Had some serious periformis issues over the past weekend at IMFLA which caused a nasty bout of sciatica (nauseating pain, no feeling in the left leg…etc.). Not much fun. Although I didn’t get hit with it until the run, I noticed that I was shifting around on my saddle a lot and that my deltoids were strangely sore. Also, in the swim, my hamstrings were seizing up…??? None of this ever occurred during the season and yes, I had gone on numerous long rides followed up by bricks. Periformis on the right side has been bothering me all season, but nothing more than discomfort after sitting for a while or after a long run. Heading to the sports doc tomorrow, but curious if anyone else has dealt with this? Someone suggested doing a refit on the bike…
I second gleveq,
Don’t take those signs lightly.
See your doc asap about radiographs or MRI.
Piriformis syndrome should be considered AFTER you have ruled out the low back as a cause of sciatic nerve irritation.
I had the same issue earlier in the year. A P.T. friend recommended a few stretches and I did them without exception after each cycle and run and the pain was gone in about 2.5 weeks. It is from over use and under stretching according to her. Try it it worked for me.
Definitely get it checked out. The sciatic nerve runs below (or sometimes through) the piriformis muscle, so tension there can definitely irritate the nerve. Believe me, I know exactly how painful that can be. As others have mentioned, the sciatic pain could be due to back issues, but this is often a misdiagnosis for a problem with the piriformis, since doctors tend to see more people with back issues than athletes who irritate the piriformis through overuse and/or a strength imbalance. Don’t rule anything out, but make sure your doc is considering all the potential causes. It can really be a bitch if you get a bad case of it.
I did the stretching, massage, ART route myself with limited success for about 3 years before it finally got so bad that nothing helped. The first x-ray and MRI of my life showed the obvious root cause of my pains.
If I’d had any idea it might be back related (I had zero back pain) I would have insisted on an MRI right away and maybe have avoided surgery altogether.
FWI, my surgeon is a pretty accomplished triathlete and we are both optimistic about a full recovery and return to racing.
Lulu, just consider, and eliminate hopefully, all possible causes.
I have dealt with and resolved both piriformis syndrome and sciatica. My advice is as follows: First, find an MD that deals with athletes to (hopefully) rule out an acute physiological problem (e.g., a herniated disc). Second, and assuming nothing major is found by the MD, try glute and lower back specific stretching, massage, chiro adjustment (if you are in to that), and core strengthening. Third, a bike fit wouldn’t hurt, but I doubt that is causing your problems. Fourth, try some heel inserts in your running shoes (short term only). All of the foregoing worked for me, after the first (non-sports specific) MD I consulted said I’d never be able to run again (that was seven years ago, but I’ve had no major problems since). Good luck.
Trigger Point Therapy massage ball, www.tptherapy.com amazing for getting in there and releasing the piriformis and surrounding muscles… after you see a doctor of course.
I had piriformis issues this past spring. I am huge believer in Yoga/ flexibilty, but after 3 weeks or 20-40 minutes per day and no 100% cure, I looked at strength imbalances. I ended up doing a search and came across some Functional strength routines that Dave Scott provides and sells. It turned out to be a muscle imbalance and as soon as I started the functional strength routine I was cured within a few days. Most of the workout was elastic band work and one leg squats with light weights. I found the initial tips on You Tube, which Dave Scott posted fo free.
oh yeah the TP ball is the most important tool I use daily for recovery. I bring it to work and use it daily. I manage a running shop and we just strared carrying their products so I am looking forward to many happy runners in the days ahead.
LuLu, By any chance did you have a long drive to IMFL? in 1998. a 17 hour drive to Lubbock, TX triggered my periformis flare up at BSLT. I began with Orthopedic surgeon and MRI. Warning: MRI’s are so detailed they usually come back with false positives (no one’s spine is perfect, so your pain is diagnosed at one of the imperfections). He told me I had degenerative disc disease, and my running days were basically over. Next stop, Physical Therapist…deep tissue massage and ultra sound, but I didn’t get relief until I went to Chiropracter. I wore heel insert in right shoe for about 1 year (leg length discrepancy), but I do periformis stretches, and focus on my hamstrings. Before every run I do my stretches, and knock on wood, haven’t had any trouble. Good luck.
