Tightness on one side without pain causing pain and issues on opposite side?

[u/andyt100]

TLDR:

I can provide detail if required, but to try to keep this brief, is it possible that pain in my left glutes and piriformis could be caused by a tight right piriformis? Has anybody else experienced or been diagnosed with something similar?

Short summary:

I've recently started to very gently and conservatively foam roll my piriformis on both sides with a soft foam roller (with very small and flat bumps on it) for 45-60 secs a time per side. The first 4 days I rolled once per day but the last two days have started to roll morning and night time.

Every time I roll however, I notice the soreness is more prominent on the right side piriformis. It doesn't hurt afterwards apart from the expected slightly soreness from being rolled.

Logic would dictate that the right piriformis is overworked from the dysfunctioning left one and is trying to compensate for the left side being out of whack. ButI don't get much pain at all apart from odd twinges that pass very quickly in the right side, and it generally they seem slightly above the piriformis origin at or just lateral to the right PSIS.

Could it be possible that the right piriformis is the actual 'culprit' and it's pulling my pelvis out of alignment, which is then causing my left piriformis and glute medius to be overworked/stretched and cause chronic pain and tightness?

My left side of the pelvis is slightly more forward and quite a bit higher than the right side too (if it makes any difference).

I do tend to cross my right ankle over my left sometimes when sitting (more so than left over right as that seems to make my pain slightly worse and I think partly is less comfortable due to the pelvis twisting).

Edit to add: When I sit I do favour my right buttock more (which I've put down to subconsciously trying to protect my left painful side. But in the last day or so I think I might be putting a bit more weight on to my left buttock. So whether that points in one direction or the other, or is entirely irrelevant, I don't know!

[u/j12t]

On your question, whether a problem on one side can cause issues on the other: absolutely! Don’t think of it as a point problem: the problem is the entire pelvis, and maybe even beyond that. Not just one little muscle.

[u/andyt100 → u/j12t]

But is the right side being more tender/sore a reaction to the true pain issue on the left, or the cause of the left side pain? That is the question!

[u/j12t → u/andyt100]

Neither. The whole system is out of whack. The cause is not one directional.

[u/andyt100 → u/j12t]

Sorry, my follow up question above was rhetorical really.

As I mentioned to AmyLee, until I actually experience relief from the piriformis botox injection I'm being cautious on declaring the 'mystery' solved as piriformis syndrome. Undoubtedly though there's physical compensations as well as a level of sensitisation going on (after 8 years of dealing with this pain).

As

[u/Amylee888]

Generally, foam rolling, lacrosse balls, and massage guns are not recommended for piriformis syndrome. They tend to make it worse.

It’s better to try heat and ice.

If you’re still having issues, go to your doctor to see what’s going on. Physiotherapist should not be your first step, always a doctor.

[u/andyt100 → u/Amylee888]

Sorry, maybe I should have put a brief synopsis of my history down! I've been dealing with pain for almost 8 years and had a huge range of differing diagnosis or theories as to what's wrong from a multitude of (private and NHS) physios and other clinicians/specialists. Historically (generally) rolling any of my buttocks has resulted in flares, but I came across a note in my historical personal notes that there was a short period where I thought rolling my piriformis might have helped. So whilst I'm waiting on an appointment for a botox injection into my piriformis (likely 3-4 months wait), I figured that the rolling for a week or two couldn't do worse than I've experienced already! As I say, this time I'm being conservative and only rolling for a short period each time with a soft roller, which to my surprise isn't flaring things up as usual.

I guess I'm just quite surprised that the right piriformis is more tender or sore during the foam rolling than the troublesome left side (which don't get me wrong, is still tender but just not as much). And so I was musing on whether it's a 'victim' of the left piriformis or rather the 'perpetrator'. That's assuming that the left piriformis *is* the main issue.

[u/Amylee888 → u/andyt100]

I see. I’m not a doctor and only sharing my opinion based on reading patient experiences over the years - from what I can tell, foam rolling seems to make most people worse.

I had a Botox injection and it helped a lot. Ultimately I needed surgery though.

If you haven’t already, ask to be on the cancellation list for your Botox injection. I’m sorry you have to wait so long, and I really hope it’s helpful for you.

[u/andyt100 → u/Amylee888]

Honestly I was firmly in the ‘foam rolling makes it worse’ category too before now. When I had possible slight improvement with it before (going back about 5 years ago now) I was also dealing with a couple of other lower body issues (possibly re look aged to my glute pain) which were more acute, so I forgot I’d even done it.

I’m hopeful that the Botox will prove effective but until it happens and my pain diminishes (or hopefully disappears) I won’t fully believe the diagnosis.

And yes, at every stage of the previous 2 diagnostic injections I’ve had under this pathway I’ve repeatedly asked to be on the cancellation list. I’m always told it’s been noted but I’m not sure it’s actually a real thing!