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zeta
Trad climber
Berkeley
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Topic Author's Original Post - Jan 21, 2011 - 02:01am PT
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hey, has anyone ever dealt with piriformis? It's literally a 'pain in the ass'--wish I was kidding about this, but I'm not. It irritates the sciatic nerve, it's difficult to diagnose, etc. It's been hurting ever since my first day of tele in December and doing a lot of stretches doesn't seem to be helping (yet). Am considering acupuncture, physical therapy, massage (etc.) but would love to hear about anyone's experiences with this first
thanks!
Jen
http://en.wikipedia.org/wiki/Piriformis_syndrome
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Mighty Hiker
climber
Vancouver, B.C.
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Jan 21, 2011 - 02:16am PT
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It sounds like a pirouette with piriformis would be out of the question.
Did you get it checked by a physio or such? At least to make sure of diagnosis, if not treatment or therapy.
Anyway, good luck with it!
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Seamstress
Trad climber
Yacolt, WA
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Jan 21, 2011 - 02:24am PT
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My husband is a massage therapist. I highly recommend seeing one who does deep tissue work and is familiar with that issue. Working the piriformis and gluts will help.
I also recommend PNF stretching or allowing gravity to help gently stretch out that area. Lie face up on a high, flat surface. Dangle your legs (or just one at a time if it is too painful) off the surface. Just a minute at a time, alternating left and right if need be. Do a set of three. This may be somewhat uncomfortable, but you will feel relief and your back should feel better, very quickly.
You can add a component to this stretch by employing a partner to provide resistence as you activate the opposing muscle group. With a partner to help you, you can do pull up your legs against a force (their hands) gently applied when you are at the end of the muscle's range. Push against that force for 7 seconds, then release. Your legs should dangle just a little bit lower. Repeat 2 more times.
As a confirmed "tight-ass", this works. Like anything else - try it. If it makes matters worse - stop.
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Clint Cummins
Trad climber
SF Bay area, CA
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Jan 21, 2011 - 04:34am PT
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I know Amber Trotter had it. It pretty much ended her running career.
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can't say
Social climber
Pasadena CA
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Jan 21, 2011 - 09:16am PT
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I would suggest as others have, to get thee to a deep tissue massage therapist. It's what I do for a living and I work on people who have Piriformis Syndrome quite a bit. It's particularly common among very active people.
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Skeptimistic
Mountain climber
La Mancha
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Jan 21, 2011 - 09:27am PT
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Definitely find a PT who is a Certified Manual Therapist. They have extensive training in deep tissue manipulation and supporting treatments. While massage may temporarily fix the problem, there are often other factors at work such as posture or gait changes that are the underlying causes which need to be addressed. Good luck
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Tony Bird
climber
Northridge, CA
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Jan 21, 2011 - 09:44am PT
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everyone's body is different and responds in different ways. i developed some sciatic nerve problems and the cure proved to be some regular trail running. i think there's a lot to be said for cross-training--using different muscle groups, exercising the ones that may be getting ignored.
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Wade Icey
Trad climber
www.alohashirtrescue.com
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Jan 21, 2011 - 10:42am PT
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before sinking a lot of time and money into pt and massage, get an xray to rule out or confirm arthritic conditions. I could have saved a year and several k.
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Branscomb
Trad climber
Lander, WY
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Jan 21, 2011 - 10:47am PT
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My daughter did a couple of months of PT after she had an enclosed abcess in the piriformes region this last summer. Lot of toxic muscle damage/adhesions in there post-infection.
The PT consisted of 3x a week doing heat and electrical stimulation and ultrasound stimulation. She also did a lot of gentle stretching twice a day, nothing agressive, just gradual.
All that stretching and PT really helped, she had a lot of trouble walking before she started it and now she's walking fine. Our insurance covered the whole thing, since the doc ordered it as part of her recovery.
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zeta
Trad climber
Berkeley
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Topic Author's Reply - Jan 21, 2011 - 11:55am PT
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thanks!
seamstress: i didn't even realize what PNF stretching is, but maybe I should add that to the stretches I'm doing now--there's seems to be divided opinion on stretching & piriformis. Some warn not to stretch too much; others say it's the best thing to do so I'm trying to hit it somewhere in the middle...
stzzo: massage rec. in berkeley? yes, PM me in the info, though I hope they're not too expensive or take insurance
regarding deep tissue massage, that's what I normally do but I really wonder if the massage will be able to 'get there'--it's a pretty deep spot!
branscomb: how did your daughter's abcess diagnosed?
thanks for the recs/ideas, keep em coming!