Cool! I have a magazine in Hawaii and we just started carrying TP products too. I’ve been an addict for a few years. Our first big shipment is coming in today! Hmmm it’s getting dark, maybe tomorrow…
I saw my Dr. today for similar issues. Turns out I have a bulge in L5-S1 that is causing nerve issues. The pain is not in my back it goes from the Greater Tronch down to my knee with a numb lower leg and part of my foot. Dr. says it is manageable with PT and possibly an injection.
Tightness of Piriformis muscle does not cause sciatic nerve root aggravation on it’s own. It will contribute to symptoms of above mentioned and much more serious issues such as a derangement in the Lumbar spine ie. buldging or herniated disc etc… If you were getting numbness down the leg it was coming from the nerve root where it exits the spine. Some buttock symptoms could be caused by piriformis muscle but no significant referred pain like your describing.
As for the deltoid soreness you mentioned it has nothing to do with this if you were trying to make a connection. We are not wired like that. Referred pain in shoulder/arms comes from cervical spine issues. Hip, buttock, leg referred pain from Lumbar spine.
One of the things that I noticed is that my left hamstring has been incridibly difficult to stretch this year. I’m typically a very flexible person and had previously been able to touch nose to knee without any trouble at all. Again, I’ll report back after the visit to the doc.
In late spring I was having trouble in my left leg and it seemed to be piriformis syndrome. Found out a week or so later that the the symptoms were either directly caused by 2 disc herniations or the PFS was caused by (or worsened by) the 2 herniations. In addition, my almost constant priformis and low back stretching actually worsened the herniations and made them much more symptomatic. I was lucky enough to recover over the next three months with rest and progressive extension exercises under the guidance of an ART chiropractor.
This just sounds sooooo familiar. My left hamstring just got tighter and tighter and I just kept stretching more and more. Eventually felt like a knife stabbing me right in the upper hamstring attachment point. Turns out that the pain I thought was caused by a lack of flexibility was actual nerve pain and that my attempts at stretching were actually irritating the nerve even more. My NS said that because I waited and the nerve was so irritable, I had decreased the odds of a full recovery. Sigh…
As I said, I hope that your issue is soft tissue related or easily fixed with stretching & functional strength training, however, it doesn’t hurt to investigate all the possible causes instead of grasping for one that makes it seem less serious.
A good ortho or neuro doc will not “force” you to have a disc issue, but I know that I wasted a lot of time with practitioners of various types trying to pretend I didn’t.
One of the things that I noticed is that my left hamstring has been incridibly difficult to stretch this year. I’m typically a very flexible person and had previously been able to touch nose to knee without any trouble at all. Again, I’ll report back after the visit to the doc.
This may be your body’s reaction to the injured piriformis. As a protective measure, muscles around the injury area can tighten in order to allow the injured muscle to heal. I had a similar hamstring issue with my piriformis.
I know people like the TP ball, but I’m cheap and I find that a tennis ball works great. No substitute for ART, but it does encourage blood flow in the muscle, which aids healing.
OK campers - just got back from the doctor and here is what he found…
Good news is that there are no apparent issues with herniation of disks, muscle tears or really even any periformis strain. He believes the culprit is very weak and in my case, almost non-existent gluteus medius muscles. He commented that he sees this a lot in distance runners and to a lesser extent, in triathletes.
The gluteus medius muscle originates at the dorsal ilium below the iliac crest and inserts at the top outside surfaces of the greater trochanter. It is the major abductor of the thigh (thus possible the original diagnosis at the race that I had torn an abductor). The anterior fibres rotate the hip internally and the posterior fibres rotate externally. The muscle is innervated by the superior gluteal nerve (thus, the possible reason for the pain that I was thinking was sciatic) and gains its blood supply via the superior gluteal artery.
No running for the remainder of November; some light swimming and cycling to stay loose and focus on PT.
Wow. Your diagnosis sounds remarkably like mine. I was told that some of my core muscles were “shockingly weak” compared to others. The good news is that we’ve gotten this far without using are largest muscles (glutes). Just think how much faster we’ll be once we start using them.
