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Discussion Starter · #1 · (Edited)
Ok guys, I am pretty much at my wits end here and was hoping someone might have some insight about what I've been dealing with.

A little history- I am 40 years old and started riding "seriously" in 1999, first mountain biking for a couple years and then moved to road only after 2002. At my peak I was riding maybe 100-120 miles a week so not a huge load by any means. In 2004 I started doing Sprint Triathlons and did that the next 3 years for a total of about 8-9 races. 2006 was my heaviest year as far as training load and I finished the tri season in Sep 06 with some good results.

In October of 06 I did a half marathon and then took some time off because I was feeling burned out. A planned 2 months off of training became 6 months off. I began some half hearted training for the 2007 season, but my first and last Tri that year was in June. I pretty much stopped most training after that except for the occasional ride every few weeks.

In April of 08 I started having low back pain which has continued now for a year. Its evolved from just simple lumbar pain to the inability to sit for more than 15 mins without serious pain upon standing. The pain is now also in my right hip and shoots down my right leg causing pretty intense pain when I stand or rise from lying down. I have tried riding myself back to health, so I've gotten in about 4 rides over the past 6 weeks. It's hard to ride though because on the down stroke extending my right leg is not good at all, sharp pain going down the right leg.

Medical history- MRI shows mildly bulging discs at L4 and L5 and mild arthritis, Doc says my MRI results are not consistent with the amount of pain I have. Xray of my sacro-iliac joints shows mild arthritis in SI but nothing major. I've had a cortizone injection directly into the SI which didn't help (hurt like a mother though) Blood tests show nothing abnormal, no abnormal inflammation on CRP serum. I've tried physical therapy which is focused on balancing my core as the PT said my pelvis is tilted/ higher on right side.

I've also tried Acupuncture (just twice so far), yoga and stretching. The only thing that really relieves the pain is standing instead of sitting and anti-inflammatories like Naproxen which I've been on for way too long.

Anyhow after all this time I started reading about piriformis just today and it really sounds like thats what I have going on.....What say you? I'm sure I'm not the only cyclist thats been through this.

Jim
 

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Piriformis Syndrome is compression or irritation of the Sciatic Nerve as the nerve passes under or through the Piriformis Muscle. It is a difficult diagnosis to make, and usually requires exclusion of the more common causes of back, hip and leg pain.
It is seen in runners and cyclists.
It sounds like you have had an extensive workup to preclude other causes for your pain.
An MRI of the hip, not the back, can in some cases make this diagnosis.
There are stretching exercises for the Piriformis.
Most Ortho docs can perform a provocative 'Piriformis Tests' that is diagnostic if it reproduces/aggravates your pain/numbness symptoms.
A Steroid Injection into the Piriformis Fossa may relieve your symptoms.
If the injection helps, but doesn't last, it is none-the-less diagnostic, and a surgical release of the Piriformis Muscle should alter your symptoms.
These comments are from a life long avid cyclist who used to be an Orthopaedic surgeon and raced from 1975-1988.
Bottom line; get back to your Ortho doc and have him R/O Piriformis Syndrome for you.
Hope this rambling helps a little.
 
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cyclejim said:
Anyhow after all this time I started reading about piriformis just today and it really sounds like thats what I have going on.....What say you? I'm sure I'm not the only cyclist thats been through this.
My wife had a very bad bout of piriformis syndrome. It took a long time to diagnose, but once it was diagnosed, a few months of physical therapy, massage therapy, and stretching exercises were able to get it very well straightened out and it's been fine since then.

The big problem is that is a self-reinforcing syndrome: the priformis spasms, which compresses the sciatic nerve, and in response to the pain, the piriformis spasms more, so it keeps itself going. Exercise and PT to loosen up and relax the piriformis did the trick in my wife's case, but it did take several months before it really went away.

FWIW, the "Wharton Stretch Book" has a good active-isolated stretch for the piriformis.
 

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Discussion Starter · #4 ·
jmlapoint said:
Piriformis Syndrome is compression or irritation of the Sciatic Nerve as the nerve passes under or through the Piriformis Muscle. It is a difficult diagnosis to make, and usually requires exclusion of the more common causes of back, hip and leg pain.
It is seen in runners and cyclists.
It sounds like you have had an extensive workup to preclude other causes for your pain.
An MRI of the hip, not the back, can in some cases make this diagnosis.
There are stretching exercises for the Piriformis.
Most Ortho docs can perform a provocative 'Piriformis Tests' that is diagnostic if it reproduces/aggravates your pain/numbness symptoms.
A Steroid Injection into the Piriformis Fossa may relieve your symptoms.
If the injection helps, but doesn't last, it is none-the-less diagnostic, and a surgical release of the Piriformis Muscle should alter your symptoms.
These comments are from a life long avid cyclist who used to be an Orthopaedic surgeon and raced from 1975-1988.
Bottom line; get back to your Ortho doc and have him R/O Piriformis Syndrome for you.
Hope this rambling helps a little.
Thanks John, very helpful stuff....!
 

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Discussion Starter · #5 ·
Fredke said:
My wife had a very bad bout of piriformis syndrome. It took a long time to diagnose, but once it was diagnosed, a few months of physical therapy, massage therapy, and stretching exercises were able to get it very well straightened out and it's been fine since then.

