I may or may not have or have had piriformis syndrome. thats the problem, i don't know for sure. But its a pain near my right glute muscle. At its worse, it went all the way down to the top of my knee, but mostly it just stayed in the glute area. It started early last year and i also had physiotherapy, chiro (only twice, it freaked me out) and massage therapy. What ended up helping was time. i never really completely stopped exercising, but i did let up a bit and found that over time i got better. I also was doing yoga once a week, so that may have helped.

I think the physiotherapy exercises also probably did some good. I was told that the crux of the problem was that both my glutes werent "firing". When i was running during this period, i really tried to focus mentally on using both glute muscles (this is mainly mental, not physical). I still have the issue, but its not that bad, and i'm able to just train through it.

I see this in athletes I coach occasionally - if they don't do their stretching and core stability exercises (I have had a similar issue before too)

Typically brought about by a lot of cycling in the aero position with the hip flexors tightening over time due to the restricted range of motion. Exacerbated to some degree by jobs that involve extended periods sitting down.
The tightening of the hip flexors will, as indicated in the previous post, inhibit the function of the major gluteal muscles (glute max and med), and the piriformis muscle, a complementary thigh extensor/external rotator, will become overloaded as a result, tighten up and impinge on the sciatic nerve. ITB problems can result from this scenario also.
I think there was some debate about whether this was a legitimate "syndrome", but I think it is "ridgy didge", so to speak.

The fix:

1st and foremost - Improve the flexibility of the hip flexors (iliopsoas group, as well as rectus femoris, which is the middle quadricep muscle)
Kneeling hip flexor stretch best for the iliopsoas group, but you must make sure to stabilise the pelvis when performing the stretch. To do this, contract the glute muscle of the side you are stretching, as well as the lower abdominals, when performing the stretch. You may find it difficult to switch on the glute when performing the stretch, which is a good sign that it isn't functioning as well as should be.
A google search will uncover some pictures of the stretches.

2nd - Glute activation exercises

3rd - Glute strengthening exercises - through the appropriate range of motion.
I can flick two important ones through to you if you contact me - go via my website - www.courtneyogden.com

4th - Once up and running again, maintain hip flexibility and glute function, which doesn't require a great deal of time investment.

Generally, if you keep your hip and abdominal musculature strong, balanced and flexible, it is unlikely there will be any problems further down the kinetic chain.

Highly unlikely you will need surgery.

Courtney Ogden

I self diagnosed myself with it. Pain in the sacrum area, super tight left hip, numb left toes. Look up some of the trigger point therapy stuff online. It's been helping me tremendously..painful initially though when you start hitting those tight muscles.

this is a good website/video

http://www.athletestreatingathletes.com/...-pt-3-posterior-hip/

Yes sir, I had this same problem. Didn't realize it till much later but it started while I was trying to increase my cycling while running every day. At first only my glut was tight, then it started after track sessions and races to feel like my entire leg all the way down to my foot was going numb. Then in the mornings it felt like my glut muscle was so weak that I couldn't straighten my right leg when I stretched. Finally went to a sports doctor. They had me go twice a week for a chiropractor adjustment, because my hip was out of line and to have some ART treatment on my glut and hip. The things that I felt that help me the most was, slowing down the intensity of both my running and cycling. Start stretching your quads and hip flexor at least 3 times a day. I have had pulled hamstrings a lot when I played soccer so I always stretched them but never my quads or hip. Get on the foam roller daily, and start icing you glut and hip. She gave me several exercises to do but the ones that I think helped me the best were the exercises with the bands and light squats with high rep. When you go swimming, you will have to stretch your hip flexor after your warmup and periodically through-out your workout. This didn't happen over night, so it will take months before you feel fully recovered. I was half way through my half IM training when I finally went to the doctor. I was able to continue my training and do good in the race, but I would have healed much faster had I taken it easier and focused more on stretching, icing and the hip, quad, and thigh exercises. PM me if you want some specific exercises, or if your have any questions.

I had it; it felt like a hot ice pick in my right buttock. The pain was scary bad. My chiro helped me with new stretches and adjustments. I now regularly sit with my right ankle on my left knee. I may not have had a case as bad as yours; mine was better in a month. I hope you get this behind you asap. Speaking only for myself, I would find a good chiro before I tried surgery.
Good Luck !

I experienced this a few years ago. Very difficult to get rid of. I would normally never suggest you go see a chiropractor, but if you can find one that does active release it may be worth it. Not sure that ART is what solved my problem, but there was a correlation between having it done (a few times) and the injury finally going away. Good luck.

Check out this blog: http://www.mobilitywod.com/ You may have to search around a bit but this guy is dead on with mobility work and big on hip movements. As for the chiro comment, not all of us are crazy (chiro student), especially or usually the ones that go the active release route...go to activerelease.com and search for providers in your area.

MD

It is worth finding an ART practitioner near you and trying some therapy first. It may help get you through the season. It has helped me for sure. My ART guy is a Chiro so he also adjusted my hips a bit. Sure I still have a little bit of pain here and there in my one leg, but it comes and goes and doesn't seem to affect my running at all.

