Piriformis/SI issues and Iron distance race

Triathlon Forum
1

I have an iron distance race in 8 weeks and recently came down with very significant piriformis/SI dysfunction to the point it took me 5 minutes to get out of bed due pain referred down past my knee. Has been a problem for almost 2 weeks. Went to MD on Friday and got the dx of piriformis after a negitive straight leg raise ruled out a disc issue. He wanted to inject it but I opted for oral prednisone in hopes that if it was a disc that I would be covered with that med.

This weekend is a forced recovery week while I am on the medication but I am freaking out a bit and would like some guidance as to where to go from here. i searched the forum and got great info on treating it and have been more religious with stretching, kiniseotaping amd massage consisitantly every two weeks anyway. I have been doing hip/core strengthening but only 1-2 times a weeks. Need to do more often, I know.

Training wise, I already have 1 century down and 2-3 runs over 2:30 or a bit better. I know I am hitting the hard part the next 6 weeks.

I know it is difficult to give guidance when pain is my limiter. Anybody run in a SI belt and did that seem to help? All the tips from the search really didn’t have long distance training suggestions included in the actual treatment.

I think it is too early to throw in the towel. The pain I feel is right around my right PSIS into my gluts(ouch!) then reappears lateral calf right below my knee. Definately neuro pain as I know that pain well. I rode today 3 hours(slow) and felt OK, swam 1 hour with pain only on the turns at the wall. Yesterday I ran 60 mins with some discomfort improving when I posteriorly tilted my pelvis. I thought about chiro but that scares me. I have had it before and not hugely successful.

I know I may have to alter my goals for this race and that is fine with me.

Thanks for your suggestions!
C

2

To get rid of mine I needed to find the narrowest saddle I could. Although it hurt worst when I ran I think my saddle was the culprit. No problems since. But mine wasn’t nearly as severe.

Good luck!

Jodi

3

I’ve had similar problems leading to and during 2 IM’s. My case was maybe not as severe but led to pain and weakness in the right hamstring and major problems producing power on the bike.

My suggestion would be:

  1. get somebody who understands these things (more likely a qualified athletic therapist than an MD) to address alignment of the pelvis / sacroiliac joint. I don’t understand what they did to me but one or two treatments involving pretty simple manual re-aligment worked wonders;

  2. get to work on hip / core excercises asap. My understanding is that these are less about building strength and more about re-activating inactive muscles, neuro pathways, reinforcing good alignment, etc. This means that very simple exercises (step ups, waiter bows) that don’t interfere too much with ‘real’ training can have a big impact.

Doing these two things, you should be optimistic about seeing improvement in days and weeks rather than months. Good luck with your training.

4

I am not sure what you mean by dysfunction.

I had very similar symptoms to you, chronic (over one and a half years in fact - felt every day without fail to varying degrees) I had one single IMS needle on the piriformis and have not had another symptom for 4 months since it was done. A decent sports physio might be your saviour. Good luck.

5

Gweedore has great advice, I have had SI problems and Psoas issues, your need to understand why they hurt and have a professional get you on a rehab program. Get a flotation belt and do deep water running, one of the most overlooked means of rehab

