Piriformis Syndrome
By Dr. Ricard Izzo
So you are building up your swimming, biking and running mileage and then bang it happens. You wake up the day after your first century with butt pain that radiates into your leg. You have never had lower back problems before, or maybe you have. You go to work out and it feels better after warming up.
But after sitting down it gets worse again. Some guy you know who had lower back problems tells you it’s sciatica and you think that your season is over, hell maybe you can’t do endurance sports anymore. You can even hear the surgeon sharpening up his scalpel. You go for an MRI and x-rays and they are normal. After a complete workup the doctor tells you to stop all activity.
What the heck is going on?
You are suffering from Piriformis Syndrome. The piriformis is a muscle that lies beneath the gluteus maximus and runs from the border of the sacrum to the greater trochanter. It acts as an external rotator of the thigh. It lies pretty much exactly where you sit. This condition is most often mistaken as a disc herniation due to the pain that is referred into the leg.
Since the sciatic nerve travels beneath the piriformis on it’s way to the thigh and leg, it can become entrapped by the pirirformis muscle if the muscle tightens in any way. This can happen when you increase your biking mileage too rapidly, or have a job where you do lots of sitting and the muscle shortens over time. In 3% of the population the muscle is bifurcated (two heads) and the nerve actually goes through the belly of the muscle. This lends itself to entrapment even more so.
Getting back to our athlete’s scenario. Stopping activity will only make the condition worse, as will continuing full activity. So what do you do?
Treatment for piriformis syndrome first requires pin pointing what caused it. Overuse injuries usually have some biomechanical abnormality as a cause that requires normalizing. Next, modify activity by decreasing intensity, duration, and distance by 30%. Modify your bike seat height by lowering it down by1/8-1/4” (only temporarily). Next get aggressive conservative treatment ASAP. Deep soft tissue work should be done on the area to decrease any adhesions of the piriformis and other muscles. Daily stretching of the piriformis should be done. Moist heat should be applied to the area before activity. Always warm into activity. And finally take it easy, and enjoy training with others at your own pace.
Dr. Richard A. Izzo
(914) 251-1223
r.izzo@worldnet.att.net