# Piriformis pain the a**



## M5Tucker (Aug 8, 2011)

I'm experiencing a sharp pain in the right side my butt & hip, with pain & tightness down the back of the leg to the knee & sometimes carrying down into my calf. I can't fully extend my right leg, and moving between sitting and standing is almost impossible. It's like an impenetrable knot in my bass that just radiates pain and causes the whole leg to cramp, plus sharp pain around the front of the hip when walking. 

It's been 3 weeks of almost constant pain & treatment, with no appreciable improvement. My chiropractor is an avid rider & former competitive cyclist and has worked in the bike industry, so he understands my plight and his office has done everything in it's power to fix me but nothing seems to get it. Adjustments, ultrasound, electro-stim, massage, heat, ice, stretching, anti-inflammatories, all of it. I'll feel better when I leave the chiro office, but the next morning it's back to square one. I've battled sciatica on & off for years (I'm a mechanic...stupid), and usually a couple of chiro visits, some yoga stretches, and some time on the road bike sorts me out, but this is a whole new level and it's quite debilitating. 

I can't walk straight, and sitting on the saddle hurts. Because I can't extend the leg I can't pedal a bike either, which is the biggest pisser because the weather has been amazing, the dirt is perfect, and I've got lots of trailwork & riding to do! I just upgraded the fork & shock on my Kona too, and it's just staring me in the face because I haven't ridden on them yet. 

Anyone have a magic bullet to shoot me with? This is really getting old.


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## Wherewolf (Jan 17, 2004)

*Duhhh*



M5Tucker said:


> It's been 3 weeks of almost constant pain & treatment, with no appreciable improvement.


See a real doctor.


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## team ti (Aug 13, 2006)

Go to a registered massage therapist for a diagnosis. A simple test for piriformis syndrome is to do a straight leg raise while seated. This will tension the piriformis along with the hip extensors and you would feel the symptoms of pain, numbness down your leg. Relax for a minute and repeat the straight leg raise but with the leg externallly rotated (foot pointed outwards) and see if the the symptoms are recreated. If yes, it may not be the piriformis. If no , then book yourself in for some treatments focusing on releasing the offending muscle. Because it is a muscular issue, chiro would not the most effective treatment IMO. You can also look on the net to find stretches for that same muscle. BTW, I've been an RMT for 15 years and suffered for years with the same problem before getting properly treated. My doctor told me I had a blown disk, prescribed anti inflammatories, and told me I would have to live with it, with the next step being disk removal and spinal fusion. Drugs and surgery. Their answer to everything


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## skankingbiker (Jan 15, 2010)

team ti said:


> Drugs and surgery. Their answer to everything


So true


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## skankingbiker (Jan 15, 2010)

I have same problem. What works for me is to stretch it out by folding leg into my chest and leaning forward. You can do this sitting up or lying face down.

Also, it sounds silly, but get an old tennis ball, sit on it, and wiggle your a$$ around. It will help work that out.

Problem is that piroformis muscle is under your glutes, so you have to exert a lot of pressure to get to it. A good massage therapist can work wonders as well.


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## M5Tucker (Aug 8, 2011)

Thanks guys.

As to the leg raise, when straight I can't get the leg more than a couple of inches off the ground without pain, and rotating is still painful but gives me notably better movement. My chiro's place is also a sports therapy office, including massage so we've been focusing pretty well on the problem area rather than adjustments. I'm just surprised that nothing seems to change it in the long term. Maybe it's time for me to suck it up and take a little more pain so they can work it harder.



team ti said:


> Go to a registered massage therapist for a diagnosis. A simple test for piriformis syndrome is to do a straight leg raise while seated. This will tension the piriformis along with the hip extensors and you would feel the symptoms of pain, numbness down your leg. Relax for a minute and repeat the straight leg raise but with the leg externallly rotated (foot pointed outwards) and see if the the symptoms are recreated. If yes, it may not be the piriformis. If no , then book yourself in for some treatments focusing on releasing the offending muscle. Because it is a muscular issue, chiro would not the most effective treatment IMO.


