Piriformis Syndrome

Don't stretch it. Don't stretch your hamstring either. Try this stretch:

http://www.easyvigour.net.nz/fitness/h_Itchy_Shin.htm

It is very subtle, but helps. Do your stretching with a foam roller and the stick. Sit on a tennis ball for a deeper stretch. Sit on an ice bag to reduce the inflammation. Try some deep tissue voodoo like ART or Airrosti (if you are in the southwest). Regular massage doesn't do it.

Do tons of work on your glute and hamstring (ball bridge exercises, standing single leg presses, etc.). You can’t do enough to get your legs strong.

This injury had me out for 3 months because I tried to stretch on it. It is very difficult to treat because the injury is usually deep under the glute. Back off your training a bit and do some serious hard core PT, not the wussy stuff the lady at the chiropractor has you do. I can still feel my piriformis two years later, but have been running at 100% for the past year and a half with some serious treatment. No quick fixes. But with some serious strength work and proper deep tissue, you will get better and be a faster and stronger runner. Just respect the injury. Do not taunt your piriformis.

Thanks. That has been my feeling. That strengthening rather than stretching is the recipe, but my strengthening has always been hampered because stretching keeps flaring it up.

I too have been battling piriformis; at least I think that is what it is. I had it 4 years ago after a half marathon and did physical therapy and 19 chiropractic treatments. I quit running for 3 months but didn't think that made a difference so got back to running. It went away in a year. Now it has again become a problem after a 5K in April. I ran about a month after that and havent run since and have been seeing a chiropractor for a couple months. This time the few times I ran it seemed to make it worse as does riding a bicycle. I am able to walk 2 or 3 miles a day but sure miss running. I do a lot of stretching which may be the wrong thing to do??

It will feel like inflamation right around the insertion of your hamstring, right under your glute. The pain may radiate down the hamstring or along the sciatic nerve. The onset is usually insidious. Yours sounds like it might have been traumatic, to some extent. It is very difficult to tell piri syn from insertional hamstring tendonitis.

I found that stretching (especially hamstring) irritated the injury almost instantly. I would stop stretching, feel better, and then try to do some stretching again, only to have the injury flare up again.

I really think the way out is strength+alternative stretching (stick/foam roller/tennis ball)+ice for inflamation+time. Every time you stretch and get some pain wit it you are adding weeks to recovery. Chiros and PTs are always quick to claim some sort of range of motion issue because it is something they can easily measure. But, my experience is that the range of motion issue with piri syn is the body telling you to leave it alone and let it heal.

Do you think all running should stop? I read somewhere where someone thought that easy running actually helped loosen it.

Tough question to answer. For me, I really screwed myself up pretty bad by stretching it and trying to run through the pain. I had to stop running for 3 mos as a result. It was so bad that I could feel the neurological connections in my leg shut down in response to the injury. Walking up a hill, it almost felt like I had to reach down and pick up the affected leg with my hands because everything had shut down.

Return to running didn't really help it, but I had to get back to running to keep from going crazy. I was able to get back to running by taking baby steps over a few weeks.

You will probably be able to judge for yourself when you can run on it. If you have sharp pain or if the pain gets worse as you run, you are better staying off of it. If it just aches and doesn't get much worse during a run, try running and be sure to ice after. Just be very careful. Don't try to push it just to see what happens and be patient with your progress. I think the hardest part about the injury is that it isn't hard to run through the pain. But when you do, you are screwing it up much worse that you think.

i agree with the "do not stretch" advice. strengthen the hips and butt doing #1 and #2 here.

http://www.womenshealthmag.com/fitness/at-home-workouts-0

ya, i know it's a girl magazine but it's the best description i can find of how to do these. you'll find your specific weakness really quickly trying to do #1.

once i started strengthening my hips and adductors, it slowly went away. i ran through it and speed can flare it up sometimes but it's not really a problem for long.

mitel wrote:

i agree with the "do not stretch" advice. strengthen the hips and butt doing #1 and #2 here.

http://www.womenshealthmag.com/fitness/at-home-workouts-0

ya, i know it's a girl magazine but it's the best description i can find of how to do these. you'll find your specific weakness really quickly trying to do #1.

once i started strengthening my hips and adductors, it slowly went away. i ran through it and speed can flare it up sometimes but it's not really a problem for long.

Those are all good. Here are pics of the basic bridge with the exercise ball I mentioned in prior posts:

The single leg squats are easy. Stand on one leg, bend your knee and lower yourself down until your leg is comfortably flexed, but not stressed. Push back up with your glute. Add resistance with dumbells or by leaning forward as you bend your leg.

that bridge exercise reminds me...here is an article that has been floating around here on other theads.

http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

The exercises in this article are great for strengthening butt and hips.

Just out of curiosity... how does one differentiate between piriformis syndrome and hamstring tendonitis? Are they the same thing?

