I’m devastated, 3 years of working towards the goal of completing an IM and doing it well (for me anyway), and I get two weeks out right as I start my taper and start developing sharp pain in my right glute. It gets worse, I visit a respected PT (yesterday) and a sports medicine doctor (today), both diagnose me with piriformis syndrome. The pain is not good, I can’t even walk without a limp.
What do I do from here? I’ve gone and got myself some Voltaren NSAID’s, and some Diazepam (Valium) by order of the doctor. He’s not sure it will be better by IM NZ.
Has anyone had something similar this close to a race, and figured out some sort of ‘hack’ to get them through the race? I’m not withdrawing, flights accomodation etc all booked and paid for me and the family, and if I start I am finishing regardless. I’m considering Nurofen during the race, but I know there are major concerns with using that during endurance races. Other than that I’ve got no idea what else I can do to help. I’ve just about thrown any thoughts of finishing with a respectable time out the window.
Piriformis syndrome is exquisitely rare, especially if onset was acute. Was your spine truly examined? Walking with a limp is not traditionally associated with piriformis syndrome, but more likely a lateral derangement of the lumbar spine. You could start simply by lying on your stomach, however, if this makes it worse you need to find a different PT- mckenzie credentialed to treat your back. This is very treatable in a short period of time if you do your homework. Get a second opinion and assume this is referred spine pain until proven otherwise.
What do the PT and the sports med doc suggest besides meds? I am sure someone will chime in who has more experience than I but I think if you have done all the right things even if you did very little in terms of exercise you should be able to complete if only you can get to a relatively pain free place. Three years ago I had one of my best races after not being able to run at all three weeks before the race. I couldn’t run until one week before the race and then ran 3 miles twice. I had bilateral peroneus brevis tendonitis (pain on the sides of my feet) I think from running on slushy snow for weeks. I could swim but not push off the wall and biking was less painful. I hope it works out for you.
I trust the diagnosis of the PT by itself, he is very experienced and has been a PT to Aus olympic team athletes for a number of years. The sports med doctor is also very experienced, he is someone from my work who is an expert in this area.
The limp is brought on right at the end of the hip extension movement, there is very little pain when I am in hip flexion, unless i apply force to rotate my leg outward. The PT explained that at the end of the hip extension movement, the piriformis muscle was likely impinging on the sciatic nerve causing that pain.
ETA: the onset was not really acute, it built over the period of a week or so. Started as a little niggle that I thought was just residual tightness after my last long run. But then got worse and worse.
I visit a respected PT (yesterday) and a sports medicine doctor (today), both diagnose me with piriformis syndrome.
What tests did they give you to rule out other such things like the spine causing this? I would think with that sort of pain, in order to have a chance at a proper diagnosis you would need and MRI on your spine.
When I stress out, like before IMLP, I develop very similar symptoms to piriformis. Almost could not get my wetsuit on, but once started things loosened up.
Heat therapy, stretching the area out on an exercise ball and lower back support while traveling helped immensely. sleeping on too soft a mattress can also be a trigger.
11 days out - what can you do? Work on relaxing the area, getting good blood flow to heal as much as possible, making sure you are aligned and comfortable while traveling. I would not advise drugs to mask the pain, unless needed to sleep.
Wish you the best - please let us know how it turns out.
Quick update, after no running or riding all week and using voltaren anti inflammatory tablets and small dose valium as per prescription, went for a run today and made it 300 meters before I had to stop from the pain.
I’ve got an appointment booked tomorrow morning with a sports medicine gp with a view to getting some scans done, and maybe a cortisone shot or something in my ass if it helps. Fly out to NZ on Tuesday morning, she not made ch more time left to try and get some improvement.
Looks like I’d better pack some comfy walking shoes in my luggage!
Has your therapist recommended using a foam roller on your piriformis? My piriformis gets tight and the foam roller seems to help. Considering the urgency of your time line, visiting a massage therapist may be beneficial. Good luck!
Dry needling worked for me. About 2 months before my first ironman it hurt to walk and running was out of the question. After suffering for 2.5 weeks I went for a session of dry needling. That was on a Wednesday and when I tried running that Friday I was pain free.
If I were you I wouldn’t do anything that makes it hurt at all between now and your race and be honest with yourself about that. I wouldn’t use the voltaren or diazepam, and just do some foam rolling IF it doesnt make it worse. If you have a long flight try to stand up every once in a while. When you get to your race accept you may have to walk/run the run and start conservatively (assuming biking doesn’t hurt). Definitely don’t use anti-inflammatory meds during the race, your kidneys and GI tract will thank you.
I got a coritsone shot into the piriformis after being diagnosed with this. Turns out multiple PT and orthopedics were wrong. Shot did nothing except hurt (needle 5inches through your ass) and cost $1000. Ended up being one of the small hip external rotators, not the big one…
Not sure how similar our experiences are, but if i forced a marathon at the time I would probably not be able to run again and not have been able to finish. Trying to run through it with only 5mi runs quickly progressed to shooting pain down the leg and inability to walk normally. Be careful, finishing a race isnt worth risking the ability to train/get around for years imo.