I don't want to hear "drugs & surgery" from a doc either! I've been doing every stretch I can find that's manageable and some help, but every day is the same. The chiro & therapists definitely don't think it's a problem of serious damage, and they don't like drugs any more than I do so I'm thankful for that because that's a road I don't even want to think about. 


team ti said:


> You can also look on the net to find stretches for that same muscle. BTW, I've been an RMT for 15 years and suffered for years with the same problem before getting properly treated. My doctor told me I had a blown disk, prescribed anti inflammatories, and told me I would have to live with it, with the next step being disk removal and spinal fusion. Drugs and surgery. Their answer to everything





skankingbiker said:


> I have same problem. What works for me is to stretch it out by folding leg into my chest and leaning forward. You can do this sitting up or lying face down.
> 
> Also, it sounds silly, but get an old tennis ball, sit on it, and wiggle your a$$ around. It will help work that out.
> 
> Problem is that piroformis muscle is under your glutes, so you have to exert a lot of pressure to get to it. A good massage therapist can work wonders as well.


I can do bending stretches like that without too much pain, even touch my knee to my nose after a few rounds of it. It's straightening the leg that's the worst, like a hamstring stretch or trying to bend evenly at the waist. Someone else suggested the tennis ball thing too, I'll try that tonight. The chiro also gave me this little plastic massage tool that looks like a toy jack, with different sized ball ends-it's quite painful to use but it does seem to get to the source.

Thanks again!


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## knoob (Mar 17, 2010)

I had a similar issue after a tibal plateau fracture.19 weeks non-weight bearing and things get pretty tight and stiff.

My chiro used Active Release, and Graston to get things loosened up. Google "Graston" it's basically deep tissue massage, but with some midevil looking "tools".
It hurts like hell but it will get things to loosen up.

I found it looking for some more productive rehab options. Ins considered it "non-tradional" physical therapy so it was all out of pocket,but worth every penny.

When you use the tennis ball,or baseball,it's a similar concept of releasing the adhesions to allow movment.

Good luck. Hope your back in the saddle soon.


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## Bill in Houston (Nov 26, 2011)

tennis ball... good luck, i hear that this is a tough one to get rid of.


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## 475856 (Feb 6, 2010)

Question is, do you stretch before and after a ride?? I am asking because nothing is worse than to cramp up after physical excursion because of not properly stretching.
I used to speed skate pretty competitively and our trainer always made us stretch before and after the training sessions. Massages were part and parcel too. The latter may not be an option but stretching is. Maybe doing some Yoga can offer relief as well...


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## pwrtrainer (Oct 23, 2005)

See a Physician, not a chiropractic physician, but a physician. Then get a referral to a PT. Massage is not going to do anything to change the inflammation at the nerve root. Anyone who claims it can is denying the basic anatomy. Massage is a component of a well rounded program, not the whole thing. That's like arbitrarily loosening all your lugnuts on one of your cars wheels. Sure something is going to happen, but if done at the wrong time without taking the correct steps first, it is gonna be useless and painful. And don't take your script back to that chiro and use his sports therapists. Use a real outpatient orthopedic PT. Chiros are not all bad, but you're not getting better so stop trying the same thing.


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## Kawigreen99 (Oct 9, 2011)

T NATION | Feel Better for 10 Bucks

And as other said, tennis ball.


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## M5Tucker (Aug 8, 2011)

Still no improvement, but I now know what the deal is. After an X-ray showed no real issues, and surprisingly good spinal condition for a 32 year old mechanic & mountain biker, I got an MRI on Friday that revealed a slightly herniated disk between L4 & L5, pinching the nerves going down the right leg. Sweet! They're calling it "mild", but are recommending seeing a neuro guy for another opinion on treatment options. We shall see. 

Like an idiot, my desire to ride got the better of me last weekend because it had been a month and the weather was stunning. Though I rode carefully & slowly with the seat lowered slightly so I didn't extend too far, and stopped to stretch regularly, I aggravated things a bit. The pain now almost constantly runs down the back of the right leg to the calf, making it feel like the worst cramp I've ever had. Stupid, I know. Which is why I'm now carefully sitting at home watching Life Cycles and checking MTBR on a beautiful Saturday morning instead of riding. 

Thanks for the input, you healthy guys go out and get a ride in for those of us on the DL, huh?


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## PMK (Oct 12, 2004)

M5Tucker said:


> Still no improvement, but I now know what the deal is. After an X-ray showed no real issues, and surprisingly good spinal condition for a 32 year old mechanic & mountain biker, I got an MRI on Friday that revealed a slightly herniated disk between L4 & L5, pinching the nerves going down the right leg. Sweet! They're calling it "mild", but are recommending seeing a neuro guy for another opinion on treatment options. We shall see.
> 
> Like an idiot, my desire to ride got the better of me last weekend because it had been a month and the weather was stunning. Though I rode carefully & slowly with the seat lowered slightly so I didn't extend too far, and stopped to stretch regularly, I aggravated things a bit. The pain now almost constantly runs down the back of the right leg to the calf, making it feel like the worst cramp I've ever had. Stupid, I know. Which is why I'm now carefully sitting at home watching Life Cycles and checking MTBR on a beautiful Saturday morning instead of riding.
> 
> Thanks for the input, you healthy guys go out and get a ride in for those of us on the DL, huh?


