I’ve had piriformis muscle syndrome for a while now (6 months, approx.). I’ve seen a very good sports medicine doctor, done my exercises, stretching, et cetera, but I don’t seems to be able to get past it. It had been tolerable for a few weeks until today (I did a 3.5 hour ride yesterday morning). Usually it’s running that causes it to flare up (speedwork in particular), but not this time.
Have advice or treatments that worked for you? I’d love to hear about it. Steroidal anti-inflammatories were awesome, but, alas, you cannot take those forever. Thanks for your advice.
I’m a chiropractor and deal with this problem quite regularly. Quite often there is also involvement of the sacro-iliac joint. This joint moves very slightly during walking/running and sometimes “locks up”. Chiropractic manipulations in this area often will help considerably along with specific piriformis stretches and deep tissue massage/accupressure in the priformis area. In difficult cases I’ve also sometimes recommended custom foot orthotics which also seems to help. Ask around for a good chiro in your area. Sometimes PT’s or DO’s can also do this kind of treatment.
Did the usual route for piriformis with ok results, but not until my PT finally said he can’t fix it that I’d have to see a bonecracker did it get better.
Now I just have to find a new bonecracker as mine doesn’t listen to me lately. Fingers crossed that it doesn’t flare up this weekend.
Generally, traditional western medicine’s reliance on anti-inflammatories isn’t going to alleviate your piriformis issue (which once again displays western medicine’s lack of knowledge of soft tissue issues). Your best bet is to go to a chiropractor, preferably one who is an ART (active release treatment) practioner.
A second option would be to go to a massage therapist who specializes in myofascial release. They would be the people who understand soft tissue ailments (while most chiropractors are knowledgeable in bone structural issues). As a former certified massage therapist, I had some excellent results in treating patients with an abbreviated form of active release (only techniques I picked up through the trade - not extensive schooling).
Note, these techniques are not “touchy feeley” types of treatments. They are therapeutic techniques which can be quite painful when applied. However, they do actually FIX the problems, although probably only temporarily if the behavior that caused the problem is not discovered and modified so that it does not occur again.
You can go to either www.activerelease.com or www.myofascialrelease.com and find practioners in your area. Skip the anti-inflammatories, and if someone recommends going under the knife, RUN FOR THE DOOR! Get yourself a qualified opinion by someone who understands these issues before ever allowing someone to cut into you
Can you tell me a little more about the custom orthotics you recommend? I ask because I have the sciatica in my right side only. I have a functional leg-length discrepancy and my right leg is about 3/8" shorter than my left. I also have IT band problems in my right leg (though I’ve been able to keep them at bay for some time now). Is it a reasonable possibility that my sciatica is caused/exacerbated by compensating for the shorter leg?
Oh man, I had this BAD in fall 2001. Took 4 months. All I had to do was strengthen my core muscles. But for 4 months I could hardly run a few kms before my hip was screaming at me. Had to cut way back on the cycling and get my fit reassessed too. New runners (new style) made a difference. I saw a chiro once (I see chiro as symptomatic relief, and I’m more of a full-cure kind of gal, so I’m not bought into chiro) and he said “you need orthotics”. Also addressing the symtoms not the root cause(s). What a load of hooey. The problem was weak pelvic floor muscles. That weakness was causing my pelvis to realign itself, twisted downward and to the left. Since getting killer core strength, I have completed several marathons, my first ultra, several half IMs and heaps of century rides. All with no problem. And with no chiro, no NSAIDs, no orthotics. My husband has orthotics for a wonky ankle, and they only help when he will be standing or walking for long periods of time. Otherwise, doing weights and ankle raises fixed his problems. Now no more orthotics. Don’t kid yourself, chiros and orthotics generate a lot of $$$ for Drs and fitters. They don’t always have your best interest(s) in mind. My 2 cents.
You can get custom orthotics from a lot of different sources - mostly podiatrists but some PT’s, chiros, etc. I use in the office a company called Footmaxx http://www.footmaxx.com/
I don’t sell that many, but have good reports back about these. I like it because it’s an electronic scanner that measures the dynamic movement of the foot as you walk over it rather than taking a static mold of the foot. I send the data to Footmax electronically and they make the orthotic at their lab. It’s a good sytem for my needs.