6

My piriformis syndrome story

First off, I’m no doctor but after having to deal with this pain for over 3 years, I’ve done my share of treatments ask my coach. His typical emails include “how’s the butt doing?”
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Do you have sciatic pain when driving? Flying in a plane or sitting for a while? A deep pain in the butt. Sometimes it almost feels like a deep itchiness type of pain
Ever have have pain in the butt/hip when biking, especially us triathletes in aero position? Or after running?
Do you find relief by rolling on a ball, roller or doing certain stretches only to have the pain come back later on?
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I couldn’t ride my bike longer than 35 minutes this spring without having pain in the butt and sciatica.
Driving to work was a destiny for pain. I even learned to drive with my left foot and I sat on a book to harden the seat hoping it would help.
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I’ve done my fair share of research on this, just google “piriformis syndrome” and see how many hits you get. I wasn’t alone but no one seemed to have the concrete answer. There was surgery where they cut the piriformis muscle to relieve pressure, but most of the time the pain would came back. There was the “All in my head” theory, some doctor Sarno thinks all pain is in our head and that we need to think happy thoughts to get rid of it. Hey, I was sold and even tried it. But it’s impossible to think happy thoughts for 24x7 sooner or later you have to think about crap and somehow the pain came back. Or did it never go away.
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My research was leading me to every imaginable stretch to loosen up my piriformis. It would, most of the time, give me instant but only temporary relief. I would also roll on a trigger point ball right on the pain and dang that relief felt good but the side effect was constant glut pain because I was bruising the gluts trying to reach the piriformis which is under the big butt muscles.
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Then I came across one video on youtube. Now for the record, I could be way off here. But I found a solution to my problem after 3 years of dealing with pain so forgive me if you doctors think I’m wacked. This video suggested that nerves travel in tubes or sheaths. These nerves can get stuck in these sheaths if we sit for long period of time(driving, work, aero, biking) and they travel from our heals to the lower back (they travel everywhere just sticking to legs for this story), right through the gluts/piriformis. It was starting to make sense, in my case with all my stretching and I had to have had the most flexible piriformis on the planet, I would still get pain, did I have stuck nerves. Our piriformis and gluts swell when worked hard and I also believe that if you think about pain somewhere in your body, your body starts to pump blood there, thus causing inflammation. If these nerves are stuck in their sheaths and not allowed move freely due to swelling, then I believed I would get my pain. This video I found has a stretch where you sit in a chair, stick your leg out straight and try to point your toe towards your head. I could feel a little stretch in the glut but it wasn’t completely satisfying. Then I thought of a yoga move I did with P90X, where you roll on your back, legs straight over your head, as if your trying to touch the ground over your head with your toes. This seemed like a good way to stretch the same way but not requiring any muscles to be flexed. See here, it’s called the plow

http://www.spinecenteronline.com/educational_resources/exercise_library/advanced_exercises.html
But simply letting the legs hang over my head wasn’t doing much until…
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… I tried to pull my toes towards my head. (Important the legs have to absolutely straight.) What I got was a sensational pull from my heal all the way to my lower back, especially right through the glut and piriformis. The same relief, the good pain that I got when rolling on a ball, yet I wasn’t bruising the gluts to reach it the piriformis. I often use one leg to hold the other one absolutely straight while I try to reach my head with my toes. I don’t go as far over as the picture above, my feet are probably still about 1 foot off the ground. I simply let gravity and my normal flexibility get me to where I need to be, legs straight and pull toes towards head. I’ll do both legs and hold the toes pointing towards head for a 10-15 seconds, release and do it again, maybe one leg at a time.
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I have been doing this for a month or 2 now and about 2 - 3 times a day and
I can ride a bike for multiple hours
I have no more issues driving in a car or flying in a plane
When I do feel tightness after a run, I do this stretch and all goes away
I’m also seeing a big reduction in lower back pain as well. I think this stretch is doing wonders on my lower back.
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Again I’m no doctor but I have talked to my share of friends and teammates who have similiar pain and if this simple stretch can help me maybe it can help you.

7

This is a fantastic post! My piriformis has been driving me crazy and this stretch did seem to help loosen things up.

8

Great, keep doing it has changed me completely
.

9

I have suffered through piriformis syndrome mightily. I too thought it might be a disc issue. It wasn’t but it’s good to get imaging to rule it out if you can.
I had pain so intense that it made me want to cry out. No position relieved it. Basically my piriformis was so inflamed it impinged on my sciatic nerve. You need to settle this area down. If you’re lucky it may take days. Mine took months …about eight of 'em before I was 80% or so, 10+ before I started not noticing the area while training. It was very hard to let go of the IM race I was looking forward to, but eventually it was obvious I was not going to be able to heal in time (and at times I wondered if I was ever going to heal).