I'm dealing with a small flare up of this, whatever it is, recently. It settles in when I get lazy and don't do my one leg squats and bridging exercises every day. Do them - they are a runner's best friend.

I agree, the loss of coordination in the affected leg is a pain in the ass, literally. I can normally do as much easy running as I want, but if I try to go out and push it too much, it flares up. It really feels like a loss of muscle response in that leg. Annoying as hell to deal with. At it's worst I have trouble climbing stairs.

I agree with above - do not stretch this thing. Roll a tennis ball on it 2-3 times per day and get your glutes and hamstrings in shape. This should at least manage to get you back on the road.

Anything beyond that? Is a stick or foam roller worth the money to get deep into those knots?

If nothing else works, consider botox. A number of studies indicate that the success rate is extremely high. If you Google piriformis and botox... you find tons of stuff.

For sever cases, the actually sever the muscle, since it's non-critical.

i saw this thread and realized "hey, i don't have this anymore" and i swear it's because of being faithful to the weights.

i think doing 1-legged leg-presses on a sled machine is more valuable than any stick or massage device. massage might make if feel better in the short term but the reason it got hurt in the first place is weak hips and butt.

getting all of these muscles strong takes the pressure off of the piriformis.

get in the gym and be as compulisive about it as you would trying to build up mileage.

Good work. It took me three months to figure out that I really just need to get strong. Good to hear that you were able to take care of it in short order.

How did you do your weights? Slow/Fast, high reps, low reps, # of sets, heavy/light weight, # sessions per week? Valuable info for those who use the search function.

Here are the things in my routine that i think cured the piriformis:

1) Squats - 2 sets - each set around 10-12 (2nd set to exhaustation)

2) 1 legged presses on the sled - 2 sets on each leg around 10-12 (2nd set to exhaustion). i use heavy weights here and stay with the same weight and try to increase the bend in the knee till you get to a right angle before you add weight. (tougher than it sounds!)

2) adductor and abductor machines (2 sets 12-15)

3) standard quad machine but very light weight, one legged only, with foot turned out. (works the VMO)

4) Figures 8 and 9 in this article posted above

http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

but - stick with the 2 legged version on figure 9 unless it doesn't hurt anything. that's pretty tough on the upper ham. i also avoid the ham curl machine for the same reason.

I only do 2x per week but i'll do figure 8 (plank) at home along with stretching my adductors and hips after running.

I really think this routine has done it. i went down the road of massage, chiro, PT, piriformis stretching, foam roller, tennis ball - you name it, i did it. it wasn't until i got into the gym that it went away and is swear that i had this for like 4 years.

give it a shot and report back. good luck.

I don't have access to equipment. I have been doing similar stuff with therabands and standing on wobble boards. I pretty much have it under control, but wonder how it would be if I could get on some equipment. My biggest problem is that I sit all day and travel a bit for work. That gets the muscle all tightened up.

And just so searchers find that article link:

High Hamstring Tendinopathy

This injury sucks...I had it in early 07, and much like a few other posters here, I had to take about 3 months off...You can not run THRU this injury, so don't try. I tried a few times when I first had it and didn't know what it was. I would get to about 3 miles and just have so much pain I would have to stop.

It hurt to stand for too long, it hurt to sit for too long. Forget running. I finally learned a few stretches that helped (the tennis ball one works wonders) I still have some minor issues with it, but make sure to stretch it real good before a run.

if you have therabands, try figure 15 in this article.

http://www.coachr.org/core_stabilisation_training_for.htm

you could try lunges but i'm not sure they don't hurt more

bump...anyone else have ideas?

[quote]itsgone wrote:

Here are the things in my routine that i think cured the piriformis:

1) Squats - 2 sets - each set around 10-12 (2nd set to exhaustation)

2) 1 legged presses on the sled - 2 sets on each leg around 10-12 (2nd set to exhaustion). i use heavy weights here and stay with the same weight and try to increase the bend in the knee till you get to a right angle before you add weight. (tougher than it sounds!)

2) adductor and abductor machines (2 sets 12-15)

3) standard quad machine but very light weight, one legged only, with foot turned out. (works the VMO)

4) Figures 8 and 9 in this article posted above

http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

but - stick with the 2 legged version on figure 9 unless it doesn't hurt anything. that's pretty tough on the upper ham. i also avoid the ham curl machine for the same reason.

I only do 2x per week but i'll do figure 8 (plank) at home along with stretching my adductors and hips after running.

This is it. Forget about running for about 3 months and get into the weight room. I had that b*tch for 8 months about 2 years ago, and of course ran through it until it got so bad I couldn't sit down for more than 20 minutes at a time. Once it gets stronger you can gradually stretch it.

Here's a good stretch

http://www.rice.edu/~jenky/sports/piri.2.html