Piriformis--Prednisone/prolotherapy?

I had this for 2 years and cured it with 1 treatment of acupuncture.

Thank you. I've read several people say that acupuncture didn't work. I don't know anything about acupuncture. Can you tell me how you chose the practitioner and what they did (if you know)?

Many thanks again!

try this? Cant hurt

http://www.youtube.com/watch?v=tFtUgS69rPk

Thank you. I have seen that youtube video before and have tried that and many other stetches. Honestly I have tried just about everything short of hard core drugs/injections. I am really devastated. The good news is that the pain at the moment is relatively minor, but extremely persistent, and gets worse with ANY exercise (even swimming) of any significant duration (i.e., longer than 30 or 40 minutes) or decent intensity. Through LOTS of work in PT and lots of stretching (3 times per day last 3 months), including dynamic stretching, PT twice per week, I have managed to get the pain down significantly. It's just that I feel pretty sure that if I increased the duration/intensity again, I would be back to square one (I'm not sure but that's what I'm guessing since the pain is not gone). The PT thinks I may be maxed out on improvement. I did my first 10 min run yesterday during PT, after 30 min on elliptical earlier in day, and the run didn't increase the pain more than the elliptical. But again the pain isn't gone and, let's face it, a 10 min run is pretty pathetic and not going to satisfy me for my life.

So now everyone is telling me to try prednisone. I'm worried (very worried) about weight gain, particularly weight gain AND the pain sticks around. I have a few doctor friends (not orthos) who have told me to try the prednisone, but these people are as far from connected to fitness as possible, so I'm not sure they really know.

I could just wait and see, but one doctor friend told me that with the decrease in pain/inflammation that I've already accomplished through rest and PT, the prednisone might "knock out" the rest of the pain. Whereas if I just ramp right back up and say screw the pain screw the world I'm going to run, the pain may get worse again and more likely to be a life-long condition.

HELP!!!!!!!!!!!!!!!!!!!!!! Does anyone know anything about how the body (particularly piriformis or maybe similar muscular/tendon injuries) might react to prednisone, likelihood of weight gain if I take this crap, etc. Does the doctor's logic make sense? Can you have pain without inflammation?

My doctor friend (and a couple of other docs) have told me that IF I have any inflammation, the prednisone will get rid of it. But from my own reading I *think* you can have pain without inflammation. I don't understand that fully, but I believe that is true. So basically the prednisone might not help. Any experiences with prednisone on the board???????????

Thanks so much. This truly is the worst thing that has ever happened in my life with the sole exception of losing loved ones.

I went to a family friend (retired chiropractor) who had cured me with acupuncture for some other things, including an IT band problem and even pain from a stress fracture. It seems like all the needles went in my back and maybe my ear (?). You have to relax when they do it. It was at his home and he spent a good hour and a half working on me. I think whether it works depends on who's doing it, so you should ask around to other runners in your area.

Prednisone is bad shit. It cures pain,but catabolizes muscle and bone if you take it long term. If acupuncture doesn't work, I'd suggest ART and or dry needling (different than acupuncture cause it directly targets the trigger point in the muscle).

Have you gotten an MRI? I had what I thought was piriformis syndrome for months, and and MRI determined that I actually had a sacral stress fracture.

Thanks. I haven't had an MRI yet. Unfortunately self-employed small biz owners. We cancelled our insurance last year b/c with a 5K deductible we would never pay for tests anyway. So everything is out-of-pocket. Docs suggested MRI but I thought if it was something like cancer, it wouldn't improve if I stopped exercise. But I never thought of a stress fracture. Guess we might have to bite the MRI bullet.

FYI--I'm not planning on ever taking prednisone long-term. I'm just considering a one pack deal to try to get rid of this problem. I am very aware of the long-term risks and those are out of the question for me--I would rather exercise with pain for the rest of my life, which appears to be (maybe) my only other option.

There are a few acupuncturists near me. Maybe I'll have to think more about those and consider the MRI.

I'd still love to hear pros/cons on short-term (one pack) use of prednisone. I'm specifically concerned about weight gain. Maybe non-runners would be more likely to gain weight b/c they eat more but dont exercise, which of course wouldn't be my situation.

I was able to tolerate 30 min today on the elliptical and my second 10 minute run after a 3 month lay off, so I still have hope that I'm not dead yet.

Thanks again to everyone and would love to hear anything more. Sorry to keep essentially bumping but I'm desperate to hear anything..........also prolotherapy? I wonder how that differs from dry-needling? Prolotherapy is where the inject sugar solution into the tendons and ligaments to jump-start the body's own natural anti-inflammatories/healing process. It's a new thing but PT said he has seen some people have tremendous success with it, including even those with arthritis, which otherwise cannot be cured.........

I do not believe in prolotherapy. I've had it before and there is a reason that physicians aren't advocating it and you have to travel to a holistic Dr. who still charges you hundreds of dollars for the visit. It's dextrose and water. I know you aren't going to want to hear this, but I have a sneaking suspicion that you do not have Piriformis Syndrome.

