Hi all,
For all of you who have/had priformis issues, do you ever get this bad pain when you sneeze? I’m getting this weird pain that feels like my whole glute area is going to explode(yeah, I’m expecting jokes on that one;-). Seriously, I have sciatica and my ART guy is slowly trying to work on it. He says he thinks the problem is with the piriformis. It is the worst pain(when I sneeze or cough) I’ve ever felt. Like deep inside the muscle. Any thoughts? It just won’t go away. Thanks!!
While piriformis tightness can definately iritate the sciatic nerve causing sciatica, the fact that coughing and sneezing exacerbates your symptoms would also make me suspicious of a disc bulge in your lumbar spine.
Definately let your doctor know that this is happening.
Please note that I do not know your history and have not examined you, your doctor may have already ruled this out, but this case does sound more like a disc issue than a piriformis issue. Or you could potentially have both issues.
If it does happen to be piriformis (I admit the sneezing thing is quite bizarre for that diagnosis), try this: http://sacrowedgy.com/
It saved my butt ; ).
Cheers,
Diana
I agree with the other poster, that you need to tell yer doc about this. I had very bad piriformis problems for a long time which were due to a weak core and resulting imbalance in the pelvis (tilted & rotated). 4 months of PT and lots of core work, rebuilding my running gait, and lots of hip stretches even today help keep it away. But I never had a sharp pain like you describe. Anytime you get a “sharp pain” it’s rarely a muscle issue, IMHO, usually nerve.
Go tell yer doc.
AP
Mike is totally right. I blew my L5-S1 disk twice and had surgery (microdiscectomy) in late July. One of the major hallmarks is severe pain in the hips / spine / butt when sneezing or coughing. If I were you, I would find the best ortho spine specialist in your area and get an MRI stat. An MRI is the only way to see the disc. You may not think you have a back problem (I sure didn’t and kept trying to treat / stretch my hammies and piri. I had absolutely no clue the pain / tightness was because of a disc issue.)
Be very careful, here. If you are bulging and do not start to treat it, it may herniate / rupture, and trust me, you DO NOT want to go where I’ve been in the past year… I have not ridden my bike in 4 months now, run or swum in 3. i spent the entire summer laid up on my couch unable to move cooked in pain killers. i am about 2 weeks from getting cleared to start PT and some easy cardio).
I have to say that your post is pretty priceless 
.
Exacerbation with sneezing and coughing is an indication of a disc problem. MAKE SURE to tell your therapist that so he/she can do further testing. Gluteal pain from a disc herniation can mimmick piriformis syndrome and vice versa.
Mike’s (Donia) right. Sounds like a disc.
Good Luck.
Hi all,
Thanks for the replies. I actually have had back pain for 5 years now. I’ve had two MRIs and while there is some degeneration, it’s not bad. The pain in my leg started about two weeks after I got a facet block from my pain management doctor. It was like the pain came on overnight and hasn’t gone away. That doctor said where he injected couldn’t have caused the sciatic pain. I don’t know. I never had pain radiate into my leg before;it always stayed in my back. IT seems odd that it could come on like that when I didn’t do anything unusual as fas as exercise. I went to another pain doctor(in the same HMO which shall remain nameless) and he had a completely different opinion. He said my back pain stemmed from basically what amounted to tendonitis in my back(for 5 years no less;-). He tried another steroidal shot in my muscles that he thought would help with both the back pain and the sciatica. It did nothing. I’ve been doing ART for about three weeks now. It had helped a bit for my back but the leg pain is still raging. The ART guy did an XRAY and it came back ok. He didn’t think my back/sciatic pain was caused by a disc. He thinks it’s muscular. I don’t know what to think. I have tried everything I can think of and nothing has completely solved the issue. Aaargh. I almost broke and still in pain.
I’ve had two MRIs and while there is some degeneration, it’s not bad. The pain in my leg started about two weeks after I got a facet block from my pain management doctor.
It doesn’t sound like an MRI was done since the onset of leg pain, correct? The leg pain came on suddenly, but it was 2 weeks after the injection, so assigning the injection as the cause of the leg pain may be a red herring. There are other correlations that your Doc can make to rule in/out disc irritation, but the MRI would show for sure what is happening there, especially with prior films to compare it with.