I know you’re grasping at straws right now so here’s another one: when mine flared up (& after a MRI ruled out lambrum, spine and other possibilities), I had a Doc use a CT scan to guide saline injections to push the piriformis away from the sciatic nerve. It offered mild relieve. Cortisone didn’t help me at all.
I had my first piriformis flare up(had a few others over the following couple of years) that started about 10 days before a marathon and got to the point where i could barely walk at about 7 days out from the race. Had a PT do active release therapy 6,4 and 3 days out. The active release really really hurt, to the point where I was sweating and swearing out loud, but it really helped. I also rolled on a baseball(roller not targeted enough, tennis ball too soft), which also really hurt, to keep the legs loose. Plus i recall doing some hot baths and stretching. By the end of the week i was feeling decent until an 8hr car ride to the race site 2 days out tightened things up. The day before the race i did a 30min easy run with strides and i had some pain on the strides and felt like the leg wasn’t fully extending back, so I was concerned. However, the race went well and while I did feel some pain I it didn’t really affect me much. Anyway, to sum up, my advice is to roll the shit out of your piriformis, glutes and hamstrings, then do some light stretching.
Congrats to the OP on three years of working towards a goal, and a big one at that. It sounds like you have decided you are going to race despite your pain. You are gonna have the race of your life!
It is easy for pain to be magnified the weeks leading up to a race when training is tapered and thoughts are running wild. Race day comes around though and you get in your zone and the pain is put into perspective. Follow the advice of your medical professionals, but keep a calm head. If you have decided you are doing this race, the best thing you can do is relax and not let the pain worry you. As the poster above put it:
…the race went well and while I did feel some pain I it didn’t really affect me much.
I hope that it is not too late for this. I am really sorry-I have had piriformis syndrome and it’s really terrible-I have had it for six months and am finally mostly better. The good news is you will be fine on your swim and bike-piriformis syndrome shouldn’t affect this. However, running is another story.
Rest nor drugs will help this condition. Here are some steps to take based upon what my AT had me do:
Manual Therapy (hopefully this is enough to get you through the race):
If your sports gp or physio hasn’t checked already, have them look at your SI joint. Usually, a tight piriformis can lock your SI joint, or a locked SI joint can cause piriformis syndrome. If your SI joint is locked, you will need your pt/chiro or AT to mobilize it and this will loosen up your piriformis and make you feel better. This is relatively simple step.
You will also need ART on your hips/psoas to loosen that up as well.
I agree with the other poster-get acupuncture on the piriformis/glutes to get rid of the trigger points and get your glute muscles firing again
Stretching/Mobility:
**1. **A lot of deep/paleo squatting pushing out your hips and strengthening your glutes at the bottom of your squat. If you can’t squat below 90 degrees hold onto a table or use a theraband tied to something.
back bends (camel, cobra, wheel, bridge pose etc) and mobilizing your T-spine with your foam roller (this will take pressure off your pelvis)
for the piriformis itself-pidgeon, lizard, 90-90 stretches, figure four etc. along with foam rolling.
Glute Firing:
This is really important for running-do a lot of bird dog/fire hydrants/clams to get your glutes firing properly again. Also for your run warm up, do your As, Bs and Cs to get your glutes firing.
**Running form: **tuck your pelvis and make sure you aren’t crossing your legs over in front when you run, engage your core to keep your pelvis tight.
AVOID SITTING and Driving-try and get up as much as you can during your flight-you could do all of the above and sitting for too long on the flight will just bring it back. Try and set up a message for before your race after your flight to loosen everything again.
Scan results say it’s ischial bursitis, not pirifomis syndrome.
Doc has said to stay in the anti inflammatory meds and no running until the IM to try and let it settle down. He also said if it gets really sore during the run, pull out of the race. I’m not going to be doing that, even if I have to walk/hobble I’m finishing.
I asked him about a cortisone shot, he said he’s not a big believer, and that they may work a little bit but not really worth it. Does anyone have some experience getting a cortisone shot for bursitis? What were your results?
I do them, but never had them. On the good side, they usually relieve acute pain flares like you describe. On the bad side an ischial bursa shot just before an IM is a risk for hamstring tendon rupture. If you go that route make sure he’s using image guidance, either fluoro (Xray) or ultrasound
You’ve already been misdiagnosed yet again and forced to get some level of scan that doesn’t show what a good physical exam would. Stop chasing injections and modalities. Ready to believe that this is coming from your spine yet?
I’m interested to know how you’re so sure it’s spine related? When a scan shows an inflamed bursa that to me is fairly assuring that the diagnosis is correct.
The physical exam diagnosis was piriformis syndrome from two different professionals. I think they were incorrect, probably due to me not being able to translate where the pain was coming from accurately enough. The ultrasound showed an inflamed bursa, no inflammation of the piriformis.
I get the whole ‘the knee bone is connected to the thigh bone’ train of thought, but diagnosis of iscihial bursitis by ultrasound is very accurate
I’ve spent my career diagnosing and treating spine pain doing mechanical exams. Research is very clear that diagnostic testing is at best 50% accurate. In fact there are anatomical anomalies that can be perceived as atypical but are completely normal for you. The spine causes most of the pain in the lower back, buttock, lateral hips and into the lower extremities in athletes and the typical population. Any orthopedist or physical therapist would go in believing your issue is spine related until proven otherwise. This is what the research tells us.