How can I deal with intense pain in my piriformis?
April 29, 2010 9:20 PM   Subscribe

Any tips for handling my piriformis pain?

I have been running for about 10 years (I'm 26) and a few months ago, out of seemingly nowhere, began to experience intense pain in the middle of my––for lack of a better term––butt cheek. The pain is located about in the center, although I can sometimes feel it in my hip as well. I eventually sought out medical attention after the pain became so intense I wasn't able to walk up stairs.

I've gone to a sports doctor, taken anti-inflammatory meds, went to physical therapy until my insurance would no longer approve it, but I still feel pain so intense that I have difficulty sitting or standing for long periods of time. Any physical activity seems to aggravate the muscle, whether it be walking, running, biking, elliptical machining, etc.

I know that I need to get further medical attention, but I was curious whether others had found particularly effective ways of combating this pain. Stretches? Seated/standing positions? Massage techniques? Medications? Ice/heat?

And, were you ever able to run again? If I try to run short distances, do I risk permanent damage? I never realized how much running improved my mood/ability to cope with stress/general happiness until I wasn't able to do it. This pain has made me absolutely miserable and so any advice would be greatly appreciated.

Thanks, in advance!
posted by lxs to Health & Fitness (16 answers total) 5 users marked this as a favorite
I had intense piriformis pain for two years following a discectomy. I had all kinds of physical therapy, heat therapy, cold therapy, ultrasound, aquatic therapy, massage, drugs, was wearing a TENS unit, blah blah blah. None of it helped. I was so unbelievably miserable. Finally I got pissed off and quit doing all of it, no stretching, no nothing. Within two weeks I was completely cured and have never had more than transient pain again. I can only conclude that all those interventions were doing nothing but irritating it. So, if nothing else helps, try doing nothing.
posted by HotToddy at 9:58 PM on April 29, 2010

I have struggled with this same pain off and on for the last couple of years, and I can completely sympathize with the psychological side effects that go with the struggle to balance desire to run vs. intense ass pain.

I have tried various different therapies and treatments, and while some have had degrees of success in making the pain more manageable while I was experiencing it, nothing has ever made the pain go away except stopping running for a while. This has been very difficult at times (most notably when I was training for a half marathon last summer to raise money for the Leukemia & Lymphoma Society), but there really didn't seem to be any lasting effect from anything other than just stopping.

FWIW, the things that did alleviate pain were using a foam roller and doing that stretch where you half-bend one leg such that your ankle rests on the opposite knee and then bend forward. However, the pain while running was pretty much unbearable for me; I'd usually know within a couple of strides if I just couldn't do it.

Some other runners I know have talked about acupuncture, but I've never tried that. YMMV. Good luck.
posted by DuckGirl at 10:25 PM on April 29, 2010

The gym I workout at coincidentally just had a post on piriformis stretches: If you're in the Bay Area (or if not, depending on desperation), you could consider seeing Kelly Starrett, a physical therapist and Crossfit coach who has a reputation among the people I workout with for fixing problems that no one else could:
posted by holympus at 11:13 PM on April 29, 2010

Just wanted to add that yes, I have been able to run again - but only after a rest. And for me, the pain was actually worse in just regular day-to-day life than anything else....sleeping, walking up stairs, stepping out of the shower.....the pain from those activities were what really compelled me to stop running, and from that eventually came relief (but it did take a while).
posted by DuckGirl at 11:55 PM on April 29, 2010

What helped me was improving my posture and all the other muscled stabilizing the hip. Xcountry skiing was incredibly helpful as were some yoga and pilates exercises. I needed to target the muscles in the front, those lower ab or pelvic? ones.

Otoh a friend of mine had some botox injected into hers recently because it was causing sciatica as that nerve passes through the muscle in a certain percentage of people. She's reasonably happy with the results so far.
posted by fshgrl at 12:46 AM on April 30, 2010

The stretches duckgirl mentions worked for me too. I do them very gently!
posted by fshgrl at 12:47 AM on April 30, 2010

What I thought was and IT band problem was really a deep, deep bundle of knot in my piriformis. Tried everything (except giving up running). I've foam rolled, stretched, PTed, used heat, ice and a TENs. This went on for months.