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Seamstress
Trad climber
Yacolt, WA
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Jan 21, 2011 - 12:19pm PT
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It can get in there - my husband is over 200 pounds, also in construction and a climber. I can FEEL when he is applying pressure to those trigger points. I'vw been a runner for 32 years and competed in the local and regional road racing circuit forever. I belong to a very competitive team,and some gals are national class runners. My team mates love him.
All stretching has to be very careful not to go too far or it will trigger an armoring response...or rip. I am a terrible stretcher. It should not be approached as a competitive sport!!
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Branscomb
Trad climber
Lander, WY
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Jan 21, 2011 - 12:24pm PT
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It was a sudden onset. Her hip just started hurting and she could hardly walk. We thought she'd pulled a muscle or something, but then she started to spike a temp and we took her to a doctor who, very fortunately, is a very sharp guy and picked up on this quickly before it became critical.
It was near all these major artery and nerve structures and deep in those big muscles, so they couldn't drain it. Had to fly her to Children's Hosp in Denver where they blasted her with big IV antibiotics for a week.
Prety bad. I think Kristi and I aged about 25 years last summer.
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Branscomb
Trad climber
Lander, WY
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Jan 21, 2011 - 12:39pm PT
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Specifically the diagnostic routine was an X-ray of the hip to R/O an epiphysis (slippage of the growth plate on the femur head), then a CBC which had a low WBC count but a high granulocyte %...weird but suspicious (probably all the granulocytes were concentrated around the abcess while the marrow was pumping out more to compensate for loss), and a CRP, which is a indicator of inflammation, which was slightly elevated.
Pretty slim evidence but he picked up on it and had us go to the hospital where where they did a ultrasound and blood cultures. The next day they did a MRI and that showed the abcess pretty clearly plus the blood cultures were all ready couming up positive for gram pos cocci in clumps (Staph). Fortunately it wasn't MRSA, but a pretty susceptible Staph.
Nobody up here had ever seen this but in Denver they told us it was not uncommon in teenagers, esp girls, to get these closed abcesses like this, usually in a joint. They see about 3-4 a month at Denver Children's.
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scuffy b
climber
Three feet higher
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Jan 21, 2011 - 01:44pm PT
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The piriformis is very susceptible to massage.
It's deep, but not so inaccessible as you might think.
Probably easy to miss if you and your therapist are not
already thinking Deep.
Pigeon pose is a good stretch for me. Be patient for good
results.
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quartziteflight
climber
Who knows?
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Jan 21, 2011 - 03:37pm PT
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Ive had problems with my piroformis for years it sucks try this.
copied and pasted:
This self-performed myofacial release using a tennis or lax ball can be performed everyday by athletes (or the general population) to help drastically decrease low-back pain. Give it a try
http://www.youtube.com/watch?v=HWfnAUsYUTI
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neebee
Social climber
calif/texas
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Jan 21, 2011 - 05:17pm PT
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hey there say, zeta, hope you get well soon...
this happened to me, at the cat shelter...
i had to do a different cat cage series, to clean...
instead of the top cages...
i had to use my one leg to lug the heavy stuff out through the low door, and could not change from leg to the other, or anything, to not overstrain my leg...
well... it got to the point where i could not WALK at all, on that leg...
i learned what it was by all the symptons... and it took about two years to get well... massage therepy make it nearly well, and rest, too, and some stretching...
but the thing that made it take so long was that the sacrilliac bone joint, was pushed up somewhat, due to the muscle under it, bulging somewhat, from the muscle strain...
my friends, some osteopaths from england, manipulted the bones some, and such and it went back in place, after so long...
been about fully better, until i had been moving out of my little place, to the bigger one...
now, i am hurting again, but after rest, i think it will be well again,as the bone is not pressing outward...
really awful stuff, it was... :(
but--all in all, i am thankful that i did not hurt by back, by lugging that cat litter, out, without the aid of my leg, it would have been worse, in the long run, if i had hurt my back...
so, get well soon...
PATIENCE is what you will really need...
and rest, is for it not to get INFLAMED...
in those cases, sometimes it is said that surgery is needed, but that can make it worse in the long run, too... if it scar-tissues up...
best wishes.... i wish mine had never got hurt...
sometimes i feel i will never be the same, and i can't other folks
any more, or clean house well, etc... :(
but i am still happy, as i can WALK, run, and play with the ol pup dog...
lifting stuff, is a no-no though, as it make odd pullling, unless i hold stuff, in the middle chest area, with using both arms...
please let us all know how you fair, in this hard journey...
god blesss...
