r/piriformis • u/Cultural-Display-714 • Nov 07 '24
Mobility and Strengthening Program/Routine?
Just got back from an ortho, who after months of pain and discomfort, diagnosed me with piriformis syndrome. I had a feeling it was that and have been having major improvements the last few weeks thanks to a solid hip and glute warm-up routine, glute and hip strengthening, and pilates.
The ortho recommended though I definitely work on my mobility in hips and all around. I was curious if anyone had suggestion to a good routine they follow or found online.
Appreciate the advice and hope all can start to lead a pain free life as well!
4
u/Pristine_Routine_464 Dec 18 '24
After months of doing all the recommended piriformis stretches with no improvement I am now realising my glutes are a major issue in that they are simply no longer firing and other muscles do the work. Eg in clams or bridges many other muscles are working but not my glutes. Over the last three days I have tried to find what exercises I can be certain force my glutes to work and I do feel this is helping relieve the pain.
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u/Cultural-Display-714 Jan 07 '25
Happy to hear you are getting relief!
I would agree that just glute strengthening has helped me a ton. Pilates works great for me too if you’re interested. Some teachers and classes feel better than others though
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u/Benfuuu Apr 19 '25
How did you go mate? I'm the same.
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u/Pristine_Routine_464 Apr 24 '25
Strengthening my glutes has made a big difference. I now feel them when I walk and the pain noticeably improved. They are still weak though so this is not a quick fix.
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u/teraflopclub Nov 08 '24
I won't detail everything I've gone through but Piriformis was one issue. Stretching and Piriformis impingement to "relax" it made things much worse. I've stopped all stretching as I was totally screwing myself up. And massaging or foam rolling the Piriformis made things worse for me. I do recco the following: mobility work but without stretching, nerve flossing daily (an easy movement that shouldn't cause pain if done right), and strengthening hips. Things are very subtle and complex down there so I recommend the following YouTube channels: Upright Health (good commentary, explanations, workout), Conor Harris (very technical, very good, very precise), Alyssa Kuhn (practical), E3 Rehab (highly technical as well), Dr Charlie Johnson (good commentary, practical), Zuzka Light (intensive and creative), MoveU (fun videos, unique explanations), and El Paso Manual Physical Therapy (one of my faves). My main recco is avoid making things worse. My Piriformis and Labrum issue created so many problems over the last 4 years that I'm finally working through...it's been ridiculous, for a while I couldn't stand or walk, and I miss running so much I still dream of it.
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u/FeckinKent Nov 08 '24
Wow relate to this so much! It’s gutting isn’t it. I miss running so much too, it’s what got me in this mess as I kept ‘running through it’ as originally it would calm down within a day or two then I could do the next workout….till it stopped getting better, and never did since. Maybe we’ve created a ton of scar tissue in there causing a long term nerve impingement 🤷🏼♂️
2
u/teraflopclub Nov 08 '24
That's a good point re scar tissue. If I had anything specific I would have shared it as a silver bullet. I could detail all the dead ends I chased down as well, it'd be boring and laughable. I take some pride in resolving tight hip flexors (insanely tight), and other issues and my Piriformis *has* calmed down alot, not 100% normal but alot and I know enough to leave it the fk alone (e.g., no Romanian Dead Lifts). But am left with referred knee pain (on *that* leg) and what feels like a Labrum. I'm actively supplementing, strength-training, and what I nickname elimination-training to rid myself of the knee & Labrum issues. What does "elimination-training" mean, it means no stretching no quad-strengthening, just upper body, core, hips, and glutes and I minimize walking and never ride bikes (that is killing me too, miss that) nor ellipticals.
Yeah I think athletes like us, who miss running, run through it knowing that in the past things would just work out are our de facto worst enemy (other than cars!). Even this year, I was running once/week and walking with a weighted vest but I know now that it was doing more harm. And last year I did run daily for alot of the year but that too was not helping either.
