Periformis Syndrome?
Hi all, would like to get some opinions from the medical folks. I have been having hip pain since 2 weeks after IM Lou (mid Sep~). I had slight pain on my hip prior to the IM while riding, but I had a great run, and no issues in hip during the race. Started running 2 weeks after the race, and the pain started. Saw an ortho PA, X-rays of hip/back, no issues, diagnosis was radiculitis, had 3 weeks (2x/week) PT, have gotten better, but I still have pain during my run. I am now up to 45min of run, slow pace (12min/mile) with some pain in my hip, but if I pick up my pace even a bit from there, the pain goes from hip to hammie down to calf. My PT thinks I had muscular damage, and she diligently worked on massaging, and I have been working on strength workout as we discovered I am significantly weaker on my ride side (non-injured side). My question is how long the hip muscle injury (seems to be periformis) would take to heel? This injury is different from any other injuries I had in the past and doesn't get better even if I don't run, and very frustrating. Should I go back to the doc and re-evaluate if there is anything else going on, or should I just keep doing easy run? I am doing stretching/roller foam massaging at home as well. Appreciate any feedback.
Comments
It sounds like you've really improved the soft tissue mobility which is good. The only thing I would add is some nerve specific mobility work- have any ART people in your area?? They do lots of nerve entrapment stuff and that could make a huge difference now that the more superficial stuff is gone. That in addition to balancing out your strength is going to be the key to getting rid of this stuff. Stick with it. The process is slow but it will improve.
Have you had someone look at your run form? The faster you run with bad form, the more it falls apart. Also, do you have the right shoes for your foot strike? Sounds like a structural issue that is based in the function/form of your running.
Good Luck, and as Leigh said, "it is a slow process"
Ebe
Going to second Ebe. Time to really start breaking down the run form to see what's off and where. something is off to continually shift the workload to the back of the hip. hard to say what that is remotely though since what we think we look like and what we actually look like are usually two very different things.
Did your PT ever actually put you on the treadmill to see you run?
@Yasko...I know what you are going through! I've been battling PS since 1999 and it truly has been a battle. I was not doing endurance sports in 1999, just started running in 2009. Just had my 4th bout since 2008 and I've been down since Jan 10th...in JOS...uggh. No running, minimal cycling, and ART.
To answer your questions....I have had the steroid injection 3 times with marginal success. I'm not sure they really helped.
I was diagnosed with an EMG (electromyography) study in which a 5" needle connected to electrodes was inserted into the piriformis muscle. The electrical activity was off the chart...my prirformis was in tetany or a severe spasm which was choking the blood supply to my sciatic nerve. My pain presents as leg pain and also constrict my hamstring to the degree I cannot stand up straight and have trouble walking. Some days, I cannot stand or walk for than a minute at a time. Another sign for me is that my glute on that side gets very, very tight compared to the other. Many times, actually too often, PS is mistaken for L5-S1 disc issues. Each bout lasts for a couple months for me. I am one of the "lucky" 8-12% of the population in which my sciatic nerve goes through my piriformis muscle...hence the leg pain. Lucky, huh?
I would suggest asking about an EMG study to get a confirmatory diagnosis. If the piriformis is in spasm, steroids will not help. If the piriformis is inflamed, steroids will help. A Physiatrist (MD) performed my EMG and injections.
Another option for me, since mine is not an inflammatory response but a spasm, is actually botox. The botulinium toxin will prevent muscle contraction at the muscular/nerve junction.
I wish you the best of outcomes and will echo Leigh's sentiments....stretch, stretch, and more stretching! Not only the piriformis, but the hip flexors, adductors (inside thigh) and hamstrings. All of those are kinetically part of PS and the more that you take care of those, the less trouble you will have. Unfortunately, but mostly fortunately, I have finally learned that its all inter-connected.
Take care!
@George Good info. Hope you keep on the healing path.
@Barbara, it has been quite a haul. I too have a "bulge" in my disc but fortunately not bad enough to be causing the pain in my leg I was experiencing. Very blessed that none of the Neurosurgeons that I saw wanted to operate or I would still have the issue and be really upset. After 3 rounds of PT since 2007, it has been clear that none of my therapists, until now (sorry Leigh
) ever taught me about the hip flexors and adductors and their kinetic involvement in PS. None of the Neurosurgeons either ever mentioned PS, an Ortho friend of mine at my hospital was the first to utter the words. It was nice to finally have a diagnosis, but boy, its a hard one to treat. No magic surgery or treatment...mostly just keeping it mobile and stretched. My wife did hear with her own ears that it is best for me to multi-sport train for my condition! 
Since my bout just jumped on me this time, the working theory is that because I stopped cycling (which more than likely kept the piriformis stretched, especially in aero) in October to concentrate on running (which shortens the piriformis) to train for a Half Mary in December, once I started cycling again, the piriformis rebelled. It got tight, fibrotic and did not allow the nerve to "floss" or move through it cleanly from running...it was probably adhered or stuck in the muscle and that precipitated the spasm. So, my point, ...training consistently is actually good for it, especially with some piriformis-specific stretches on most days, especially after training (running and biking but running is a bad culprit) and off-days. Remember, hip flexors and adductors!
@JB...coming along, albeit slower than I would like but nonetheless working hard at rehabilitation. Thank goodness for Renick and regina!
Early season Sprints are on the shelf...target for first race is possibly Langley Pond Sprint or the Y Rock Hill on 5/7.
I have been doing some stretches, but haven't paid any attention to adductor at all. I will check out Leigh's site to start incorporating the stretches. I am in process of making an MRI appt now (not too excited about going into the tunnel, yeeek!), and am anxious to see what it will show. I will def. mention EMG to my ortho doc. and see what he says. I will keep you all posted.
@Barb, I hope you will get some good treatment plan for your pain soon.
@ Yasko, no bother with the questions...I hate it that ANYBODY would have to endure PS
So I guess my muscle could be stuck for biking, and causing issues for running??
PS is very individualized...your sciatic nerve may not bifurcate your piriformis but some peripheral nerve bundles may. As soft tissue heals it can get fibrotic (leathery) and lose elasticity, that in itself can cause nerve irritation. We can hope that you are not one of those "lucky" ones like me. It really is about the stretching.
So, now you know what's causing the issue, is getting botox shots the only option you have whenever you have issues?
At the moment, I have no plan for botox. I have a little more kinetic information that I have not had in the past and plan on being a little smarter and more diligent about my stretching and its importance in my lifestyle.
Is there any option for you to correct the problem so you won't have to have shots?
Very last option is a piriformis release which essentially detaches the piriformis from the sacrum and great trocanter. That is a career ender from what I have heard. So teh answer to that one is a resounding ...no.
Yasko, my race is in Sep so I'm in the same time-frame as you. I plan on being ready and healthy by then but I am working at stretching 5-7x each and every day right now. It has made a marked difference, but I am nowhere near where I hoped I'd be before my injury. Stretching and mobility is really the key to PS. Have I said that before? LOL
My only advice is to really make the stretches a priority and then train by feel.
I wish you the best of outcomes and know that all injuries can get better but can get worse...so be smart. Don't derail your season before it really gets started.