:)
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zeta
Trad climber
Berkeley
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Topic Author's Reply - Jan 27, 2011 - 07:28pm PT
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so...i've done a bunch of things lately and am figuring some things out that are helping my piriformis
first, deep tissue massage:
i had this sports medicine guy massage my butt for 1 hr which was *awesome* I realized that I had been doing some stretches wrong--which was actually making the piriformis hurt more than less... he gave me some good tips on correct stretching
then, acupuncture:
after she put needles in my toes and hand, she had me do the piriformis stretches on my back (carefully, with the needles in!) When I did that, the piriformis pain didn't hurt and there was all this heat in my leg. Not sure if it helped but for $20, it was worth a try. Think I'll go again
and then today, PT:
i did some finagling to get an appointment w/ a well-known PT which was definitely worth it. She's awesome. My piriformis is not at all radiating (no related sciatic which is great!) but appears to be linked to lower back pain that I've been ignoring for a long time. Taught me different ways to sit, posture stuff, ways to set up my laptop to be better for my back. Have 3 more appointments set up.
I still need to be patient--which means no climbing, running, biking, or skiing any time soon--but I think if I'm religious about these stretches (icing also and rolling on the tennis ball), it'll get better.
hope some of this was useful and definitely planning to be back in Yosemite this spring!
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HHL
Trad climber
Stumpcreek, WV
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Jan 27, 2011 - 07:40pm PT
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I have chronic low back and piriformis pain. Stretching and just being active helps. Try to avoid any prolonged sitting as that seems to cause flareups for me. Good luck.
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zeta
Trad climber
Berkeley
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Topic Author's Reply - Jan 27, 2011 - 07:48pm PT
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avoid prolonged sitting?
i'm writing a dissertation! but otherwise, yeah, well i'll try!~
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Seamstress
Trad climber
Yacolt, WA
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Jan 27, 2011 - 08:24pm PT
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Unfortunately there are times when you have to scale back and take action. That can be very difficult. Be diligent enough to make this a short, healing break. I find it hard to stick to a healing plan until I am crippled. Then I get religion and do all the right things for the days/weeks necessary to get past it. Patience and diligence are your friends.
Your experience about stretching incorrectly is very common. These folks - massage therapists and PTs see a lot of that. Sounds like you are using this time very productively!
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Aerili
climber
Reno, NV
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Jan 27, 2011 - 08:27pm PT
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I had this for years from ballet. Nothing helped as long as I persisted in my activity (stretching only helped the symptoms temporarily...and my piriformis was not tight, anyway.)
Finally I saw a chiro who did ART (Active Release Technique) on my sacro-tuberous ligament. Most amazing treatment ever! I would make a bet that it will be more effective than something like acupuncture if you find a good practitioner.
Your PT may also address some muscle imbalances you have going on. Although I also lifted weights in my ballet days, I feel the muscle corrections did not come until eventually I stopped dancing altogether (due to a hip injury).
Good luck.
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Sierra Ledge Rat
Social climber
Retired to Appalachia
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Jan 23, 2012 - 06:34pm PT
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Just stumbled on this thread
I developed piriformis syndrome 20 years ago while running trail ultras. Still have it today. Tried everything, the only that has worked is "acceptance."
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Adamame
climber
Santa Cruz
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Jan 23, 2012 - 06:47pm PT
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I've had it pretty seriously over the last few months. PT and doctors didn't really help. Then I went and saw Elaine Lee at Midline in SC. Being a climber she was able to pinpoint some problem areas that she loosened up through rolfing. This has helped a good amount.
But from what I have been told the biggest contributor to this is stress. Whether it is work related or perosnal, Id find a way to shed it. Don't let the injury be the stress. And if you work at a desk you are pretty much screwed, we aren't made to sit on our ass all day long. But what really cured this problem, going into the woods and hiking, it may be painfull at first but the stress relieving properties of the nature take over at some point and open you up to healing.
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HHL
Trad climber
Stumpcreek, WV
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Jan 23, 2012 - 08:06pm PT
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Buy a foam roller and roll back and forth on your trigger points. Also, try doing the number 4 stretch. Put your left ankle on your right knee, reach between your legs, grab your right knee, pull towards chest while pushing down on left knee with left elbow. Stay active.
