Friday, 11 August 2017

What I've learned about piriformis syndrome

Piriformis syndrome has been the bane of my life this year. I've tried to learn as much as I could and I thought I'd share it here.  Piriformis syndrome is a result of tightening or spasm of the piriformis muscle, a hip abductor. In many cases this results in not only a pain in the butt but compression of the sciatic nerve, which passes behind the muscle.  Compression of the nerve can cause pain and numbness all the way to the toes. In some rare individuals the nerve actually goes through the muscle making those people more prone to piriformis syndrome. Often damage or spasm is due to the muscle being overworked due to tight hips and inactive glutes.
It's considered a rare injury. It's often misdiagnosed as other conditions but that's not surprising considering that other small hip muscle injuries, high hamstring tendinitis, slipped discs in the lower spine and si joint disfunction can cause similar types of pain. It takes a physical therapist or Doctor to be able to diagnose it properly. Luckily the muscular problems have a common treatment, core/hip stabilization muscle strengthening seems to be the way to go! Also stretching is very important.
Not all cases are created equal either, as some people don't have bad nerve pain and can function pretty normally, except for sitting for long periods of time. Some people can be back to normal activity in weeks or like in my case it can take longer. My feeling is that it probably depends on the amount of nerve involvement.

Conservative treatment consists of pain management and PT. If that doesn't work Botox or pain killing injections directly into the muscle seem to be a common treatment and if all else fails a surgeon can 'release' the muscle. 
It seems to be very individual as to what works. I guess it depends on what triggered the problem and any individual muscle imbalances contributing to it. 

I think I originally had a very mild case, due to bad posture and muscle imbalances, but didn't realize it. Then a friend came over and I sat on the floor for an hour chatting. BAM I woke up that night in agony!
I've split my experience into what I'd consider my phases of treatment and recovery.

Phase 1
 Excruciating pain: moving hurt. The kind of pain I'd never felt. Moving short distances was enough to reduce me to a mess. Luckily thanks to muscle relaxants and painkillers this lasted only a few days.

Phase 2 
I still hurt a lot but if I was careful it was constant rather than sudden and unbearable. I still could not dress myself for a while and for the entirety of this I couldn't bend down or do simple things like put on shoes and socks. I basically moved between my bed, bathroom and couch and considered myself lucky. So more painkillers. I actually lost about 8lbs over this phase because I had no appetite either because of the painkillers or the pain.  Martina was a lifesaver and literally did everything around the house including all of Boomer bathroom trips. PT really helped. It started slow with hip bridges and a gentle back stretch. Dry needling gave me amazing temporary pain relief (hours-day with much reduced pain). Lasted around 2-3 weeks. 

Phase 3
The nerve pain slowly went from bad to barely there but my leg down to my ankle was still numb a lot of the time. The nerve 'waking up' felt like raindrops on my leg. PT got more intense and I actually felt the least pain after doing my PT exercises. Squats, clamshells, leg raises amongst other exercises were added to my hip bridges. I could roll part of my butt cheek on a ball but I never found trigger points and parts I avoided rolling because it was inducing nerve pain. I had constant muscle pain isolated to 3 main spots; top of butt cheek, trochanter (bony protrusion on side of butt) and at the butt crease into my hamstring. Massages still felt like it was 50/50 as to whether they helped but anything that made the rest of me relax after being in pain for so long helped. Walking, swimming and elliptical were ok for workouts <1hour. Lasted around 2 months.

Phase 4 
Barely any pain day to day just a little tightness around the lower back. I finished PT. I was able to expand on my PT exercises myself including more and more strength work but avoiding anything that induced pain. Any impact related cardio, running/stairs, caused nerve pain. Frustrating, because I felt so much stronger in general but was stuck to a lot of swimming and walking. I had trigger points in my hamstring which releasing really helped me be able to bend over again. Everything from my lower back to my toes on my left side were substantially weaker so I had to work on strengthening everything including my ankles and feet. I also spent a lot of time stretching, trying to gently improve the flexibility in my hamstrings and hip flexors. 

I bounced back to phase 3 after a month or so of phase 4 but I think this time it was due to trigger points building up in the tissue. That's not so surprising considering I had been building up muscle in a previously injured area and sitting more frequently. Many painful times with an elbow DIGGING deep into the muscle helped break those down and drastically reduced the daily pain.

My long drive from SC to CA to move was an exciting but terrifying prospect as sitting is generally not good for piriformis  syndrome. The drive (and the previous break from running) actually made it better! I drove with a lumbar support which forced me to sit up straight with good posture. I'm back to pain free day to day life. While my piriformis is a little tighter the day after running it doesn't cause any nerve pain. I mostly feel it if I've been sitting on something hard or with bad posture or lifted something too heavy (impossible to avoid with moving). Now that I know this I can really focus that much more on my posture.

If you think you have this get yourself to a Doctor and/or physical therapist. If you have a severe case like mine my biggest piece of advice is patience. Pushing beyond what you've been advised to do or what feels ok is going to set you back. I've cried many times at the beginning because I was constantly in pain, which really messes with your head, and later because I was frustrated and convinced I'd never get fully better but oh so slowly it's going away.

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