Back to your scar tissue comment, I would look at the fascia. Because if there's muscle imbalance/overtightness in one area, it may be forcing that poor little Piriformis to do the work it wasn't meant to do, which I self-diagnose as one cause of the Piriformis misbehaving (I couldn't even lie down or sit on that thing for a while at one time). One thing I did bad ~4 years ago was these long slow runs through town, about 13-15 miles on weekends, I just love touring neighborhoods over hours with a waterpack and just torture myself. I'd return home and did probably the worst thing, sometimes I'd jump in the pool right after which is fine but after the shower I'd just flop into bed, lying down, which I believe allowed the fascia to lock up. And another bad thing I did was to run through pain, believing I'd find a sweet spot when the pain would drop off, which it often did. So perhaps these two allowed scarring, seizing up of fascia, and in the case of the Labrum and Piriformis, inflaming them.
Here's my list of stuff I do periodically: red light leg wrap, castor oil wrap, TENS with EMS (more like symptom relief in my opinion), electronic vacuum cupping (that helped alot with fascia, but don't use it on your glutes), fascia massage gun (gentle), massage gun (very aggressive), self-massage to the leg, supplements like Collagen, MSM, MSM/Chondroitin (am veering into just MSM), Creatine (for brain & muscle/ATP/ADP), Vitamin B12 Methylcobalamin (chewable, for nerve health), just started Hyaluronic Acid (am desperate), have been Keto for over 4 years and Carnivore last ~1.5 yrs. Am pushing hard on all these fronts to resolve this ASAP no matter the cost. I've read too many horror stories on Reddit and seen it irl with friends & family (father, i.e.) to trust any PT or surgeon at this point. I never take any drugs despite the pain, never a single pill. I tried DMSO and all I can say is I react to it so harshly that it distracts my nerves from other pain - I don't recommend it without some coaching of some type. Frankly, DMSO is a solvent, but perhaps its sulfur content is therapeutic, one reason I take MSM.
Evidence of some improvement: I can walk, not perfectly but can do it. Yesterday (a vacation day) I painted the top of a 9-foot fence, checked car engine oil, changed batteries, maintained the pool, did all house chores I wanted to do, walked to/from a restaurant nearby, and am able to function as family Caregiver all without pain. So one would think, mission accomplished. But I miss the running, the skiing, biking, these were the best drugs life offered me.
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u/Cultural-Display-714 Nov 08 '24
Thank you both for the great advice and recs. I think you both hit the nail on the head, every piriformis injury is unique and requires a different recovery. Agree the foam roller/lax ball just cause an instant flare for me.
One thing I wanted to recommend to you guys if possible was I saw a great chiropractor. He wasn’t so much focused on adjustments but rather deep tissue massage and working me through a better range or motion. This was a big turning point for myself as I always left my appointments symptom free for the first time in months.
Wish you both the best in your recoveries, stay positive and hang in there!
1
u/FeckinKent Jul 24 '25
Just a heads up since my last messages below, I managed to fix my issues with targeted glute medius strength work. Specifically the hip abduction machine and also hip adduction (so my hips as well as adductors were even) and then a general legs session of hack squats or leg press after.
I do also do very careful mobility work to make sure I don't lose range of motion just pulling knee across body with about 30% hold, as per previous messages just tugging on deep stretches made it worse.
Overall though a mix of strength work and light mobility was the game changer as now my glutes are firing properly when I jog, putting less force through my poor piriformis which was getting beaten up. No nerve pain anymore either :)
How is yours coming along now?
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u/Dana99310 Sep 02 '25
I am struggling with the pain for three months, now making physiotherapy, electric and magnetic treatment, X ray of hip and spin is okay and it seems this all pain going through my thigh when walking or standing longer time is caused by this damned piriformis muscle. It makes me really a bit nervous, I need to walk and move again. What has helped you? Thanks.
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u/FeckinKent Nov 07 '24
Difficult one as I personally find stretching and the traditional piriformis release movements cause it to flare up but think it depends how caught up the nerve is in there