Good luck, I have been treating my pain with this technique for years. It never goes away completely, but it is manageable.
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neebee
Social climber
calif/texas
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Jan 23, 2012 - 08:28pm PT
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hey there zeta... glad to hear the update...
after the two years... mine has been well...
but, if i sit on low stuff, or lift, or sit funny, i will suddenly feels it haunting me...
it goes away, though, within the hour, after walking and stretching it out..
i never had pre-back pain, though many do...
mine was always in the hip, that started from that bad job at work...
folks do not realize, YES:
it builds up, does not happen over night, though it SURE feels like it :O
a pretty fearful thing.. makes you think you will never walk again :O
keep letting it rest before you get back to the really hard stuff...
and keep AN EYE OUT for what triggers it in the future...
so thus, you can avoid such positions, etc...
some folks claim they never really get well, but i think those folks
have not gone through all the 'learning process' to see the how to, as to fixing it early... and the damage may be deeper... from a longer stress time....
edit: wow, siera ledge rat... sorry to hear this...
yes, it must have progressed pretty far, ... you never know, you may still
find something to help... i thought the therapy etc, would never make mine well--but some osteopath friends of mine, a year later think it was, found some more trigger points to help solve it... don't give up...
though i still LIVE with having to take care... :)
keep on getting well! :)
i am happy i can run, dance, and do my garden, clean house, and all kinds of stuff again!
thank the good lord! :)
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nature
climber
Aridzona for now Denver.... here I come...
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Jan 23, 2012 - 08:56pm PT
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If I did I'd be SHOT at dawn...
fux that locker, we wouldn't wait!
give acupuncture a try
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brat
climber
El Portal
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Jan 23, 2012 - 08:57pm PT
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I, too, deal with piriformis and radiating sciatic pain.
As far as I can tell, the trigger is lots of activity followed by lots of sitting -- big trip and then a long drive home.
I've done the massage therapy and the rolfing and the PT... and through all of it, the thing that helped most was getting a cushion thing for my car seat. Now that I'm back in school, I move it from the car to the desk chair.
Just something to consider, especially if you spend a lot of time in a bucket seat.
The foam roller was also the best $12 I've ever spent.
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klk
Trad climber
cali
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Jan 23, 2012 - 09:02pm PT
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hi zeta,
i used to have piriformis problems at least once a year.
http://www.youtube.com/watch?v=HWfnAUsYUTI
i now use a lax ball as part of a daily regimen, and it's done away with it entirely, so long as i stay on top of it. if yr piriformis is already ganked. i would second a goody body worker until it gets to a point where you can do more on yr own. (when mine was bad, i couldnt even put my shoes on by myself.) i find a quick routine with a swiss ball (for iliapsoas) and then using the lax ball on the it, pf, and long back muscles makes a huge difference-- better than all the years i did of chiro, pt, etc.
mike papciak is a berkeley bodyworker who is also a good climber.
http://mikepapciak.com/
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Johnny K.
climber
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Jan 23, 2012 - 09:32pm PT
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Inversion therapy,try it,you have nothing to lose but pain.
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Riley
Trad climber
Canada
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Jan 23, 2012 - 11:20pm PT
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This stretch has helped me immensely. Stemming used to be out of the question, to say the least.
Note however, that it is very deep and painful!
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zeta
Trad climber
Portland, OR
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Topic Author's Reply - Jan 24, 2012 - 02:11am PT
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yep, this thread still goes on, b/c I still have piriformis!
In the last year, I've been to 3 different PTs, done lots of different stretches, massages, resting/taking it easy...all to various degrees of success. The foam roller--for all the rave reviews--never quite got to the spot. But I have balls of various sizes that I roll on which sort of help.
the things that have helped the most? core strengthening exercises, buying a cheap inflatable pillow for my computer chair and car seat, moving around a lot more, and learning type on my laptop standing up at a cafe...
it still sucks though. It got a lot worse in the past month b/c I tore my ACL in Dec. and haven't been able to do any of the piriformis stretches, b/c of the swollen knee post-surgery. I guess I was walking in such a way to compensate for the knee and ended up messing up the piriformis instead!
complaining about my ass makes me feel suddenly old! anyways, I think Sierra Lodge Rat is right, I think it's just about "acceptance"
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Bruce Morris
Social climber
Belmont, California
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Jan 24, 2012 - 02:36am PT
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Piriformis syndrome is a rather frivolous concept with no evidence of validity.