In the meantime, avoiding these : flexing the trunk forward (while sitting, lifting), Valsalva maneuvers(straining while holding your breath), stretches of the hams/sciatic nerve, and sitting in soft, deep furniture would be a wise course to follow, if it is your disc.
And oh yeah, internet advice is often worth what you pay for it! 
Not to dis your ART guy, but an x-ray ain’t gonna show squat.
Also, you don’t have to do anything “different or special” to herniate your disc. I did mine while out for a garden variety ride in June. I know 2 guys who swear they herniated theirs rolling over to get outta bed. The disc can take months to get to the point of implosion, and then one little move in the wrong direction, and ca-boom.
Again, do yourself, and your checkbook a favor and GO SEE A SPINE ORTHOPEDIC SPECIALIST OR NEUROSURGEON. These dudes know exactly what to do and how to treat you. My doc, all he does are discs and back surgery. He’s has been 100% on the money with every treatment and diagnosis. BTW, I feel your pain. I know all about the $$$ you are spending, as since last August I’ve spent more than a new P3C getting my back fixed, and I have very good insurance. It blows.
The previous poster is dead right about not doing any forward bending.
I’m curious, but have you tried laying on your stomach to see if that relieves your pain?
Hi again,
I did go see a spine surgeon about a month ago. He was recommended by a friend. He looked at my (year-old) MRI film and said he didn’t see anything that was too bad. He said about all he could do was give me more injections.
Aside from an ART treatment last Monday in which I stretched beyond my limit(forward bending while seated and with doctor getting into the muscles in my back with his thumb), the forward movement has actually been ok. I had definitely shown some inprovement as far as pain and more flexibility. On Monday, he had me bend forward and to the left(with my face close to my knee) and I knew at that moment we had gone too far. We took a couple of days off and then started back with no work on my back except for the E-stim and ice which helped alot. Now, I’m almost back to normal and the tenderness has gone down.
At this point, I’m kind of thinking about just getting another MRI just to make sure. Maybe, like some of you have suggested, I did something to cause the disc some damage. HMO just seems like they will not give me another MRI(the last one was done in like May 2006) so I guess I’ll have to pay for it out of pocket. All they want to do is shoot me up with steroids even though it’s not helping me and gives me all kinds of nasty side effects.
Say it is a disc thing, what besides surgery, is there to do? I am really hesitant to do anything drastic because I’ve heard that it’s really a 50/50 thing as far as relieving pain. One HMO doc said that disc problems don’t really even cause that much pain. Is that crazy? He’s one of their top docs who trains other docs. I get such conflicting info from the HMO guys I feel like I’m watching a tennis match. Back forth, back forth…
Thanks again for everyone’s help on this. It’s been great to get so much advice. You guys are awesome!!
Agreeing with what’s been said so far… let’s do say it’s a disk thing, hypothetically. Is your pain continuous, or does it come and go with activities and changes in positions? If the latter, do whatever makes it go away, a lot more, and avoid like the plague the activities that bring it on. Typically people don’t think it could possibly be that easy- that it has to be more complicated than that- etc. If you can change your pain significantly with activity and positions, the real question is how quickly do you want to get well? No amount of good advice or management can compete with continuing to insult your injury. It’s entirely possible and even likely that a disc injury will self-reduce with time and protection. Studies show that on repeat MRI after documented and confirmed herniations, a large majority of folks herniations on MRI are gone after a year or so. So even if it is a disk, and who knows, it’s not likely to be a long term problem, although you never can predict that too well. Without a doubt, not all injuries work that way. Best prognostic tool for recovery with back and buttock or leg pain is the ability to bring the symptoms towards the spine, away from the periphery- i.e. do what makes the buttock better, even if the back is worse (likely won’t be much worse, and if you can do it, it typically doesn’t last long at all). Just to bring this into perspective though, the presence of herniations is only loosely associated with the incidence of back pain though, so supposing what tissue is the culprit of your symptoms is not always a good use of brain power. I would steer far clear of surgery unless you have exhausted conservative care, and there are a lot of options. Best of luck.
STO-
So, has your back been fixed? What did they do? And are you feeling better?
Thanks!
S
Scooby. I had surgery (microdiscectomy) on July 23. Seeing it was my second disc herniation in less than a year, the doctors gave me the option to do surgery or do another epiidural. I had 3 steroid epidurals (2 last summer, 1 in early June) in total. The epidurals worked wonderfully last year, but did not do squat this time. I spent hours and $$$ at PT in June, as the doc did not believe that I herniated a second time. The PT basically kicked me out and told me to tell the doc I needed another MRI in early July, and I got the 2nd MRI mid July and they immediately called and said it was time to consider surgery.