I tried everything…
Useless: acupuncture, chiro
Moderately helpful: icing (the affected area is quite deep, so hard for icing to reach)
Probably helpful (hard to tell when used in combination with other things): anti-inflammatory meds (Naproxen, etc)
The most helpful: stretching, and especially deep massage

After many trips to the athletic therapist, which were helpful but expensive, I looked for alternatives. Get yourself a pinky ball (harder than a tennis ball) place it under your butt while lying on the floor. Roll around on it. It will be very painful and you won’t be able to take much pressure at first. This is your clue that the piriformis is extremely tight and inflamed. You will think you are doing more harm than good at first. Keep it up. The more you can get on the ball too loosen things up, the better. I confirmed this with various medical professionals - the more stretching and pinky ball rolling, the merrier.

Every case is unique, of course, but if your piriformis is inflamed you need to shut things down. There isn’t an amount of exercise that is small enough to not annoy it. It’s that simple. It will not get better until you deal with it. You may have to chuck the race, as I did. There will be other races. I wish you the best of luck.

10

I have an iron distance race in 8 weeks and recently came down with very significant piriformis/SI dysfunction to the point it took me 5 minutes to get out of bed due pain referred down past my knee. Has been a problem for almost 2 weeks. Went to MD on Friday and got the dx of piriformis after a negitive straight leg raise ruled out a disc issue. He wanted to inject it but I opted for oral prednisone in hopes that if it was a disc that I would be covered with that med.

This weekend is a forced recovery week while I am on the medication but I am freaking out a bit and would like some guidance as to where to go from here. i searched the forum and got great info on treating it and have been more religious with stretching, kiniseotaping amd massage consisitantly every two weeks anyway. I have been doing hip/core strengthening but only 1-2 times a weeks. Need to do more often, I know.

Training wise, I already have 1 century down and 2-3 runs over 2:30 or a bit better. I know I am hitting the hard part the next 6 weeks.

I know it is difficult to give guidance when pain is my limiter. Anybody run in a SI belt and did that seem to help? All the tips from the search really didn’t have long distance training suggestions included in the actual treatment.

I think it is too early to throw in the towel. The pain I feel is right around my right PSIS into my gluts(ouch!) then reappears lateral calf right below my knee. Definately neuro pain as I know that pain well. I rode today 3 hours(slow) and felt OK, swam 1 hour with pain only on the turns at the wall. Yesterday I ran 60 mins with some discomfort improving when I posteriorly tilted my pelvis. I thought about chiro but that scares me. I have had it before and not hugely successful.

I know I may have to alter my goals for this race and that is fine with me.

Thanks for your suggestions!
C

Yes I am biased but, go to a physical therapist. And go SOON.

There are a whole host of tests besides just a SLR to determine what is the pain culprit. Proper evaluation of your spine, hips, pelvis, muscular strength, fatiguability, alignment, muscle length, nerve tensioning exams, etc, etc will lead to a more complete diagnosis. Questions like: do you have pelvic pain, have you had kids, kind of delivery, bike fit, running stride, etc are all important. You do have time to feel significantly better before your race and you have done a significant load of training! The MD’s did the research: Physical Therapists scored higher than any other MD profession on musculoskeletal examination except for Orthopedists. And your general PT will do a 60 min evaluation and follow up with you weekly.

Yes you can stretch, you can strengthen your glutes, you can change saddles, shoes, etc. But in the end if you don’t clarify what the source of your pain is you might be chasing your tail. For what it is worth…doesn’t sound like piriformis syndrome to me. You describe something that sounds like ‘wrapping’ pain. This is not typically associated with piriformis syndrome.

I have run with an SI belt and it can help. My sister-in-law dances in it. I like the Serola belt the best and have tried several brands personally and professionally.

Good luck.
Dana

edit: sorry didn’t realize the OP was from Sept. Hope all went well.