2 years ago I was running contently, working on mileage. Sure, I only ran about 5 miles at a stretch, but it was still awesome – I loved the high, and loved how it changed my body.
Then the pain started. It radiated down my left buttock and sometimes around my hip as well. Slowly, at first – a little stiff in the left glute when getting out of bed in the morning, a twinge here and there throughout my desk-job work day.
And then it got worse. And worse. And then I thought…”My god, I’m only 27 and I have sciatica!? How is that possible?!”
A trip to the doctor later (where he had me do some simple stretches that I, essentially, failed at doing pain-free) I had a script for 6 weeks of physical therapy, 3x a week.
The physical therapist had me do similar stretches (sad. Laying on my back, I couldn’t stretch my leg past 45 degrees up in the air!!), she measured me to make sure my legs were the same length (they’re identical. Apparently that’s uncommon), and then checked my hips (which were horribly out of alignment). Based on my pain complaints, I was diagnosed with piriformis syndrome, and told to quit running until I was rehabbed.
I ended up doing 8 weeks of physical therapy, 3 times a week. I learned stretches, increased my flexibility, had deep tissue massage, and learned techniques to strengthen my core, lower back, glutes, and hip flexors.
I was approved to quit PT and run again, however, after only one month of running, I was back in pain. I quit running again, went back to all the education I had been given during PT, and rehabbed the inflammation in my piriformis.
I tried running AGAIN – and 3 weeks in, I was once again in excruciating pain.
I have been unsuccessful in eliminating this problem on my own….but have learned a lot about it throughout my struggles. To date, I am not running, but hope to try again this spring when the weather clears up.
In the meantime, here is some of what I’ve learned…
What I’ve Learned:
- 2 million Americans suffer from Piriformis Syndrome – Sports Injury Handbook (I’m certainly not alone!)
- Women are 6 times as likely to have Piriformis Syndrome –Fundamentals of Orthopaedics
- 15% of people have a condition that predisposes them to Piriformis Syndrome. In these cases, the sciatica nerve goes through (instead of around) the piriformis muscle, causing irritation and sciatic nerve pain. (Mayo Clinic) – this is me!
- Piriformis syndrome can be caused by imbalances in the core muscles pull the pelvic bones and hip joints out of place, which causes the piriformis muscle to contract and shorten, creating pressure on the nerve (Source)
- Another common cause of piriformis pain is overuse… runners, bicyclists, and rowers commonly complain of piriformis pain (Source)
- Piriformis pain often feels like a radiating pain from deep within the left buttock. It can also travel around the side of your hip. It often continues to hurt, long after the activity that caused it (for me, running) had ended.
Triggers for continued piriformis pain (for me) included…
- Sitting for extended periods of time (I work a desk job, but I make sure I get up, move, and stretch about once per hour)
- Stair machines at the gym or using stairs for cardio (such as at a park, or at home, or on bleachers)
You should speak to your doctor about which treatment is best for you, however, most treatments for piriformis syndrome include…
- Stretching and increasing flexibility. Especially of the hamstrings, lower back/core, and hip flexors
- Balance work (which helps strengthen and balance the hip flexors and core, making the body more balanced as a whole)
- Physical Therapy
- Massage Therapy
- Discontinue activities that aggravate the problem (like running and stairs for me!) –this one makes me unhappy!
Below are some of the stretches I do. I do these every day I am active, and every day I am sitting at my desk….this prevents my hamstrings and lower back from getting to tight, and pulling on my piriformis/hip.
I don’t do all of these stretches every day – I’ll pick 5-6 and do those and then pick a different set, to keep expanding my flexibility…when I began with this problem, I could barely touch my knees in a forward bend. Now I can wrap my hands around the bottoms of my feet! LOL
Spinal Roll (front to back)
Spinal Roll (side to side…I find if I do this one JUST right, I can feel it massaging the ‘knot’ that is my piriformis muscle)
Hamstring Stretch with Belt/Towel (it’s #5 at that link)
Cross-Legged Piriformis Stretch (#3 at that link)
Sitting Crossed Piriformis Stretch (it’s #8 at that link)
Cat/Cow Back Stretches (yoga pose)
Assisted Plow Pose (yoga pose…I don’t go that far. I support my lower back with my hands, and stretch my legs out over my head, almost horizontal)
Pigeon Pose (yoga pose)
In addition, I do these strengthening exercises 2-3 times a week. My PT also gave me several good cable exercises, however, my gym is not equipped for me to use them, so I’m not including them here.
Leg lifts – lying on my side, lift top leg, keeping hips straight
Leg lifts – lying on side, place foot of top leg on the floor in front of your bottom knee, and then lift bottom leg
Leg lifts – lying on your back, abs tight and lower back against the floor, one foot flat on the ground, the other leg laying straight out; raise the leg laying straight out to about 45 degrees and lower; repeat and switch legs.
Wall Squats (I squat against the wall – you can also use an exercise/swiss ball between you and the wall – and then I hold that squat for ~60 seconds. Stand up, stretch a bit, and repeat)
Bosu Ball Balance (I stand on a bosu on one leg and work on my balance. Sometimes I stand on the ball, sometimes the flat disc, and sometimes I even close my eyes. LOL)
I also find that incorporating yoga into my fitness has helped immensely. Yoga contains a lot of hip opening flows, and it helps my hips stay centered and keeps me from being pulled off balance.
Also, the foam roller and/or a tennis ball are your best friends. The foam roller is quite popular with runners for all types of tight muscles, and works equally well on piriformis issues. A simple tennis ball can also help you massage your piriformis muscle if it’s causing you pain (you can do it against a wall, or laying on the ground).
And lastly – ice and heat. I’ve found both to be quite helpful early in my piriformis pain.
As with anything, if you are in pain or are concerned that something is wrong, please see your doctor. They can give you the best treatment options for you!
- Runners World – Runners Yoga Routine (highly recommend this!!)
- Wikipedia – Piriformis Syndrome
- About.Com – What is Piriformis Syndrome?
- eMedicine – Piriformis Syndrome
- Sports Injury Clinic – Piriformis Syndrome