recommended by Jim and Phil Wharton in their book "The Whartons' Strength Book: Lower Body: Total Stability for Upper Legs, Hips, Trunk, Lower Legs, Ankles, and Feet." If you go that route, you would do weighted exercises 3-4 times a week and body weight exercises on the off days, just to keep things activating in the right way. You would also do active isolated flexibility work every day, and you would lay off the invasive/destructive body work for the time being. Lighter touch fascial work should be okay though.

Sorry to hear about your injury and good luck with your recovery!

Peter
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Re: Piriformis Thread...Again [peter_r] [ In reply to ]
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Thanks everyone for your feedback.
I am continuing to work with my PT but my leg symptoms continue to plague me. I roll on a tennis ball, do hip strength activities and have even tried some therapeutic yoga but nothing is giving me relief at this point.


I am scheduling a visit with my Family Doctor hopefully this week to get an 'MRA' of my hip. I want to make sure there is nothing structurally wrong with the hip (i.e. torn hip labrum) that could be causing these issues. As an FYI I am getting pain in the hip flexor/front of hip when raising leg and crossing leg over the other.


I'll look into the suggestions presented here i.e. additional strengthening and I do appreciate the help.
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