I may be able to help you more in terms of how you can get on the right course in treating your issue, but I would need a COMPLETE/DETAILED list of your symptoms, when you first noticed them, how they progressed, etc etc. If it actually is Piriformis Syndrome (which I doubt) I would advocate surgery before Prolotherapy. Even if Prolotherapy wasn't a joke (which I believe it is through experience), it wouldn't even make SENSE for your situation. I'll explain why if you want to talk via e-mail. Leave an address up on here if you are interested... I can give you more advice than you think if I know more about what is going on with your butt/leg/back.

My guess from what you've described (as well as years of treating thousands of runners) is HYPERmobility of either/both SI joints. This would be even more likely if you are female (don't know from your post) and post-partum.

Prolo is very hit or miss. I've only referred a few patients for it. The results have been pretty crappy...ditto with PRP. Acupuncture has (in my experience) a much better success rate, though tends to be best suited for nerve-related pain.

As far as getting an MR, I have 3 clinics locally (Orange County) that charge less than $330 for an MRI w/o contrast for uninsured patients. Get an MR before proceeding with a medrol dose pack or injection. If there's no visible inflammation on MR, then there's no justification for a corticosteroid.

If I'm right about hypermobility, then you need to strengthen the entire pelvis (which you may have already done, assuming your PT was competent) and lengthen the surrounding musculature (via ART, Rolfing, yoga, etc.).

While your case sounds nasty, it's likely no worse than what I encounter several times per month. I think you simply haven't stumbled across the right practitioner yet.

Thank you to all of the posters. I am a female, but never had children.

I think my PT is very competent. This is my second round of PT. He is actually an athletic trainer but working in a very skilled/sports based facility. Pro and college athletes are their main customers, facility formed by a former pro basketball player. I really think they are good and the treatment has been different than my prior PT in that we have worked on moving/twisting the hip much more. Also of course core-exercise and lots of stretching.

I tried yoga once and had pain (this was a couple of months ago) with some of the poses, so I didn't go again.

I've had numerous deep tissue massages.

Not sure where to find ART.

I will follow the advice to get an MRI before taking prednisone, although it sure is tempting with that bottle sitting there on my dining room table and the running trail sitting outside my door.

My email address if you have any info is

twillis10@mindspring.com

. I would appreciate any and all feedback that might be helpful.

What is PRP?

I have had good success with the PT, but just not 100%. The weird thing is that some mornings (including this morning), I wake up feeling that I am 98% better. And this morning was a big surprise because I ran both Friday and Saturday for the first times. Weird that it feels like the elliptical (with arms) hurts more than running. Anyway, after about day 4 of 37 min elliptical followed by either 30 min walk or combo walk and one mile run, the pain returns after my workout, making feel like I'm only maybe 80% better. By tomorrow morning I'm pretty sure that I will feel 95% better--mild pain but still persistent.

So, do I continue increasing my mileage like nothing is wrong if I'm at 95%, but not 100%?

I did have a LOT of tightness that has greatly subsided, and the pain has become more localized (immediately on the area of my butt where the piriformis is supposedly located).

THANK YOU to everyone. Honestly as I said this has been completely devastating because this affects all forms of activity. Basically any decent workout seems to leave me in pain again.

I took one month off and PT thought maybe this was at least partly muscle soreness, but would muscle soreness be localized where the injury is located???!

I struggled with this injury for almost 3 years in College. It took 1 cortisone shot to knock it out, and I haven't had a real problem since then (its been about 2 years now) I don't know why you would want to mess around with ingestible steroids.

not a runner anymore wrote:

Not sure where to find ART.

When a therapist says you've reached a plateau, move on to another. A fresh set of eyes is sometimes hugely helpful. Try a chiro or another PT after asking around and finding someone in your area who has had success at similar injuries. A lot of therapists ignore the pelvis for some reason; find someone who knows how important it is. Also, someone who can assess how your glutes are working. The third person I went to finally got the full picture and within weeks my years-long hip pain was rapidly going away.

The problem with finding a decent PT is a big one--you keep paying and this is my second time around, so you know eventually dollars are a limiting factor. That being said, I have a lot of my respect for my current PT. He said last visit that we may have reach maximum improvement, but he wasn't sure til after the run. Not sure what he will say today, since run was fine. I will mention the pelvis/hip strengthening but we seemed to have been working that area a lot. My hips seemed tight--I didn't have much side to side movement in them when we started, now much better. Also my right leg (affected leg) used to quiver when I did balance type exercises. That has also gone away. Again, after 2 years of pain, this guy got rid of 95% of the pain in 4 weeks. He does have a more experience guy above him and I may ask for a consult with him. The more experienced guy apparently travels around the country lecturing on PT, sought after by pro athletes, and has taught this guy everything he knows. So we'll see.

The reason for the systemic steroids, instead of the shot, is that a doctor friend of mine gave me an article (recent NY times) saying that steroid shots over the long term lead to worse outcomes, meaning one year later in the studies 57% of patients wer worse. Her opinion, based on those studies, was that the location of the shot might be problem, so *just one dose* of systemic steroids might be better because it would fix any problem in the entire body and wouldn't be reliant on the skill of the doctor giving the injection in the right location (she is not an ortho, so she can't do it).