Not to sound like a dick, but welcome to the club...When I rwad your first post the bulged disc was my first though.

No doc or expert, just suffering with the exact same symptoms. L3/L4, with some other spots of very minor bilge for good measure.

I spent this morning building a timeline table of when the injury occurred, daily pain, days worked, not worked, doctor visits, and PT.

Today is one day short of no riding. Most mornings are almost impossible to stand without pain.

I had two PT sessions, one Tuesday where they evaluated and did some heat and Tens time. Thursday was the first day of actual therapy, was feeling improved prior to therapy, Friday I was in bed all day taking pressure off my back. Today is better but not as good as before Thursdays PT.

I'm trying to decide on how long to let it heal naturally. Opinions for this injury are all over the spectrum. Some heal, some don't, most need to treat their back like a piece of fine crystal. Some have pain for years, some don't.

I made a phone call to these folks about this option

Minimally Invasive Spine Surgery for Back Pain Relief

For now, to minimize pain, lay on your back, put your lower legs on the seat of a chair, bending 90 / 90. Find a comfy position.

PK


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## M5Tucker (Aug 8, 2011)

Not a dick at all, I literally feel your pain and we're in the same boat about considering options regarding healing naturally with therapy or surgery. Every morning is a struggle for me too, as is standing after sitting. I've had therapy 3-4 times a week for over a month with no long-term change (though it brings very temporary relief, when I'm on the table), and doing exactly what you describe in laying with legs on a chair is about the only relief I can find. After the MRI yesterday I was also told the surgery for this is minimally invasive, which is encouraging. Thanks for the input, here's to healing well & getting back on the bike for both of us.



PMK said:


> Not to sound like a dick, but welcome to the club...When I rwad your first post the bulged disc was my first though.
> 
> No doc or expert, just suffering with the exact same symptoms. L3/L4, with some other spots of very minor bilge for good measure.
> 
> ...


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## jofmon (Apr 9, 2008)

*What was the results?*



M5Tucker said:


> Not a dick at all, I literally feel your pain and we're in the same boat about considering options regarding healing naturally with therapy or surgery. Every morning is a struggle for me too, as is standing after sitting. I've had therapy 3-4 times a week for over a month with no long-term change (though it brings very temporary relief, when I'm on the table), and doing exactly what you describe in laying with legs on a chair is about the only relief I can find. After the MRI yesterday I was also told the surgery for this is minimally invasive, which is encouraging. Thanks for the input, here's to healing well & getting back on the bike for both of us.


Im feeling similiar pains as you described. I'm wondering if its piriformice or something with my spine. What was the results of your surgery? How long was recovery before you were back on the bike at 100%


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## givati (Dec 5, 2011)

I'm curious to those of you how have had, or are dealing with it currently. Can you isolate a spot in your glut which is extremely painful to press on, or when using a foam roller, or using a tennis ball? I have been dealing with similar symptoms for a few months. I have also been to a chiro twice and am going to a massage therapist next week. I will be scheduling with my MD as well.
Does anyone know if Piriformis Syndrome is specific to cycling, or at least a higher occurrence rate?


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## 4Crawler (Oct 30, 2011)

I had some back/leg/hip issues like that a year and a half ago. Tried various stretches but the pain and tightness would not go away.

So taking a cue from the chiropractor I see for a neck issue, I decided to try an inversion table to stretch out my back and decompress the discs. I started out with 2 - 15 minute sessions/day and after about 3 weeks, started to feel improvement. Then once I got the back loosened up and took the pressure off the nerve, was able to do the hip flexor stretches and have those do something.

Been over a year now and no pain and I still hop on the table from time to time when I feel my back tightening up. I had thought about seeing the chiro. about the back issue, but decided the table would cost me about the same as 7-8 sessions. So if it worked, I was ahead of the money. Not saying it'll help in your case, but might be worth checking one out if you know someone with one. 

In my case, cycling did not aggravate the pain, but it did not ease it either.