The big problem is that is a self-reinforcing syndrome: the priformis spasms, which compresses the sciatic nerve, and in response to the pain, the piriformis spasms more, so it keeps itself going. Exercise and PT to loosen up and relax the piriformis did the trick in my wife's case, but it did take several months before it really went away.

FWIW, the "Wharton Stretch Book" has a good active-isolated stretch for the piriformis.
Thanks, good to hear and I'm glad shes doing better.
 

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Read the following article particularly the part about using the tennis ball. I have had bouts with what I have self diagnosed as piriformis syndrome for the last two years. It has been diagnosed simply as sciatica though. The tennis ball really helps when it flares up. I also have extremely tight hamstrings so stretching them is a priority.

http://www.spineuniverse.com/displayarticle.php/article130.html
 

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Piriformis Syndrome is a good possibility. The diagnosis is easy to make, you just need to find a doctor, physical therapist or chiropractor who can find the muscle with their hand. When palpated it will be painful.

Sounds like you have seen too many doctors who cannot diagnose anything with their hands or minds. They need an MRI, CAT scan or blood test. Piriformis Syndrome does not show up on any test except physical examination. It responds rapidly to stretching the affected muscles, your PT should be able to teach you that. Otherwise, find a copy of Dr. Travell's book on Myofascial Pain volume 2 and photocopy the chapter on the Piriformis Muscle.

The stretch involves lying on your back. Bend the knee on the side of the pain. Cross the foot over the other knee on the leg that is lying flat. With the hand on the same side of the pain is placed on the hip of the bent leg, to hold it down. The opposite hand then is placed on the bent knee and the knee is pulled away from the side with the pain. You should feel the Piriformis stretch. Sets of 5-7 stretches, 3 sets, three times a day. Never pull to the point of pain. Exhaling helps the stretch. It is much easier to see a picture of the stretch than to describe it in words.
 

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Find a provider that uses ultrasound and cold laser, that with trigger point therapy and stretching should help.


Josh
 

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Discussion Starter · #9 ·
bike_guy said:
Read the following article particularly the part about using the tennis ball. I have had bouts with what I have self diagnosed as piriformis syndrome for the last two years. It has been diagnosed simply as sciatica though. The tennis ball really helps when it flares up. I also have extremely tight hamstrings so stretching them is a priority.

http://www.spineuniverse.com/displayarticle.php/article130.html
Thanks, good stuff at that link.
 

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Discussion Starter · #10 ·
Don Duende said:
Piriformis Syndrome is a good possibility. The diagnosis is easy to make, you just need to find a doctor, physical therapist or chiropractor who can find the muscle with their hand. When palpated it will be painful.

Sounds like you have seen too many doctors who cannot diagnose anything with their hands or minds. They need an MRI, CAT scan or blood test. Piriformis Syndrome does not show up on any test except physical examination. It responds rapidly to stretching the affected muscles, your PT should be able to teach you that. Otherwise, find a copy of Dr. Travell's book on Myofascial Pain volume 2 and photocopy the chapter on the Piriformis Muscle.

The stretch involves lying on your back. Bend the knee on the side of the pain. Cross the foot over the other knee on the leg that is lying flat. With the hand on the same side of the pain is placed on the hip of the bent leg, to hold it down. The opposite hand then is placed on the bent knee and the knee is pulled away from the side with the pain. You should feel the Piriformis stretch. Sets of 5-7 stretches, 3 sets, three times a day. Never pull to the point of pain. Exhaling helps the stretch. It is much easier to see a picture of the stretch than to describe it in words.
Thanks.. one of the things about the traditional HMO approach is that if they can't see anything on the MRI, Xray, they pretty much just say good luck with that. I've been reading up on the various piriformis stretches and started some gentle streching last night. Good stuff thanks
 

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Discussion Starter · #11 ·
jjjdc1 said:
Find a provider that uses ultrasound and cold laser, that with trigger point therapy and stretching should help.


Josh
Thanks I'll do some reading on that too.
 

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cyclejim said:
Thanks, good stuff at that link.
I've been undergoing PT for some severe IT band issues, and have been using a foam roller to loosen it up.

Just so happens that I've also had piriformis issues for the close to 2 years with it only getting better very very slowly.. When working the IT band on the foam roller I started working the Piriformis as well, doing essentially what that article describes w/the tennis ball.

Working the piriformis on the roller while doing the stretching worked miracles. All pain/soreness in the piriformis went away after about a week of working it twice a day on the roller while stretching.

The foam rollers are about $30 (ripoff IMHO), so I made my own out of 4" pvc and carpet pad for a few $.

Sounds like the tennis ball works well, and is probably the cheapest solution of all.
 

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Great, info thanks

I have been having the same pain described in this thread since February. I just ignored it and thought it would go away once I got more active so I had been doing some core strengthening work and the pain amount lowered but ios still hanging around. I had gone to my Chiro twice and got no relief. Yesterday I went to a PT and she did some diagnosis, some adjusting of my position and then some ultra sound, gave me some strengthening exercises to do so my hip will not rotate forward and not function properly. Note my pain was not severe or debilitating and her exploration for the cause did not indicate that I have a huge problem (February to late April, I finally decided to do something about it). I will ask her what she thinks about the tennis ball massage. I'll bet she thinks it will help.
 
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