jbird-if you take a second and visit any of the web sites that concentrate on Orthopedics/Physical Medicine, etc. you’ll find the piriformis to be a rather small muscle from the sacrum to the upper part of the femur through an area called the sciatic notch near the sciatic nerve-the big one that feeds many of the muscles in the back of your thigh and further down. Rather than the acute onset you describe, many present with a more gradual onset and worsening buttock and posterior thigh pain. Common to both can be weak hip abductors (moving leg to the side away from the body) or tight adductors, the muscles on the inside of the thigh as they can lead to piriformis overload. You may also see this condition in people with lumbar spine or SI joint issues (am I ringing any bells here?)
Other than eventual plain xrays to rule out a bony cause of the problem, I’m not aware of any specific test like MRI, etc. that will make the diagnosis. It’s more of a clinical diagnosis.
If indeed this is your diagnosis, there are any number of exercises that a physical therapist can teach you (supplementing previously offered suggestions.) I have had some success with them using ultrasound, and in cases that go on for a long time (six or more months) injections have been of benefit. I’ve never operated on one.
Lastly, as you can tell from other readers, some of these take an extended period of time to resolve, sorry. Maybe you could review both your training in the days leading up to the 1/2 marathon and your specific route/shoes/external factors that make this an issue now but not in the past. If it lasts, get it checked out.
Thanks for all of your input John. I just got back from my appointment with the PT. You mentioned weak abductors and that is exactly what he told me. He gave me an elastic/giant rubber band to take home to help out with abductor strengthening. He said that it will take time and that I may be more soar at first, but could see results in a few days.
In regards to ultrasound, I had it done twice by the PT at a pretty intense level and didn’t feel much better.
Finally, my PT mentioned injections (by a surgeon). He said it would be a mixture of cortisone and some other stuff that I don’t recall. While Boston is an A race, my other A race is IM Wisconsin (Sep). Would an injection and the pounding of 26.2 miles put a summer of high volume training in jeopardy? I am just worried I could do damage and not even be aware of it.
The 1/2 marathon was on a course of rolling hills, which I rarely run on. I also wore my DS trainers. I train in Kayanos and have had success with DS trainers at that distance before so it really baffles me.
jbird-Looks like you’re headed in the right direction. As Ed Harris said in Apollo 13, “Work the problem people.” In your case, the Sherlock Holmes details of why this has occurred and how best to ensure it does not recur.
As fan as the injection therapy, I wouldn’t count on it as a guaranteed fix but rather one of many potential aides, some of which help, some don’t.
Lastly, with regard to Boston. That’s a toughie. Hopkinton, Wellesley, Heartbreak…it’s all magic isn’t it? But, if I weren’t painfree come April 20th, I wouldn’t be toeing that big green starting line with the little clover. Besides, I think Cheers went out of business!
John
Thanks for your contribution. I have a general question regarding how well understood is this condition in the medical community? I have read Sciatica Solutions by Fishman & Ardman. I don’t know if this is well regarded in the medical community, but they at least raise the question of whether misdiagnosis of Piriformis Syndrome often occurs.
I know you can’t speak to my specific condition, but the ortho I saw diagnosed the root of the problem (no pun intended) being at C5 - S1. Physical therapy recommended only made things worse. Changes in the program did not improve it. I gave up on the diagnosis, doctor & PT.
What I did was ask myself what I was doing when this occurred, and could I make an appropriate change to reverse the problem. I was assuming, and still do, that this was the piriformis muscle compressing a nerve and not at the spine.
To make a long medical history short. 25 years ago I had an AC replacement and high tibial osteotomy done on my left knee. A few years latter I developed a dull ache in my left but when sitting in any tight car seat. Flash forward to 3 years ago. I decide to do an Oly but knew I need to build the strength up in my left leg. Despite many years of physical activity (on & off) I never fully regained muscle mass in my left thigh. So I started a self designed program focusing strengthening that leg (big mistake).
3 days before the race I was doing some speed work on a track focusing on placing more of my weight on my left leg. I started to feel a very dull sensation in my left buttock. I ran a bit more and realized that something was wrong. I walked and shortly thereafter I developed a severe pain. Nevertheless as a true nut I rested for 2 days and did the race realizing I might have to walk the run - I didn’t. Triathlons appeared to be over for me.
Dialing ahead, last year after giving up on my doctor I shifted my training program to go back to the weight bearing balance I had before the injury. I felt if I reversed the process that led up to the injury (overloading my left leg) the injury would heal. When I started I could barely run 2 or 3 steps without pain. I managed the injury and completed 3 olys and 3 sprints last year. The pain never went away but I was able to control it. In fact it hurts less often, and when it does the severity is less. One thing of interest is that everyday i wake up and it feels fine, but the one thing that will do me in is sitting on it. I’m in pain the remainder of the day. The cycle then starts over the next day.
Is there a chance the doctor had it wrong? Was I wrong in concluding that as a 56 y/o athlete that I know my body best? Is it worth trying to find someone else to help me, or do you I should continue to do what I’m doing as long as I still see improvement.
I use a roller at night and it always helps. I come from a swimming background and am doing my first HIM in late June. I am definitely concerned about the run.
I had the issue last year and the TP products worked, but in the end it was a muscle strength issue. I utilized a stabilization workout from Dave Scott’s website ($24) and that fixed it for me.
S
Bob-this is a long post! My wife would say you need a day job. First, a couple observations:the fact that you can still run at all this far out from a high tibial osteotomy, an operation done at that time by taking a wedge of bone from your upper tibia to shift the stress from the arthritic side of your knee and haven’t had a knee replacement is simply amazing. Secondly, 25 years ago, early 80’s, most surgeons were still doing a vastly different operation for ACL deficient knees than is done today. Part of the reason for change was that the older procedure didn’t hold up over time for many. Again, you are very lucky.
Although you currently have pains, it sounds like you’ve reached a “middle ground” with your body, did 6 tri’s last year (and probably some other races), and had at least some medical care. So where from here? Tough question but I think I’d be inclined to “heal myself” and, if I got to the point where the pain worsened, I’d see my local runners doc for some “tweaking.” Good luck.
Sorry about that and thanks for the advice. In case you are interested my surgery was done by Stan James at the Orthopedic & Fracture Clinic in Eugene. The AC replacement procedure used a portion of the patella tendon. I was screwed and stapled. I think the clinic pioneered the procedure and Dr. James did a bit of surgery on Joan Benoit’s knee before the Olympics in 84.
One thing that help post op was that I gave up recreation basketball and running, not that I was any good at them anyway. I stuck with swimming and cycling. I did not start running again until 4 years ago, primarily in the mud in the rain. The only other racing I’ve done is open water swimming. I got into triathlons because I can’t run well, can’t swim fast anymore because of shoulder problems and enjoy riding a bike (not fast on that either). I am spreading the wear and tear around these days and finding some success.
And your wife is right, I probably do need a day job.