Once we did a few sessions and he loosened me up a bit, then he began having me do stretches and exercises. As he said no sense doing them if the muscle group is all tied up with scar tissue etc... Also I do my stretching and strength exercises after I have done my running, cycling etc.... This helps to tire out the major muscles which means the smaller stabilizer muscles get a chance to take part. Seems to help me.

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Ian

Not to throw a wrench into things, but are you completely sure that the problem is not an impinged sciatic nerve root due to a bulging disc in your lower back?

The symptoms are incredibly similar between these two conditions, but the treatment is different. Have you had an MRI done with contrast to show the nerve being impinged by your piriformis and NOT from the nerve root up high at the spine?

I went through the same thing you're describing, and I flip-flopped back & forth between diagnoses until the MRI was done showing the nerve was fine through the piriformis and that there was a bulge b/w L5 and S1 that was squishing it. I had to do some different stretching and strengthening to get the bulge to recede than what you'd do for piriformis syndrome.

I mention this because you indicated that stretching the piriformis and hamstring makes your symptoms worse.

Can you expand on what you did specifically for the bulge?

I literally think I'm going through the same thing right now. Its weird in that it really only affects me while I'm seated at my desk. I have no issues while running, cycling or swimming. I mean, I can tell that something is marginally off but theres no pain associated with what I'm feeling. Theres no pain ever actually. Even at its worst, while seated at my desk, it just feels like a mild numbing down my right leg and a bit of tightness in my lower back. I'm in the process of working with my chiro (who also uses ART and graston) so I think we have it under control but just looking for any feedback.

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"One Line Robert"

I can tell you what my issue was and what I did to resolve it. This will of course be fairly specific to my issue, and this doesn't necessarily mean that everyone with the same symptoms should do the same. I'm no MD. ;-)

I had a fairly significant bulge that went back and to the left. I had this in the disc between L5 and S1, which is the most common place for people to get bulging or herniated discs. I spent many years doing significant amounts of forward bend stretching for martial arts, and again as a runner later in life. I also did a pile of ab work. And while this is all fine, the problem is that I never did much lower back strengthening or back bending to ensure balanced strength and flexibility of my core. Over time, the lack of flexibility and overcompensated abs pulled on my lower spine (reducing the curve you're supposed to have back there) and created a small bulge sticking backward. It was very mild at first, I only ever noticed any discomfort when stretching toward my left foot, and the pain was up high in my glutes. 2 years ago, I fell backward off a bar (legs hooked over, doing inverted situps) and fell flat on my back. I herniated that weak spot in the disc and the screwed me up for over 6 months. I finally was able to get an MRI (thank you insurance company for the pointless delays) and get steroid injections to shrink the bulge enough that the nerve would calm down, release the muscles, and allow things to start healing. A few months after that, I started the stretching and strengthening. I had gotten to the point where I met with a surgeon and he insisted I needed the surgery, but I knew I didn't want to do that unless I just had no choice.

As far as what I did, I had to things to accomplish:
1) Increase the space between L5 and S1 for that disc
2) balance the strength and flexibility of my core

For #1, I did some very careful stretches that would increase the space. I would lie on my back, spine flat as possible without contracting abs, and pull my knees to my chest being sure to use my arms and not my abs. I would follow that with doing some very gentle cobra stretches backward to be sure I was opening the space evenly, and then follow with cat & camel stretches. I would also spend some time hanging from a high overhead bar by my arms. It's just good exercise for one, but it also would literally pull my lower body down and stretch out my whole spine. After a few months of this, I picked up yoga to really get my core flexibility and mobility back. It's also just a nice method of exercise to have in your routine.

For #2, I started to incorporate core work into my workouts, and NOT just ab work like I had before. I made sure to do exercises that would strengthen my glutes, lower back, obliques and hips (inside and out). I miss the 6-pack, but I like the feeling of better balance in my core. And of course, being able to bend forward with zero pain is a nice bonus. :-)

Here's the weird thing about a nerve issue stemming from your back: the further the pain or numbness is from your back, the worse the issue is. Weird b/c it feels less painful to have your foot hurt than it does to have your glutes or back hurt, but lower back pain is a sign that then nerve impingement is more mild than when the pain is further away.

Again, I'm not an MD. I'm not recommending that someone just do what I did. But this is what worked for me.

Thanks for posting the website. I literally have issues with all three points mentioned in the article.

I did some dead-lifts, walking lunges and ran a mile last Friday. Saturday and Sunday was spent on the bike since the weather was so nice here in NYC, 36 miles and 25 miles respectively. After spending another hour driving home after biking, I couldn't even stand up straight, nor lift my bike off the bike rack. It was a sad state. Had to lie on the floor for a bit while icing my lower back. After an hour and a motrin, I was able to move around but with pain. I had to rest both Monday and Tuesday but I'm thinking I should go for a swim today.