As for prolotherapy, I did a little research on the internet before posting and the mayo clinic does recommend prolo for various body parts (knee, ankle, shoulder, wrist, etc), but not the hip. My PT said he has seen some people have no results from prolo, but has seen a few miracles from it--e.g., ankle arthritis in wake boarders completely resolved by prolo. And tendon/ligament injuries supposedly take longer to heal, so the theory is that prolo injects something into them to jump-start the bodies own natural healing to the tendons/ligaments. *But* I was very disappointed to hear the real stories on people on this board who have had prolo without success. That was a major bummer b/c I'm really afraid on amount of PT is going to solve this.

And I don't really know how to find another PT. I will ask about hyper mobility and another consult with more experienced PT guy.

Thanks again to everyone. I'm still considering various options and continuing PT. Oh, also this morning I scheduled an MRI, so I will find out if there is inflammation before considering any kinds of steroids, again thanks to the posters on this board. Any other thoughts/ideas/questions to ask PT?

Does anyone know if you can/should increase mileage (is it normal) when you are NOT at 100% but greatly improved?

Getting rid of 95% of the pain in 4 weeks is incredible. I don't know why, given that, he doesn't necessarily think you can improve more. Doesn't make sense to me.

Check out this link, it has 2 very simple tests for glute function. When glutes aren't doing their job, it puts a lot of stress on the surrounding areas. It might be worth giving the tests a try to see what you find, and/or ask your PT what he thinks of them.

http://figureathlete.t-nation.com/free_online_article/most_recent/how_strong_are_your_glutes_really

Hi,

Don't take prednisone. The science behind joint pain is not as good as you might think. Pain cannot be explained as simply as "just a inflammation" process. Prednisone is a very serious drug and it will likely do nothing. It is a risky shot in the dark.

Pain is 100% mental. (ie...It comes from your brain responding to what it thinks your body is feeling) I have a sneaking suspicion that part of this problem is in your head and the wiring of your body. You might have trained your body to pay attention to this pain and thus sensitized yourself to it. I'm not sure what the solution to this is for you, because I am dealing with it too.

My Advice: Be patient. These things take lots of time to heal. There will be no slam dunk and it is likely you will not be able to run like you used to for many years. Accept it. Take up other hobbies, while you allow your body to recover.

I've gotten really good advice from this website.

www.saveyourself.ca

He has a very realistic and scientific perspective on pain and injury. It is worth checking out

I will check out the glute test (went to the page already and checked it out, but I will try it). And share with my PT.

He said today that he was just saying that I needed to know that there was a possibility that this could be permanent. He had always been very big about optimism and positive mental attitude, so this statement was very upsetting coming from him (since I know he wouldn't say it unless he really thought he maybe can't fix this). But he said today that he feels good about the length of time between bad feeling/achey days, and my positive response to the run. He has now said to eliminate the elliptical, which he doesn't understand WHY this would cause pain, but it seems to cause more pain than even running, so for this week I am supposed to eliminate it.

I know 95% is good (remember it's only say 80% on the evening after a workout), but I just seem to have leveled off. I've stopped improving for the last week or two (hard to remember).

Also PT has actually gone on for 3 months, but the first month I continued cross-training for significant durations (1-2 hours of swimming combined with elliptical plus LOTS of PT type stuff outside of PT). Of course I didn't get better. Then I took a month of rest, almost literally bedrest, including rest from PT, and I didn't get much better (although I accidentally ran (for my phone, in the rain, etc) a couple of times during that time, which seemed to re-injure it).

I'm just struggling with the duration of any type of exercise that I can do now while still hoping that PT will continue making me better.

I cannot just find other hobbies. This injury affects ALL forms of exercise. I'm not just going to lay on the couch, so I have to try everything. Other hobbies, sans ALL forms of exercise is not one of the options that I would ever consider.

At this point the PT says that I can run 1-2 miles, 2-3 days per week, while we are experimenting. Basically that is the experiment. Even though I have some pain on the affected spot afterward. He said this isn't like a normal injury and so I should not expect to be at 100% when I first run. The question for him is whether I recover from these runs and what we are doing in PT (and then also hopefully improve). The hardest decision is how much (duration and type of activity) to do while I'm still hoping for improvement in PT.

THANK YOU to everyone who has replied.

Did your PT have you doing adductor and abductor strengthening? Have you mastered the "perfect squat"? Did PT have you doing lunging squats?

These were the type of things that have gotten rid of my piriformis injury. I had it for a very long time at one level or another. I did alot of reading on here and talking with others and came up with a strength program. once i became diligent about this, i started making alot of headway with it. I didn't stretch at all since i felt that this was making it worse.

I'd avoid anything invasive until you've spent 3 months or so being obsessive about strengthening 2-3 x per week.

Thanks for the reply. I'm doing all sorts of strange squats, twice per week, but I don't know what the lunging squat and perfect squat are.

Do you have any links?

Thanks!