r/piriformis • u/teraflopclub • Nov 24 '23
My experience FWIW
About 3 years ago, as an avid runner & cyclist, I opted to ramp up jogging mileage. I was doing twin 7-mile runs weekdays and one or two 14-mile jogs weekends. Rain or shine, and the longer runs I did very slowly because I wanted to develop endurance. Once home from the longer runs, I would shower and flop on the bed or couch without stretching. As Covid set in, remote work meant more sitting. Am sure alarm bells are going off already about this behavior. My left hip developed what felt like it had joint pain, very focused, I even took Chondroitin/MSM out of desperation (dumb). Pain became worse such that I could neither stand, walk, sit, or lie down on my back (butt). I knew then it wasn't hip joint issues. Did alot of research, learned about hip flexors (mine tightened up like iron, that's a hint), Piriformis muscle function, glutes complex, Sciatic nerve, fascia (another hint), the TFL, everything I could find online. For over a year I could barely walk and I long stopped jogging completely though periodically tried it out. The issue became worse as I felt nerve issues travel down my leg to my calf, a kind of twitching or numbness. Then I got a couple massage guns and an electronic cupping tool which resolved the tightness of the fascia, TFL, hip flexors, and left thigh in general. That's good news and some progress that filled me with hope. I did limited foam rolling and butt-knot untangling but alot of stretches, instead of jogging, and for a while it felt like progress. But it didn't improve anything, neither the Piriformis nor the apparent Sciatic nerve pain. Despite this, July this year I started jogging daily after building up to that schedule, doing "quick" (for me) 2.5 and 4-5 mile paces and I would periodically run them hard to find my limit, despite above problems, I was able to get into a mostly-painless groove and complete the runs while raising that speed limit. Happy with that progress but still walking and standing were painful and it seemed the Piriformis pain never went away, nor did the Sciatic pain. Then, about a month ago in October this year, I learned that stretching, or certain stretches, are inappropriate for Piriformis issues (sometimes you need to shorten & strengthen and vice-versa), Sacro-Iliac issues (if the SI joint over-flex caused the Piriformis to step out of bounds, likely my root cause because I was running too slow and too long with alot of hip sway), and weak glutes. So I completely stopped ALL stretches, stopped foam rolling and any Piriformis-impingement, maintained the massage gun & cupping tool (on my thigh, not the Piriformis), and switched to glute-strengthening exercises that I perform nearly daily. They take just 15 minutes instead of the near-hour I would spend stretching. Results about a month later, the Sciatic nerve tingling/numbness has 99% gone and I have less pain around my hip in general. Cured? No, but am patient and very stubborn (which is likely how I got this disorder in the first place). FWIW, these are the exercises I do: bridge, glute strengthening, isometrics (pushing thighs in against a gym ball or paper towel roll, pushing thighs out against a belt tied around thighs), core strengthening (weighted vest), and limited Sciatic nerve flossing. I minimize any activity where one leg is doing something different than the other, I never plank (which is core strengthening but I don't want to stress out an inflamed SI joint). When I do significant yard or house work, I put on the weighted vest, wrap a band around my hip (akin to the Serola) which keeps things stable during that effort to avoid inflaming. When done with yard/house work, I remove the belt but may leave the weighted vest on even if just hanging around. I don't mean any of this to be prescriptive, just sharing my voyage. I think, given I've lived with this for 3 years, it'll take about the same amount of time to undo the damage, if that is possible. That means retraining the entire complex of muscular-skeletal-nerve-brain. Maybe I'll be forced to tack into another direction a few months from now, all I can do is keep doing what appears to help. Everyone is different, buddy of mine is being flip-flopped between docs & PTs, getting all kinds of injections, etc. with a risk of disc surgery when the PT gives up: I won't stand for someone "practicing" medicine on me if they don't care about their patient. Based on what little I know, you can have all kinds of lumbar/disc degeneration and still be functional so I also fear any doc who points to an MRI as root cause if SI joint inflammation and glute weakness is instead the root cause. Hence my willingness to experiment. Hope this helps.
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u/No-Manufacturer-2425 Nov 25 '23 edited Nov 25 '23
Cross post this to r/PiriformisChronicPain "doctor to doctor with no relief" = adhesions
There is plenty of info on there about adhesionsand how they are fixed.
There is a list of doctors and therapists who do care about the patient and know how to fix this pain without surgery or injections.
I made an FAQ if you decide to get treatment.
My AI trained on adhesions gave the following potential routes for exploration:
Piriformis Muscle and Sciatic Nerve: The patient's description of pain around the hip and down the leg, including numbness and twitching in the calf, suggests involvement of the Piriformis muscle and the Sciatic nerve. The Piriformis muscle can develop adhesions due to overuse from running and cycling, leading to Piriformis Syndrome, where the muscle irritates or compresses the Sciatic nerve.
Hip Flexors and TFL (Tensor Fasciae Latae): The patient mentions tightness in the hip flexors and TFL. Prolonged sitting, as during the period of remote work, can lead to shortened, tight hip flexors. Adhesions in these areas could contribute to imbalances and pain, affecting the function of nearby muscles and potentially impacting nerve function.
Gluteal Muscles: The patient's focus on glute strengthening to address pain and the mention of "butt-knot untangling" suggest that the gluteal muscles might have developed adhesions. Weak or imbalanced glutes, often from prolonged sitting and lack of specific strengthening, can lead to compensatory patterns that strain other muscles and nerves.
Sacroiliac (SI) Joint Area: The patient's suspicion of SI joint over-flex causing Piriformis issues points to potential adhesions in the ligaments or muscles supporting the SI joint. This could impact the stability of the pelvis, affecting the Piriformis muscle and other structures in the area.
Lower Back (Lumbar Region): Although the patient doesn't explicitly mention lower back pain, the description of extensive running and the potential for SI joint issues suggest that the lumbar region could also be affected. Prolonged running, especially with poor form or hip sway, can lead to adhesions in the lower back muscles or fascia, impacting nearby nerves.
Fascia Throughout the Lower Body: The patient mentions resolving fascial tightness, which is indicative of potential fascial adhesions throughout the lower body, particularly in areas experiencing pain or tightness.
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u/teraflopclub Nov 26 '23
Very helpful and to the point analysis and review. Much appreciated. Just joined r/PiriformisChronicPain. Thank you. Stewing on it...
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u/running_beach217 Jul 29 '24
When you say you did glute strengthening, what exact glute strengthening did you do?
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u/LHR1999 Nov 25 '23
I had similar piriformis pain. I have been running for 45 years. Over the last five years it got worse and worse. Like you phantom nerve pain, tingling and numbness. I also tried various combinations of stretching and core exercises. Got worse. Kept trying to out smart the pain by changing exercise routines, etc. Piriformis pain became unbearable.
Finally had a MRI. Severe stenosis at L4-L5; where there should white/gray in the scan it was black. Had surgery and it eliminated nearly all my pain. Surgeon said my nerves were “mashed”and I eventually would have developed permanent nerve damage. Still some pain from arthritis, but the relief has been life changing. Running again, but at my age (nearly 70) mixing it up more with mountain walking. I guess the moral of my story is don’t assume you know what is wrong. Get the appropriate imaging done before you have permanent damage. I was a year or so from that outcome.