I echo what others have said here - Active Release. Worked for me - stretching, myofascial release, all had limited benefit. AFter a few sessions of active release, I’ve been pain-free. I’ll go in for the occaisonal tune-up after weeks of long rides, runs, etc, but otherwise I’m fine.
I have had major problems on this front. Most recently this past fall/winter during marathon training. I have not had any problems since March but several variables have changed so I am not sure which was the solution. My best guesses are:
Quit doing weekly track workouts after my marathon as I started IM prep. Lots of slow/mod running and very little speed work.
5 Intense sessions with ART guy last February…very painful!
2 deep massages per month since March…lots of fucus on hips and glutes.
Lots of stretching…glutes, hamstrings, hips.
I have not had any problems since Marth. Marathon training/track workouts will start again in the next few weeks so it will be interesting to see if the problem returns.
***The problem was weak pelvic floor muscles. That weakness was causing my pelvis to realign itself, twisted downward and to the left. Since getting killer core strength, I have completed several marathons, ***
For me, I suffered through PI Syndrome from 1991-1999. I basically couldn’t run during that time. I had all of the classic symptoms of PI Syndrome. I went to 3 different MD’s and 2 or 3 PT’s with no help. On my 3rd chiropractor that actually spent some time with me to try to figure out this problem - his solution is very similar to the 1st post you received from Cerveloguy. The problem was in the SI joint, plus a leg length issue as well. After receiving treatments and getting a pair of custom orthotics, I’ve been back running. I have to be careful not to push too hard, but I’ll take that anyday over not running at all.
My advice is to see a good chiro and try the orthotics and see how that goes. Also add core strength workouts as suggested by Andypants.
Andypants - please provide some more info about your core strength workouts. Thanks!
You didn’t mention self-applied massage. It helped ease the tightness of my piriformis (with was pulling on my ITB). All you need is a tennis ball for now. Lie with your back on the floor, knees bent. Place ball underneath your piriformis, and while your at it, the gluteus minimus. Doesn’t hurt to roll to your side and get the tensor fascia lata too. A least 1 min. over each spot that feels like a spasm or trigger pt. Stretching won’t help and may aggravate things if you have untreated spasms. http://www.julstro.com has a forum for these type of questions. Their e-book, “the pain-free triathelete” has been very valuable for my leg & hip injuries.
Might be worth a try before resorting to ART. You can’t beat free!
The sciatic nerve can run through any number of places including under, over and through the piriformis muscle.
Leg length discrepency is normally (in all but 1/1000 cases) corrected by the appropriate manipulation of sacro-iliac joint (Yes even cases that have been CT scanned and found to be different)
Herniated disc can often present as sciatic type problems: ask for CT scan of lumber spine.
the ball: ab curls, ab curls with twist, balancing on stomach, standing on ball, squeeze between lower legs and raise while lying on back, lie on ball and roll down to have most of your weight on your arms (i.e. legs higher up, ball on thighs) then roll yourself side to side and use your abs to pull you back to centre, ball behind your back and against wall and do squats/plies (also good for glutes - I had to train my glutes to refire properly as part of the rehab)
the medicine ball: pass the ball around your torso (10x one way, 10x the other), throw to partner, thigh squeeze and raise (change from using the ligher ball, more resistance)
other weight exercises: twist with bar, pull-ups (roman chair) alternating each leg, then pulling up both, back extensions (these are key to keep your lower back nice and strong, balance against all the ab work), good morning raises.
other non-weight bearing exercises or changes: kegels, kegels during swimming (i.e.: tighten the core muscles while swimming - I found this really helped with maintaining good body position), kegels while climbing out of the saddle, maintaining a good pelvic position while seated, pelvic tilt while running (i.e.: improving the running form to have the bum tucked in and the spine straight).
I did a variety of these exercises religiously for 4 months. Had a nice 6 pack and strong lower back to go with it (gotta maintain the balance). Then I had to go get pregnant and watch it all slowly disappear… hopefully by next summer I’ll have ditched the kegger.
