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Piriformis syndrome...

Old 12-22-20, 01:25 PM
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showlow
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Piriformis syndrome...

I fairly regularly get (what I am pretty sure is) Piriformis syndrome. Reoccurs with me at least once every year. If I'm going to have an overuse injury from pushing too far, or riding too hard, it's going to be my left hip that gets angry, with aching pain radiating down my left quad and into my left butt cheek.

Been through PT before. Know how to fix it. What I'm wondering is if any of you have dealt w/ similar issues and what you did to PREVENT it. Advice on bike fit and positioning especially welcome.

Thanks!

Last edited by showlow; 12-23-20 at 10:10 AM.
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Old 12-22-20, 02:29 PM
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I feel for you. I would get that off and on a good deal in the 90s, including a stretch while on a four month tour. It was awful. Wish I could tell you how to prevent it other than the recommended stretches even when its not hitting you.
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Old 12-22-20, 04:10 PM
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I dealt with that for the better part of the last year. Tried riding less, chiropractor, stretching, yoga, bike fit, you name it. Even bought a recumbent.

Turns out I had an arthritic hip. When the hip starts to lose mobility and cause pain the surrounding muscle tends to compensate for it.

I just had a hip replacement 2 weeks ago tomorrow. Can't wait until I can ride again.

I would suggest getting a hip xray to at least rule that out. An xray is how they found mine.
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Old 12-22-20, 05:14 PM
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isolated stretches will help. you'll need to do it at least every other day or everyday for a better outcome. massages as often as you can are an even better addition to addressing it.
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Old 12-23-20, 05:58 AM
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I use a hard foam roller under my quads.
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Old 12-23-20, 10:10 AM
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Originally Posted by shelbyfv View Post
I use a hard foam roller under my quads.
got one yesterday.
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Old 12-23-20, 10:12 AM
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Originally Posted by Pop N Wood View Post
I dealt with that for the better part of the last year. Tried riding less, chiropractor, stretching, yoga, bike fit, you name it. Even bought a recumbent.

Turns out I had an arthritic hip. When the hip starts to lose mobility and cause pain the surrounding muscle tends to compensate for it.

I just had a hip replacement 2 weeks ago tomorrow. Can't wait until I can ride again.

I would suggest getting a hip xray to at least rule that out. An xray is how they found mine.
Bummer. How old are you if you don't mind me asking? I may make a trip to a doctor if I can't find a way to sort it out on my own. Hope you bounce back even stronger.
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Old 12-23-20, 10:13 AM
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Originally Posted by Troul View Post
isolated stretches will help. you'll need to do it at least every other day or everyday for a better outcome. massages as often as you can are an even better addition to addressing it.
I have a whole routine. Sometimes it works.
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Old 12-23-20, 11:07 AM
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Originally Posted by showlow View Post
I have a whole routine. Sometimes it works.
Likewise. My routine, such as it is, includes the usual stretch and a gentle massage every day for immediate relief and then a couple of sessions per week of exercise and yoga to try to "cure it." Oddly enough I find riding provides relief - I'll get on the bike in pain but perhaps get 2 or 3 days of relief after before it sets back in. So its in the longer gaps between rides that i noticed it the most.
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Old 12-23-20, 04:39 PM
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I used to get hip joint pain that would leave me limping. I began a daily routine of emphasizing stretching, strength and balance for all of my joints including my hips. I do yoga and pilates like exercises for 20 to 30 minutes every morning whether I am riding or not. Since I started this program 5 years ago I rarely have hip joint pain but if I do it is usually because I overdue it taking too hard or long a ride. Once I have hip joint pain from overuse I continue with my daily exercise routine avoiding any moves that cause hip discomfort, and I take as many days off from riding as needed until there is no more hip pain, then I get back to riding.
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Old 12-23-20, 04:41 PM
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Originally Posted by showlow View Post
Bummer. How old are you if you don't mind me asking? I may make a trip to a doctor if I can't find a way to sort it out on my own. Hope you bounce back even stronger.
I'm 62.