I chose surgery as they success rate for someone like me / my injury, a microdiscectomy is over 90%. My doctor also felt that I was a risk to herniate a 3rd time, and was concerned about cumulative nerve damage. Upon waking up in recovery, I knew immediately that it was the right move, because I had absolutely no pain in my leg, feet, calf, butt for the first time in 2 months. The doc had to cut a second hole in the annular membrane to remove a piece of the disc, and hence told me no exercise, twisting, lifting, ANYTHING but walking until 10/1 (10 weeks post surgery). Tomorrow is week 8, and I have been getting better EVERY day since the surgery. Today, I got in the pool for the first time since June just to test out how things felt and swam a 300 really easy (no flip turns or hard kicking). I can tell I that the disc is fine, and ready to resume.
Years ago, I think back surgery was a risky proposition. From what I understand, there have been major advancements and it is no longer that big of a deal. I have an amazing doctor who only does this kind of surgery, and every doc friend I have in town (several) tell me that my guy is the best at this kind of thing.
Good luck with whatever comes your way, but I would NOT be freaked out with by having surgery if they think it is the right way to proceed.
Scooby,
At the risk of inviting jokes on this question, too, does it hurt to sit on the john? I think I might have the same problem.
Hi Billy-
No, the bathroom isn’t a problem(thank GOD!!!). What else do you have going on? What kind of injury? What were you doing, etc?
I think I’m going to end up getting another MRI, just in case.
S
I’ve been following this thread…getting my first facet block tomorrow (hope this doesn’t cause pain like it did to ScoobyDoo). Doc says we are a long way before surgery…and did not seem to want to do another MRI (last one 23 Jul 2006).
I can bend forward…extension is my most prominent issue and really irritates nerve. No leg pain just sacro, spine, and flares around iliac crest. Every once and a while coughing may cause pain spikes. Sore & stiff in morning in low back. Although about 4 weeks ago no stiffness because I quit running and loading the back. It was incredible how good back felt. But I started back running very responsibly and pain/stiffness is back.
Doc seemed a little miffed I even brought up surgery (previously asked about prolotherapy). I looked on internet at some minimally invasive laser surgery in florida…seemed piece of cake.
Are you still glad you got it done and making progress (how is running especially)? Heck I am 60 and I keep telling doc we don’t have tons of time to figure this out.
I have good insurance…ballpark on your surgery?
thanks and best of luck!
Hey, although the other posters probably know what they’re talking about - I did have a piriformis issue while in college (during indoor track) and it did hurt when I coughed or sneezed. So you’re not totally crazy 
I had access to the training room all day pretty much and they did ultrasound, massage, and heated it up before I ran (when I did start running again, I think I took about a week off). It cleared up quickly with all the rehab I was able to get, but wow did it hurt at the beginning.
Tyrod-
It sounds like a facet block is the thing to try. I could not bend forward. That was what killed me. From what I have learned if you have problems with extension, then a facet block maybe really help. Let me know if it does. Good lock to you. Also, as to what you said about the injection and pain, it really wasn’t painful at all. What was painful was the sciatica that popped up almost overnight. But several docs assured me it wasn’t from the facet block. It was just coincidence. I think I’m so locked up in the back area that it was just a matter of time. So, don’t worry. You’ll be fine.
Today, the sciatica is the worst it’s ever been. It used to be that lying down felt good and now that hurts. It feels like a nerve is exposed. I go in to the doc tomorrow. They want to do a steroid shot in the SI joint. They think that might be where the, um, action is so to speak. At this point I’m willing to consider anything. I have read lots about back surgery and it’s not as big a deal as it used to be. There are a lot of minimally invasive procedures out there. Check this link out for Cedars-Sinai. They seem to have a fairly rockin’ team of back doctors too. Thet look top shelf.
http://www.cedars-sinai.edu/7038.html
I’ve tried Prolo. I had a lot of it done to my back. In certain ways, it helped me but overall it didn’t cure my back pain. I think my main issue are disks. I don’t think any amount of prolo would help me but it is a valuable alternative to have.
Again, good luck.
S