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Piriformis - what causes it?

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Piriformis - what causes it?

Old 12-01-10, 01:15 PM
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Piriformis - what causes it?

This is the 4th time in the past 6 months that I've had pretty severe piriformis. Stretching helps and it goes away after 2 days or so, but it is a pretty painful 2 days - especially sleeping, when the slightest change in position hurts. Funnily enough, cycling is not a problem.

Any idea what could be causing this? Feet too far apart, feet turned in too much, feet turned out to much, etc?

I have done a lot of riding over the past 3 days - about 240km including 4000m of climbing (a lot for a flatlander like me). However, the pain seemed to have started a little at night on day 2, and really got bad last evening (a few hours after I finished day 3). The previous times I have had it, the pain has always happened well after the ride - I never notice it coming on during a ride or just after a ride.

Any ideas would be appreciated.

Thanks,
V.
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Old 12-01-10, 01:40 PM
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Well the only thing I have to add here is that a herniated disc can present symptoms as piriformis when its not - its a herniated disc. I spent 4 sessions in physical therapy for piriformis after seeing a doctor before the PT got suspicious that it was my back. Imaging revealed the disc.
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Old 12-01-10, 01:49 PM
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Originally Posted by vkalia
This is the 4th time in the past 6 months that I've had pretty severe piriformis. Stretching helps and it goes away after 2 days or so, but it is a pretty painful 2 days - especially sleeping, when the slightest change in position hurts. Funnily enough, cycling is not a problem.

Any idea what could be causing this? Feet too far apart, feet turned in too much, feet turned out to much, etc?

I have done a lot of riding over the past 3 days - about 240km including 4000m of climbing (a lot for a flatlander like me). However, the pain seemed to have started a little at night on day 2, and really got bad last evening (a few hours after I finished day 3). The previous times I have had it, the pain has always happened well after the ride - I never notice it coming on during a ride or just after a ride.

Any ideas would be appreciated.

Thanks,
V.
Piriformis is just a muscle in your gluteal region, not a disorder. Do you mean piroformis syndrome? The piriformis muscle is closely associated with the sciatic nerve and can impinge on the nerve in some people, depending on their particular anatomy. Symptoms are similar to sciatica caused by herniated disc. How do you know you have piriformis syndrome and not sciatica? I suggest you get an MRI and figure out exactly what the problem is before attempting to treat it.
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Old 12-01-10, 01:50 PM
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Teterider - Did your symptoms of piriformis persist? I get the symptoms, I do the prescribed stretches and after 2 days, I am fine. It's been 3 months or so since my last incident. I am assuming that with a herniated disc, the symptoms would persist, right?

Mihlbach - yes, I mean piriformis syndrome. Sorry, was being a lazy typist. Reason I believe it to be piriformis is b/c I've had it happen a few times before and each time, after 1-2 days of doing the stretches prescribed for piriformis, the pain has gone away completey. Even after 1 set of stretches, I can feel the relief immediately.

I do plan to go get an MRI tomorrow, if the pain persists. For once, I am not on the island and so actually have access to a medical facility where the doctor isnt drunk by noon.

V.

Last edited by guadzilla; 12-01-10 at 01:54 PM.
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Old 12-01-10, 01:59 PM
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Ruling out sciatic pain from a nerve root lesion - Piriformis syndrome is primarily caused by a rotated sacrum and/or a rotated femur. Structural misalignnments caused by trauma, overuse injury to the muscle, muscular adhesions which have developed, and then subsequent hypotonicity leading to pain (your body's way of saying STOP). Stetch correctly and see a good chiropractor
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Old 12-01-10, 02:06 PM
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Rotated femur sounds like a possibility. My feet splay out quite a bit, and have a lot of varus as well - I use 3 wedges between my cleats to fix it, and I am still not 100% sure about whether the alignment is still correct or not. Although I have been cycling 10-12 hours a week quite regularly for the past 6-7 months, the past 3 days were more consecutive hours on a saddle over 3 days than I have spent before. So overuse + structural misalignments seems like the most probably cause.

Am going to get my fit looked at again this Saturday in Singapore.

