Hey all, I was seeing in the massive group of triathletes we have here, if anyone else has/is suffering from piriformis syndrome?
I've been battling this all last season, where my PT was able to get me to train without much pain, but in Sept, it flared up pretty good. have been out of commission since then and only recently started running again and has been very promising!
I'm up to about 5-6 miles without any issues. Took a road trip 3hrs over the weekend and the nerve/piriformis flared up again. Ironic that I got "injured" while sitting!!
Anyways, it's extremely frustrating and seeing if anyone else had any tips on healing up fast. I've held off signing up for races because I have no idea if I'm even able to race... :( :( :(
Sorry to hear that this is an issue. A couple of things that have helped me with "the pain in the---"
Sit on a tennis or lacross ball and work it into the area when you drive. Also try it at work. Maybetry sitting on a balance ball at work. You can also foam roll the glute by crossing one leg over the other and working it over.
Strengthen your glutes, hips and aductors (probably been doing this in PT)
Have you tried ART or Graston? I have found it very helpful in releasing the tightness.
Also try some skips and other running drills at the end of your runs if your hips are tight.
Hope this helps
I suffer from this and I coach many athletes that suffer from this same issue. It can be very debilitating. Malissa offers some very good ideas. The tennis ball can really help, along with deep stretching. However, I have had my best relief from having a massage therapist literally put her elbow deep into the piriformis and hold pressure on it. This is NOT a pleasant feeling. But I find that if its held for a period of time (as long as you can tolerate, upwards towards a minute), the muscles releases. If you are familiar with trigger point release, this is the same idea and it seems to be the best way I can get relief. And believe it or not, sitting in the car is probably the fastest way to have it reflare (muscle is extended in a static position).
If you can tolerate a strong elbow, it might put you back in working order.
Hope this helps!
Thanks everyone for the tips. Had PT this morning to get it worked out. The strength of the hip/gluts for the most part has been "fixed", but the lingering nerve issues are not. Apparently, they take forever to heal.
I'm going to take a look into the ART/massage therapy to see if that speeds up the process.
Do you train through the "pain"? it's in quotes b/c it's not really pain, but more so uncomfortable. What do you find works best?
To deal with those lingering nerve issues, consider dry needling, which sometimes involves electrical current to stimulate nerves that aren't acting quite right. I've been getting this done and it has helped immensely with activating my glutes and taking strain off my piriformis.
I rarely have pain while training, possibly some aching while running and a little pain towards the end of a bike ride with a lot of time in aero. With that in mind, I just train through it, but if it were painful during training I'd re-evaluate. I mostly just have pain while sitting.
I have trained through it, but would defer to someone like Coach AJ, your PT or chiro as to what is best for you. I have found it very painful on hilly courses and had to stop during a marathon to stretch as it was seizing. I wonder how much faster I would have been if I had taken care of it during the off season.
BTW I found that I can dig my saddle into the tightness during stop lights.
Please be careful and good luck.
The best thing I've found is to do less sitting on it. I started using a standing desk for part of each day, and it really helps.
I went to PT last fall and found that after all the strengthening and massage, it would be fine, and then I would be stuck sitting at my desk for three long workdays and it would totally relapse.
Just my experience -- good luck!
Two additional thoughts... I too have had many years of piriformis pain. In addition to the tennis balls and elbow to the gluts (both of which have really helped me over the years), I would also recommend avoiding high heels when things get really bad. In addition, I once had a chiropractor stretch my ab muscles out through streching combined with pushing on my lower abdomen and it somehow ended up relaxing the piriformus. I never have been able to copy what she did, but I do know that the stronger my abs are, the less trouble I seem to have with the gluts. Hope that helps and good luck!
A few thoughts on the piriformis problem.
As a sports chiropractor I would want to know what your symptoms are. Was the pain you experienced originating in the butt and then radiating down the leg? How far did the pain go? How long did it last? What did it feel like, etc.?
It could be more than a tight piriformis, including a lumbar problem placing pressure on the spinal nerves which make up the sciatic nerve. It could also be a few other things. If it IS the piriformis then here are a few suggestions.
1. I talked about this in an interview with a runner from the DC Examiner. Here is a link to that to give this discussion some background www.examiner.com/running-in-washington-dc/chiropractic-treatment-for-runners-dr-john-dandelski-on-common-injuries.