Definitely going to spend some time stretching today. My question is this, while I was on the bike, I did spend a lot of time in the aero position, what should I be doing instead? I don't know if it's the combination of x-training and biking back to back days or that I should just simply not be doing dead-lifts anymore. This is the second time where I had so much pain in the lower back that I spent a couple of hours lying in bed.

To the OP, sorry if I'm hijacking the thread.

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2009 Cannondale CAAD9
2011-First year at Tri; 2012-HIM; 2013-IM

I am not sure, but that is a damn good idea. I have been wondering why I get no relief from stretching my piriformis or my other hip flexors. It just seems to make the problem worse. Another thing is that I always had some cramping in my glute on my right side, but the real sciatic nerve flareup happened after I single handily moved my girlfriends whole apartment and my back was so screwed up afterwards that I was bed ridden for 4 days. Because of my previous glute problems I just assumed that I had exacerbated that issue. I will request an MRI today.

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"Wait.....and Hope" -Edmond Dantes

I battled pirformis for years and stretching seemed to make it worse. 5 years ago I stopped all forms of stretching, and my pirformis flareups have been vastly reduced in frequency and severity. They are now manageable with ibuprofen and only last a couple of days.

One exception, I had a nasty flare up last summer a few days before a HIM, no idea what triggered it. After a week of suffering I tried ART, and that seemed to immediately help. It took 4 sessions over 10 days, but I was in good enough condition after that to climb Whiteface in Lake Placid.

I hope you get some relief soon. Good luck!

I tell you my story and I hope it is not the same
After 35 years without any issue with my back, at some point, at the end of an HIM race, my whole leg got almost paralyzed and the gluteus muscle was really painful. A local physio made me a massage and it slowly improved over the next few days but the pain was coming back and forth. So I went to a doctor who diagnosed piriformis syndrome and gave me 2 months physiotherapy. The physio tried hard to get rid of it but we could not do anything. Running, swimming especially were extremely painful and my left leg was getting numb often.
After 6 months like this, going around like a zombie I went to a specialist who made an MRI right away and he could diagnose clearly a severe spondylolisthesis L3-L4 by 1.5cm dislocation and the disc in between was totally gone!
This can not be fixed easily and I live with it. After 4 years now with this problem I managed to go around it and do my triathlon anyway.

This is just to say that as soon as I hear somebody with nerve pain in the legs, back pain, etc. they always ignore the possibility that something is damaged in the spine (disc or spondy). Piriformis syndrome is rarer according to my doctor compared to disc damage. Anyway, with physio usually this syndrome can be healed after 2-3 months. If you see no improvements, go for an MRI and it will tell you everything.

Good luck!

Herniated disc l5/s1 flares mine up, it's lovely.

See a GOOD chiro, get a massage.

If it is p.s., I'd consult a platelet doc.

amen my wife was treated for 2 years for piriformis syndrome with out any results, turns out it was a bulging disk

It seems like a lifetime ago that I wrote this post. I had been diagnosed by TWO doctors in San Diego that both work with the US Olympic Training Center Athletes!!!!! They are widely known to be the best in the business. Not only did they disregard the fact that I had just injured my back moving boxes, but they refused to send me in for an MRI. Three months of ice, stretching, and waiting in terrible pain every time I took a shit or sneezed!!!! Finally, thanks to all of your posts, I demanded an MRI, and what do you know...a severely damaged L5-S1. Surgery by Dr. Todd Allen at UCSD Thornton(the best in the business) and I was back in business in 3-4 months. Dr. Allen said if I had not spent almost 2 years trying to rehab it, massage it, acupuncture it, ice it, chiropractor it(by far the biggest waste of time and money considering that there is ZERO data showing that Chiro can do ANYTHING for ANYONE) I would have walked right out off the table. As it was the sciatic persisted for 3 months. Some kind sole finally recommended Foundation Training to me, and within a month I was back on my bike. Long slow process, and surgery is nothing you want to jump into, but its amazing the infrastructure that has popped up around this type of very common ailment, and how much of your time and money they are designed to bilk you for before you finally just go under the knife and get the problem solved. About 95% pain free today.

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"Wait.....and Hope" -Edmond Dantes

Plissken74,

Glad to hear you have found a solution to your problem. Anyone with back or lower leg pain severely made worse by sneezing or passing a BM likely has a disc injury. Thats textbook.

Standard of care for a suspected disc injury in any conservative intervention whether it's PT, Chiro, etc is 4-10 weeks depending on presentation. If no improvement then order the MRI and refer for surgical consult barring any caudal equina symptoms or progressive neurological deficits.

Please keep in mind you are a sample of N=1. No one tool works for everybody, but your statement of my profession being absolutely worthless is ignorant at best and completely contradicts the research.

Top studies of 2014

Top studies of 2013

Congratulations again on your recovery!

Zev

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"No matter how hard you train, Somebody will train harder. No matter how hard you run, Somebody will run harder. No matter how hard you want it, Somebody will want it more, I am Somebody"~ST Post