This one's a bugger. Oh there are other buggers - Plantar Fasciitis, Achilles Tendonitis, etc. But this is difficult - it's hard to describe, it's hard to stretch, and it's hard to get rid of.
I won't go through the symptoms and diagnosis here. There are lots of places on the web that do this just fine.
The first bugger is getting it diagnosed. From what I know there isn't a specific test for it, so you end up coming to Piriformis Syndrome through a process of elimination. A bulging L4/L5 disc is the most common alternative diagnosis. Some people will claim "I have sciatica." Sciatica is more of a symptom than a cause. Piriformis Syndrome causes sciatica symptoms, but so do other things.
The second bugger is to stretch that baby out and get it calmed down.I've found the following the most helpful:
Check the range of motion for internal and external rotation. Stretch appropriately to improve ROM if not good or symmetrical.
Piriformis is an external rotator. If it's tight and in spasm it may be because the other extneral rotators (such as gluteus maximus) aren't doing what they're supposed to, causing Piriformis to do more work. Check recruitment and strength of other external rotators.
Lastly, pay attention during every-day activities and see if you're doing things which keep the Piriformis chronically contracted. Here are two that are extremely common:
Driving. Do you let your legs stay splayed out against the door or center console?
Sitting. Do you hook your ankles under the seat?
In both of the above situations your thighs are externally rotated and the Piriformis will be chronically contracted.
I've had many people tell me they wish they could take up running, however it's just too hard and they end up giving up.
Running is extremely hard on the legs and lungs. Additionally, it takes a while to learn the pace that one should be running. Some first-timers think running means "sprinting".
As in many aspects of life, to begin running you need to walk first. Therefore, here is a simple-to-execute schedule to get you running: (Each week perform the listed activity 3 times.)
Week 1: Walk for 30 minutes
Week 2: Walk for 9 minutes, jog for 1; 3 times
Week 3: Walk for 8 minutes, jog for 2; 3 times
Week 4: Walk for 7 minutes, jog for 3; 3 times
.......
Week 11: Run for 30 minutes!
When you're starting focus on time spent in the activity and not at all on speed. Pay attention to your breathing. If you can't hold a conversation with someone running with you (either literally or figuratively) then you're going too fast. The goal is to get your body accustomed to the routine and pounding of running.
Does 3 months seem like too long of a time to get running? Well, if you're really committed to establishing a long-term running habit, 3 months is no time at all.
You know who is most concerned with your health? You.
The internet has fundamentally changed the dynamics of how we interact with the healthcare ecosystem. We now have the power to do research ourselves. We can look into a drug that has been prescribed. We can research symptoms and potential causes. We can determine treatment effectiveness.
While us laymen obviously don't have the training of the professionals, we're in a pretty good position to decide whether we agree or not with their recommendations.Make sure you agree with the path your healthcare team is suggesting you take. Challenge them. Question them. Make sure you understand them. Tell them when something isn't working. And if they can't handle this attitude, find someone who will.
What a great Star Wars line.........................................
The pain we feel may not (typically not) be a good indicator of where the problem is. Oftentimes the real problem is opposite the pain - either the opposite side of the limb or the opposite side of the body.A muscle can be stressed because something else isn't doing it's job.
The hip flexors can hurt because they're tight from sitting all day. When sitting Gluteus Maximus (which does the opposite motion of the hip flexors) is stretched. If one sits for long periods of time Gluteus Maximus becomes not only chronically stretched, but the nerves get lazy and it's hard to engage the muscle very much at all. Recruiting and strengthening Gluteus Maximus not only gets this important muscle working, but also loosens up the hip flexors.
"Can I run?" That's gotta be the most-asked question a healthcare professional gets from a runner when they're injured.
My PT has taught me the concept of Active Rest. "Rest" is relative. Maybe you cut back on your running but still run some. Maybe you quit running for a bit but do something else. Go to the pool. Get out your bike. Go for a walk instead of a run. Or maybe you cut your weekly mileage in half. That's resting. And your fitness level won't deteriorate nearly as fast as you think it will.
Resting is a balancing act. The amount of rest needed is determined by what you're recovering from. You want to ease off to give your body a break and chance to heal. If you listen closely enough you'll know if you're resting appropriately. Interestingly, however, movement promotes healing. So find that level and type of activity that will promote healing but not put you in a deeper hole.
I studied Mechanical Engineering in college. That gives you an indication of how my brain is wired.
Physical Therapy has been the most fascinating and rewarding aspect of staying on the road. It's so refreshing to have pain eliminated not because of some chemical, but because muscles have been tweaked, nerves gotten retrained, or coordination has been improved.
My first experience with PT was about 5 years ago. I had a pain in my calf and my doctor (not my current doc) concluded I had compartment syndrome. The solution is to cut open the compartment, relieving the pressure and leaving a knee-to-ankle scar. Thanks to Google I determined this is a relatively obscure condition for runners; let alone a 40-ish guy running 9:00 minute miles. The doc was ready to get me into surgery. And the insurance company would have agreed and approved.
I didn't believe him. On the advice of a friend I went to a Physical Therapist. Fortunately my friend recommended a really good one - the one I use today. He discovered some interesting stuff. The big leg muscles (thighs and hips) weren't doing what they were supposed to do, so the little leg muscles (calves and ankles) were "upregulated". They were stressed because, with every foot strike, they had to take on all the responsibility for making sure I didn't fall to the ground.
After about 6 weeks and a few appointments I was back to running completely pain free. By getting those big muscles to do what they were supposed to the strain on the smaller ones was eliminated. Astonishing - go under the knife and not get my issue resolved - or do something completely non-invasive and be back to normal.
Brad Ott @ Rebound Sports and Physical Therapy (Loveland, CO) is the PT who has helped me through these and other issues. Hopefully when you're looking for PT you can find someone like Brad: Someone who knows their stuff unbelievably well and will also take the time to explain what is happening and why. This has made an indescribable difference in helping me understand how the body behaves and reacts.
I love to run. It began 13 years ago. I told myself if I got up every morning and went for a walk I'd buy myself a Nordic Track. Forget that. After a couple of months the walk evolved into a jog which further evolved into a run. Since that beginning I've participated in countless 5Ks, a number of 10Ks, and 1 half-marathon. I've fought my normal share of running injuries over the years. Then in Dec 2006 "the big one" struck - the one that makes a runner cease all running in order to heal.
I reluctantly went to the doctor - reluctantly because the pain was hard to pinpoint. That was the start of what has turned into a 2 year journey to get back to running again. I'm not totally there but the progress is undeniable. The last 2 months have been the most positive out of the last 24.
Currently (Dec08) I can run 10 minutes out of 30 minutes of total activity. It's pretty small when compared to doing half-marathons, but the vector is in the right direction. I'm currently adding 1-2 minutes/wk to my running time.
My hope is that, by sharing some of my experiences and learnings, others can more quickly get back to what they love to do. Jim