V.
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Old 12-01-10, 02:17 PM
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If the priformis is hypotonic it will externally rotate the femur. Which happened first? - kind of like a chicken and egg thing. I'd vote for 1. pirformis overuse from riding -> Not stretching enough before and after -> Not resting enough so it can heal -> overuse again-> spasm -> reinjuring the muscle -> pain and compensatory changes (rotated femur, sacrum, bad pedaling technique, etc.). Go to number one and repeat process.

A pill isn't going to cure this one. You got to play a part with any or all of the following - Chiro, PT, Massage, accupunture, witch doctor, Brady Bunch taboo, etc.
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Old 12-01-10, 02:18 PM
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By the way your seat or bike fit might suck too, but it probably just sucks right now because you're all inflammed
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Old 12-01-10, 02:20 PM
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"My feet splay out quite a bit"

Are you sure you're not a senator from Idaho?

I'm guessing overuse. I have some serious back issues myself, related to a bulging disk and age-related arthritis.
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Old 12-01-10, 02:49 PM
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Overtight hamstrings. #1 culprit. Trust me on this.

Stretch 'em out. GENTLY.
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Old 12-01-10, 03:26 PM
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Originally Posted by vkalia
Teterider - Did your symptoms of piriformis persist? I get the symptoms, I do the prescribed stretches and after 2 days, I am fine. It's been 3 months or so since my last incident. I am assuming that with a herniated disc, the symptoms would persist, right?
Same issue I used to have. Assuming it's just an irritated sciatic nerve & not a herniated disc:

In order to keep it in check you need to do maintenance after EVERY ride:
* Post ride stretch (piriformis stretches & hamstring stretches)
* Ice 20 minutes
* Ibuprofen if it's already sore

Do it even if it's not bothering you that day.
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Old 12-01-10, 05:11 PM
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Yes, the symptoms of piriformis syndrome persisted for a long time while the back healed. My back really never hurt; any pain was related to sciatica caused by the herniated disc. I unknowingly injured my back in January '05, and wasn't diagnosed with the herniated disc until about May. It took about 9 months to get to 90% and a full year to get to 100%. Oh, and that was the year I stopped carrying my wallet in my back pocket and that really sped up the healing (my wallet pocket was the leg pain side too). I can't stress enough how bad it is to sit on a wallet for anyone.

In my case, I couldn't ride without pain which may have been my particular injury or my bike setup, but I could hike all over and the walking made it feel better, as well as the stretches.
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Old 12-01-10, 06:27 PM
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Originally Posted by teterider
Well the only thing I have to add here is that a herniated disc can present symptoms as piriformis when its not - its a herniated disc. I spent 4 sessions in physical therapy for piriformis after seeing a doctor before the PT got suspicious that it was my back. Imaging revealed the disc.
This is almost exactly what happened in my case with regards to the PT, etc., but it turned out my disc was totally extruded and I ended with no choice other than surgery. For me the pain was extremely bad because my sciatic nerves go right through my Piriformis muscles (an anomaly shared by ~15% of the population). In my right leg, from my hip to the tip of my toe, it felt like every bone was broken, every muscle pulled, every ligament and tendon torn, 3rd degree burns on my skin, etc. The only thing that gave me any relief until surgery was a daily dose of cyclobenzaprine (a muscle relaxant that also blocks nerve impulses (pain) that are sent to the brain).

And according to all of the research I did at the time - all of the comments here (tight hamstrings, overuse, etc.) are accurate and could all be causes. Keep after it until you find out what is causing it.
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Old 12-02-10, 09:28 AM
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An update - went to the physio today. Was expecting him to be in awe of my glistening guads of destruction, but he poked and prodded and tut-tutted about how weak my hamstring and glutes were. Gave me some exercises to do daily to strengthen them.

And +1 on the stretching the hamstrings and piriformis muscle daily. I've been very flexibly all the way to my 30s, thanks to 20+ years of martial arts training, and I've never needed to stretch. Now I think I need to accept that I am older and do all those things.

Thanks for the feedback, all. I have a 140km road race next Sat, and an 8 day/1000km grandfondo-type event a few days after, so I hope this gets sorted by then.

V.
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Old 12-02-10, 01:15 PM
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Originally Posted by patentcad
Overtight hamstrings. #1 culprit. Trust me on this.

Stretch 'em out. GENTLY.
Get a foam roll to help. https://www.youtube.com/watch?v=N9Qw4aAFdbc
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