Piriformis Syndrome - a pain in the butt!
The piriformis muscle in the buttock, covered by the great glutes is little heard of and indeed quite small, but "boy" it can cause a lot of trouble. Ten days ago I was at my pilates session, and whilst "pushing my body out over a barrell" (I should know the name of the exercise, but I am terrible with names), I felt a pain in my buttock, which immediately went away. A couple of days later I started to feel a pain in my bum, particularly whilst walking, on the phase as one goes over the stationary leg to make the step forward. The pain was in the buttock of the non-moving leg, in my case the right. I hope you have computed that description. I thought to myself I must have torn something there and remembered the pilates session, but to be fair it could have been something else. The pain worsened. At the back of my mind I thought this is like nerve not muscle pain. It is possible to get sciatica from a disc protrusion in the back without back pain. However, my back felt fine, in fact thanks to Nigel at pilates more mobile than it has been for years.
The pain got worse to the point that walking Charlie the Dalmatian was reduced to a hobble on the flat. I was specifically avoiding hills. Pain killers made little difference. So I "googled" buttock pain and found the answer; piriformis syndrome. The sciatic nerve passes close to and in some of us through this muscle. Damage to the muscle can irritate the nerve. In many ways piriformis does not do a great deal. It is an external rotator of the hip; not a common movement. Its main function is probably stabilisation of the joint when walking or running. Thus the pain on walking when the knot, blood clot, tear, or whatever pulls on the sciatic nerve. So it was nerve pain after all. I was pleased now I had a cause for my pain, but needed to sort it out, otherwise my wife would be doing all the Charlie walking, and she is at work a good deal, so I would be limping around with him on walks that would be too short for his mental and physical well-being.
There was and is a silver lining! Guess what? Yes, I can cycle pain free and indeed after a session on the bike the pain on walking reduces. Presumably it stretches things a bit, but does not hurt because of the low impact, and clipped in the pedals piriformis has nothing to do. Phew!!
I embarked on a programme of self treatment. Ice - probably a little late for that since the acute injury was a while back, but the numbing was nice. Stretching, which for me seems to make the most difference, but is awkward because the muscle is difficult to stretch and the limited range of movements in my hips make it even harder. Ultrasound with a little portable machine I have, to try to break down the tear, and reduce the inflammation by using ibuprofen or diclofenac (voltarol) gel at the same time.
Then there is massage on a foam roller, roller ball, or a roller stick I have, and then Nigel gave me this cattle prodder to dig into the trigger points!
I think it is improving, but it is slow and somewhat resistant to treatment. This makes me worry for you out there. For the athletes among you, you may have a pain in the butt and struggle getting a diagnosis, and even if you do the slow improvement, which seems to be the norm will seriously affect your training. You definitely need to be aware of this potential troublesome injury. Perhaps there are some with it in a mild form who are just muddling along. For the non-athlete the worry is that you will visit the GP, not get a diagnosis and end up on stronger and stronger pain-killers, getting less and less mobile to the point of severe disability.
So remember when you have a "pain in the butt" is it priformis syndrome?