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## mtrhead (Apr 21, 2007)

I had a bad case of this too a few years back – summer 2010. I didn't get it from cycling but a very fast sprint to first base in a charity baseball game! At first I truly thought I did something to a disk in my back since I have broken my back before, but after reading for weeks on this pain I finally figured out that I had the Piriformis pain. So I did the stretches on youtube, did the tennis ball thing and always sat sideways in my chair/seat for a LONG time (read below). I didn’t go to the doctor since I read it was pretty involved repair (if needed). It was a brutal first year of pain.. However, I was able to competitively ride MTB and play hockey after the first few weeks of heavy pain dulled itself. One point of note is: I never ran for exercise since my ankle got messed up racing MX. I think that is why I had this happen in the first place so bad, my muscles/nerves hadn’t experience that sprinting condition in years. I have read many runners experience this problem. 

Bottom line is I'm pain free today - It was honestly 1 year of serious: "daily you knew it was there and it hurt", 1 year of sitting funny to prevent the pain, to the last 1-2 years it has slowly gone way....could of been all the riding or hockey? don't know...never saw a doctor and never ran to reintroduce the pain. 

Think positive!


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## Old Cheez (Feb 7, 2013)

I have the same issue now and have seen a real doctor who gave me pain pills and told me to go to the chiropractor! I am doing every stretch they tell me and working hard to try and keep this under control. After a long hard ride though, it comes back with a vengeance! Has anyone had any luck fixing this by switching to a different saddle? I am now wondering if that is my next option to try and keep this under control? Maybe narrower and with a cutout in the middle? Any actual knowledge on saddle to piriformis control would be appreciated!


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## mlevinson (Mar 17, 2010)

Been through the L4/L5 thing. I think I started out with a mild case like you, but I thought the symptoms (pain down right leg) were from ITBS - an orthopedic actually agreed... so I thought I was good to go with some ITB rolling!! Wrong! 

I kept riding until the pain really got bad and I must have injured the disks more. Imagine a knife being stabbed into your calf and twisted whenever you are in a seating position. SUCKED BAD!!! It was so bad one morning I literally fainted in the kitchen. Out cold. My wife freaked!!! She made me go to the ER.

MRI confirmed the problem.

I was down for the count for 12-18 months as I slowly healed. I got one epidural which really didn't help me much. I took a little Vicodin to help me sleep for a few weeks and then just let myself heal. I also began working with an excellent chiro that my new Orthopedic recommended. He's helped me get back the last 10% which I was missing after the healing phase.

I wouldn't wish what I went through on anyone, so my recommendation would be to stay off the bike and don't do anything which loads the disks.. which is pretty much anything physical!

I know how hard it is, but the back is VERY VERY slow to heal so listen to your body and rest. You caught it early so your recovery will probably be quicker than mine was.

Good luck dude... I plan to ride today and will be thinking of your disks hoping they heal quickly!


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## ashwinearl (Jan 2, 2004)

Trigger Point Massage Therapy ball is great for getting the piriformis. I put mine on the floor and lay on it and when I hit the trigger point right you can hear it resonant on the carpet.

The TPT ball is much better than a tennis ball which will just collapse, and better than a lacross ball because the TPT has some give on the outside material before a solid core. This allows it to deform a little (like a thumb) to get deep into the belly of the muscle. I use it on my upper back, under arm, chest, hips, hip flexors, quads, calves


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## freeriderB (Jan 9, 2004)

My story was initially thought to be pirifomis syndrome. My left gluteal pain was so extreme that I could not sit at all...especially driving. Working in a cube all day was unbearable. So now my insurance denies an mri and requires pt. Five sessions later and I'm in the worst pain of my life...Finally approved for mri and learn L5S1 is herniated and pressing on my nerves....so...just spent 3 days in hospital after microdiscectomy and have been home for 1 hour
Any back pain that reoccurs should have an mri...GLute pain is the worst by far...teamed up with sciatica is unbearable.
I never wanted surgery but it really was the best option for me.
Mt biking resumes in 4 months...road maybe as soon as 2 months.

I feel for all you guys...good luck!!!


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## xcguy (Apr 18, 2004)

I had a similar pain a few months ago. First, I tripped and fell on my left hip but ignored the pain. Second, I lifted something while re-arranging my storage unit and the pain was unbelievable on my left side, middle of outside of pelvis. I tried to ibuprofen my way through it. I was favoring my left leg so much that I was "short legging" my walking gait so that I wasn't getting full ROM on my left side.

Then I decided to just take a short hike, ya know, take it easy and go slow. Midway through the pain was so incredible, just like that, I literally could not walk. It was like a two inch knife stabbing into that area. Jab! Tears shooting out, nearly falling down. I called out for another hiker to assist me back to my car. Oddly, sitting wasn't painful. I dreaded the idea of getting out of the seat!