A chronic piriformis issue is very often the result of a lumbopelvic hip complex (LPHC) dysfunction. It can take months to correct an imbalance and allow the glutes to do their job properly, thus relieving the piriformis from trying to pick up the slack.
So fix the LPHC and the piriformis issues usually die away.
2. For my patients who have a clear piriformis problem they almost always show up in the office having stretched it like crazy. So my first question to them is, "show me the stretch you're doing." 95% of the time they are either not doing the stretches correctly (yes, you should be doing 2 different stretches for it, not one) and/or they are not holding the stretch long enough. IF you are doing the stretches correctly, then you should be holding them for 2-3 minutes and work up to more in a week. 95% of the time they say they have been holding them for 20-30 seconds. For a chronically tight piriformis that is woefully inadequate.
3. Stretches: (contact me directly at email@example.com for more info, but here is the basic concept)
Ideally you'll have an expert guiding you through these the first time. Again, usually people do these wrong then blame the stretches for not working.
Position 1: Figure 4 (lying on back, crossing the painful leg over the other bent knee (this looks like the number 4), then pulling the good knee toward your chest, thus pulling the tight leg toward your chest also). You'll have to play a bit to find the sweet spot. When you do, work that leg toward your chest and every 30 seconds take a deep breath in and bring the leg closer. This hurts, and it sucks, but it works if you commit to holding it for the 2-3 minutes.
Position 2: To get a slightly different aspect of the involved piriformis sit erect with both legs out in front of you. Cross the involved leg over the good leg, placing the foot flat on the floor next to the extended knee (the leg still flat on the floor). Grab your bent knee and bring your KNEE to your OPPOSITE SHOULDER, NOT your opposite shoulder to your knee. Usually one of the positions will be dramatically more difficult than the other. This is because these stretches get at subtly different aspects of the piriformis. Again, do this stretch for 2-3 minutes.
4. PNF works fantastically for this. PNF is proprioceptive neuromuscular facilitation. It is a type of active-assisted stretch and when done properly can greatly improve the pliability of that muscle in the first treatment. I use PNF on all my piriformis patients and nine times out of then they walk out of the office mostly pain free. They then go home and do the stretches I prescribed and by that evening they are either pain free or mostly pain free.
5. ART and Pin and stretch work well. I have to say I have found that the PNF and self stretches work the best.
This post is longer than I meant, so I'll let it go at that. Any other questions please feel free to contact me directly!
Dr. John, D.C., C.C.E.P., A.R.T. Provider
I also struggle from these issues and have for many years. I have found the yoga, but more importantly Pilates help to maintain my pain free training. Pilates really targets the areas in the body that become neglected with all the linear training we do as triathletes. It focuses on your core, which is not just your abs but also includes your lower back and hips (to include both the large glut muscles but also the medial and lateral aspects of the hip). I find that if i can do pilates 2x/week in combination to my tri training, then i continue to stay pain free.
I agree that stretches listed above and the PNF are very effective. I also sleep with a pillow under my lower stomach/hips when i'm sleeping prone and then between my legs when on my side to promote proper alignment of my lower back and hips when sleeping. This helps to prevent over stretching or tightening of certain muscles when the spine is placed out of its natural alignment.
Traveling has been the hardest and most common flare up for me. When I fly i try to pick seats that will allow me to my painful side (my right side is my painful side so i chose either the left window seat or right isle seat). I also tend to get up every hour to walk around for 2-3minutes. when driving I try to stop every 1-2 hours and i use cruise control a lot to prevent the static position of my hips.
Ok...again..this post is too long. GOOD LUCK! Thanks for starting the feed. I've learned a few things that I look forward to trying myself.
I'm pretty sure this is enough people to form a support group! :)
I have been dealing with a mild hip un-comfortableness for almost a year. I was able to train through it without many issues. Did HIM in Sept, rested for about 2 wks, then went on a quick 3 mile run and have been out since then. My pain actually started out in the outer hip. I called it the "hip meat", kind of under the Ilium wrapping around to my butt. Never anything in the front or groin.
The hip issues have mostly subsided, and now what's left is the tingly, constantly engaged right butt.
Thanks Dan for all the info- I'm checking out the articles!