Weird thing is I had no idea it was the hip until about two months ago. I've been slowly going down hill for about 3-4 years, figured it was just age, but flat hit a wall about a year and a half ago. Got the hip xray because of an unrelated back injury.

Good news is hip surgery has a high success rate and is bicycle friendly. Mountain biking I'm not sure about yet, much more banging around there.

Hopefully yours can be managed with something less invasive, but figured I would throw out my experiences.
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Old 12-23-20, 04:52 PM
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I’ve had it myself. Foam roller and massage help, but the only thing that really worked was to strengthen the muscles surrounding it. The PT exercises (stretching bands, etc), but also cross training including rec league soccer.
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Old 12-23-20, 05:37 PM
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Figure. Four. Stretch.
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Old 12-23-20, 06:10 PM
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Originally Posted by datlas View Post
Figure. Four. Stretch.
Yep. I dated a physical therapist who taught me that.
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Old 12-24-20, 08:02 AM
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I'm dealing with it now. Again. Had it while training for the Trans Am Bike Race. PT, with the strength and stretching routine got me out of it and it didn't bother me on the race. But after the race, I just rode my bike. Four months later it was back with interest after a cold 400k brevet. Again, got better with PT, which included dry needling. This year I've had some cervical fusion surgery, followed 3 months later with a bike crash. When I started biking again, the piriformis acted up again. Finally hitting the PT and stretching etc. Just need to get it through my thick skull that it takes more than just a stretch or two along the line to keep it in check. The strengthening part has to be a regular thing. 63 yo.
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Old 12-24-20, 09:03 AM
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Originally Posted by datlas View Post
Figure. Four. Stretch.
That maneuver will tell you real quick whether you have an arthritic hip, LOL.

Pigeon pose is another pose a step or two beyond this one
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Old 12-24-20, 11:59 AM
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Originally Posted by datlas View Post
Figure. Four. Stretch.
This is the correct answer, along with a few other manipulations that involve a therapist. Never seen pigeon pose, but I'll look it up.

The piriformis is in the buttock and internally rotates the femur. The stretch does the opposite. When it gets tight or inflamed and swollen, the piriformis can impinge on the sciatic nerve bundle which runs deep to it, causing the symptoms. Forget about anything lower down in the thigh and don't put your weight on the muscle with a foam roller: That will only further compress the nerve. Non-steroidal anti-inflammatory drugs are helpful and heat may help too. Treatment can get more invasive in very severe cases.

If there is associated back pain or loss of strength, it is important to rule out a lumbar disc herniation or other bad things.
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Old 12-24-20, 12:39 PM
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I will add what no one else has. Be sure your seat is not too high. I know I harp on this on this forum, but pain on one side is often caused by dropping to one side to compensate for a seat height that is too high. I had hip pain like that for years caused by seat height. The pain remained after getting the seat height correct, for me, due to the damage it caused. Thankfully it is gone now, helped by a taper pack of steroids.
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Old 12-25-20, 06:07 AM
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Besides physical therapy, try a percussion massager. Works better for me than foam rollers. Foam rollers are really awkward to use where needed -- usually the back and hips.

Check out some dual-head percussion massagers with long handles. Much easier to use. And the dual heads straddle the spine so the heads aren't clattering against bone.

I also have a single head percussion massager that's shaped roughly like a cordless drill, but it's not as handy. Somewhat more powerful action, but impossible to use on my back and difficult to use anywhere other than the hips and legs. If I could choose only one, I'd get the long handled dual head model.

If you've never used one, they aren't quite like vibrating massagers. So take it easy the first few times. But it's easy to isolate specific places where muscles are spasming. And some percussion massagers include multiple heads, ranging from baseball to golf ball size, and single tips about the size of a Sharpie marker -- those are good for specific points but can also bruise and cause injury.
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