I don't have a history of back pain with my insurance so I figured I needed to deal with it on my own. I'd limp to my gym, hold myself up on a rail as I SLOWLY would walk forward, lifting myself up as my left leg went through the painful parts of my motion. Then I'd walk backwards. Then I'd get down and roll that area (sort of outside of the top of my left pelvis) with a black foam roller, back and forth. I found multiple "pain nodules" in there. My right side didn't have any. I've rolled for ITB problems and it works.

Finally I went through one day without the two inch knife jabbing into my hip. Then two days, then three days. Whatever muscle or nerve or whatever in there hadn't spasmed and maybe was calming down.

Then five days, then a week of no knife jabbing in there. It took about three weeks of the slow walking along the railing, forward and backwards, and rolling like a sumb!tch before I could walk again without thinking about it. Yesterday I took the same hike I did over a month ago when it all went south and made it out OK. I carry a safety whistle now!

I don't know exactly what I had but I'm telling you my story to let you know how I dealt with it. ROM and rolling.


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## bamwa (Mar 15, 2010)

This also happened to my gf after a collision with a car 6 months ago. After chiro and massage to no avail a mri revealed an 11mm herniated l5s1. Looking like surgery since that large of a bulge can heal up leaving the protusion still in contact with the nerve.
Those of you with the mri's, how big were the herniations?


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## freeriderB (Jan 9, 2004)

bamwa said:


> This also happened to my gf after a collision with a car 6 months ago. After chiro and massage to no avail a mri revealed an 11mm herniated l5s1. Looking like surgery since that large of a bulge can heal up leaving the protusion still in contact with the nerve.
> Those of you with the mri's, how big were the herniations?


they never told me a size or measurement....they just said "severe herniation" that will not heal on it's own, won't heal with drugs, wont heal with pt. when they opened me up i was told it was bad and actually had a spinal leak which required extended hospital stay flat on my back.

I wish your GF the best of luck.


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## M5Tucker (Aug 8, 2011)

So here's a bit of resolution to my original post, having started this thread. Sorry it's been so long, but I've been out of time & off the bike for most of the last year, because my kid was born less than a month after I had (dun dun dun...!!!) surgery to fix my ruptured/herniated L5, which became apparent after I crashed my bike in May of last year at Laguna Seca. It's a long story...

At Laguna for the ALMS race in May of last year, I wasn't even doing anything fast, cool or difficult (or drunk), just cruising from the Corkscrew back to camp on one of the "trails" above the scoring tower and caught a hidden sinkhole filled with grass and went straight into the ground, badly injuring both arms, hands, left elbow and the left side of my face. If it had been actual, serious riding I probably would have seen it coming, but it was a cruise, and it bit me. Fortunately I was right above the medical station outside Turn 10. He tended to me as best he could, then sent me to the hospital in Monterey for a few hours of excruciatingly painful cleaning, bandaging, & evaluation. 

3 weeks later, after the external wounds healed but not knowing of the hidden escalation to come, I tried riding gently again, and when I got to the top of Hazard Peak in MDO, I got off the bike and the whole right side of my body locked up and engaged in violent contractions & cramps. I laid in the dirt for an hour, stretching as best possible until I could swing my leg over the bike & coast down to the car. Fortunately I was at the top of the hill & not elsewhere in the park, because I would have been F'd. 

The next MRI revealed that my previous bulging disc had become a ruptured disc, by 15mm. Therapy was no longer an option, so I did my homework on the surgery & went in July 3rd of last year for a micro-discectomy & lamenotomy (I'm sure I'm not totally accurate on the terminology, so please correct me if I'm wrong), the operation in which they make a 2-3" incision, then "burn" the offending edge off the disc in question. 

Long story short(er), my back is only just now coming back to "normal" a year later after a long recovery which was made more trying by the birth of my wonderful child shortly after surgery, but I'm confident I couldn't have done without the operation because I'd be useless as a dad or at work if I was in anywhere near the kind of pain I was in. 

I've still got some intermittent sciatica that has dogged me for years, and being a mechanic doesn't help, but I'm basically without pain. I've been riding road & mountain as much as possible to get back in shape for the last couple of months, I'm feeling good, not taking any undue risks, and not crashing. I'm going to Northstar this weekend, to bring things full circle because that's the last really cool riding I did before this whole injury started late in 2011. 

I really, really feared surgery at first, but I have absolutely no regrets & look forward to getting back to riding & trail building in full swing. If you're in a similar situation, do your homework on who's good, don't be afraid to say no to a doc you're not totally comfy with, and with good rehab you'll be turning the pedals again in less than 8 months. 

Cheers all, ride on & stay injury free!


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