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rottingjohnny
Sport climber
mammoth lakes ca
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Jan 24, 2012 - 04:08am PT
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Zeta...I have that sh#t..had this olympic trainer stretch me back and forth like a rag doll and it got rid of it ...But what really has helped is getting 3 inches of padding on my chair from where i post on supertopo...Don't sit down...keep running in circles and wave your arms...Getting rid of coffee from the diet helps also... but i'm a weak cuss and can't part with the devils brew...Stretch your hip-flexors...quads...RJ
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rottingjohnny
Sport climber
mammoth lakes ca
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Jan 24, 2012 - 04:11am PT
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PS...and the blue butt plug..! RJ
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Sierra Ledge Rat
Social climber
Retired to Appalachia
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Jan 24, 2012 - 05:39am PT
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Piriformis syndrome is a rather frivolous concept with no evidence of validity.
Ignorantia beata est.
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gunsmoke
Mountain climber
Clackamas, Oregon
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Jan 24, 2012 - 09:26am PT
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everyone's body is different and responds in different ways
I had some really bad trouble with the piriformis a number of years ago. Finally I found a doc who thought that the trouble was actually with the SI joint, which is an insertion point for the muscle. They did a really painful cortisone injection into the joint. Problem solved. I've had some minor flare-ups since, but that one injection took me from non-functional to functional.
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Bruce Morris
Social climber
Belmont, California
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Jan 26, 2012 - 03:45pm PT
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You've got to realize why the piriformis muscle is contracting and cramping in the first place: Lack of oxygen. Big question: Why? Obviously the autonomic nervous system, which is responsible for sending oxygen to the nerves, muscles, and tendons, is reducing the oxygen level in the piriformis for some unknown reason, like maybe self-imposed emotional stress from within or environmentally imposed emotional stress from without? No one really knows why steroid injections work, but they do sometimes. Quite possibly a placebo reaction. That's why you can never predict their effectiveness or why the pain comes back. No doubt the piriformis muscle is contracting and putting pressure on the sciatic nerve, but no one really knows why except that it hurts. My guess would be that the sciatic nerve is also involved in the oxygen debt syndrome and that's really why it really hurts a lot.
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Patrick Sawyer
climber
Originally California now Ireland
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Aug 20, 2014 - 08:11am PT
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I had piriformis syndrome several years back (right leg). I was seeing a friend who is a neuromuscular therapist, he was working on a shoulder injury of mine (skiing in Italian Alps about two years before, pins and needles, numbness in lower left arm/hand).
Because Dene (a Kiwi living in Ireland, where his folks are from) did such a good job of ridding me of the pain, numbness etc (primarily using dry needling and deep tissue massage and some stretching), I asked him to tackle my piriformis problem.
Several sessions of release massage (and some dry needling) and voilą, no problems for about five years now.
For my sciatica (left leg, numbness/pins/needles down to the toes), I found a bloke that specialises in several therapies and ran a clinic with his mom.
He used Amatsu to both diagnose (pinched sciatic nerve fifth lumbar) and treat me. After five sessions, again, voilą. Haven't had trouble for over four years. He also gave me some stretching exercises.
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Bruce Morris
Social climber
Belmont, California
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Aug 20, 2014 - 12:28pm PT
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The placebo response is very powerful no matter what elicits it: dry needling (ouch!), acupressure, stretching, massage etc. etc. Sometimes surgery does it too. Whatever works for you!
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Patrick Sawyer
climber
Originally California now Ireland
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Aug 20, 2014 - 04:00pm PT
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Hey Bruce, I didn't find dry needling to be painful. Helpful for sure.
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Bruce Morris
Social climber
Belmont, California
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Aug 21, 2014 - 11:03am PT
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"Deep in the buttock there is a muscle, the pyriformis, which is in close proximity to the sciatic nerve as it passes through the greater sciatic notch on its way into the leg. I do not know where or when the diagnosis was first proposed, but it was theorized that buttock pain was the result of compression of the sciatic nerve by the pyriformis muscle. It has not been scientifically explained why this happens or under what circumstances. In my view the diagnosis is without substance and has only been proposed in the absence of a better explanation for buttock pain . . . . The diagnosis of pyriformis syndrome is a fad that appears to be fading away."
Dr. John E. Sarno, Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation, New York University Medical Center.
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