Finally, I had a massage therapist work that thing out. It was 45 minutes of sheer misery, but after the the therapist was done with it I didn't have that problem again. He didn't just work on that butt check for the entire session; he also worked the other muscles in the area.
posted by 26.2 at 1:26 AM on April 30, 2010

In addition to the piriformis stretches already mentioned, I've found relief by using a tennis ball to massage the area before I go to bed. I lay down on my back with a tennis ball under the butt cheek and roll my hips around. Not very glamorous, but it does alleviate the pain, albeit temporarily.

For what it's worth, my piriformis pain is caused by pregnancy.
posted by ellenaim at 3:46 AM on April 30, 2010

Hi lxs,

Sorry to hear you're having this issue - chronic pain can be a terrible affliction. I know you've already said it, but you do really need to seek out the advice of a healthcare professional with expertise in this area!

The pain you are feeling could just be from muscle strain due to running, but equally it could be transferred pain from a more serious spinal injury further up. In fact it's in exactly the region that people experience sciatica.

Go get the opinion of a musculoskeletal specialist to make sure there is nothing seriously wrong, then you can concentrate on the heat/massage/stretching and whatever else you find useful.
posted by ruperto at 4:48 AM on April 30, 2010

I'm having piriformis pain right at this moment! How exciting for us. I'm pretty sure mine has been brought on by cycling, though. I can also sympathise with the depression that goes along with not being able to do one of your favorite activities.

I started with using a foam roller, plus pigeon pose (the stretch DuckGirl talks about.) Wikipedia told me that piriformis syndrome could sometimes be alleviated by exercising the surrounding muscles: "An exercise regimen targeting the gluteus medius and hip adductor muscle groups can alleviate symptoms of piriformis syndrome within days."

(I did additional random Internet searching and other sports websites seemed to say the same thing -- I used this from the "Mid-Tennesee Bone and Joint Clinic".)

So I made a plan: started with pigeon and half-lotus, the yoga poses that really stretch my butt. Then simple exercises for the inner and outer thigh/glute area. Then deep stretches for the front hip flexors.

This has not really helped. Work only made it worse, as I sit all day and everything crunches into terrible little balls of fire.

So then I started walking home from work, about 2.5 miles, because the nice gentle motion of walking seems to get things moving enough to stretch out, but not crunch up into terrible knotty pain. I'm not doing anything else -- no stretches, no hip exercises, nothing.

And it finally feels a little better. So I'm going to try: walking a bit and minimal stretching for a few weeks. Then slowly back on the bike with the new stretching/abductor/adductor exercises routine.

Obviously, YMMV, but for me the "doing nothing" has helped the most. And the long walks.
posted by lillygog at 5:09 AM on April 30, 2010

Of course, as ruperto mentioned, you'd want to check with your doctor first. I did everything after consultations with my doc and licensed massage therapist.
posted by lillygog at 5:12 AM on April 30, 2010

As I mentioned here in 2005, you might want to go to see a podiatrist. My piriformis syndrome and plantar fasciitis were linked to poorly engineered feet. Getting custom orthotics helped both for a couple years.

Regular use of an elliptical machine and weight loss in 2008 & 2009 helped way more. Both pains disappeared unless I tried road running: my ass would hurt.

In 2010 I'm back to sedentary and a BMI of 30 partly due to an unrelated injury and both pains are returning but are easier to manage than before I had the orthotics.
posted by putzface_dickman at 6:28 AM on April 30, 2010

Foam Rolling is my newest-bestest-friend-ever!
I'd also suggest ART. It has been a long-time-bestest-friend to me.
The thing is with these types of pains, you're just going to have to see multiple people and do multiple things before you finally hit on something that works. But the first thing you should be doing is relaxing your body for a week or two before trying to continue with your workouts.
posted by P.o.B. at 2:28 PM on April 30, 2010

I am currently experiencing piriformis pain and the "rock in the glute" feeling that in my case was discovered to have been caused by a compression in the 5th lumbar vertebrae. My disc isn't slipped (thank goodness) but it's not happy either. So if it isn't resolving through massage and the other excellent suggestions recommended above, this could be another cause.

I have been told that L5 compression is a very, very common running/cycling/triathlete injury for the record. I'm not a big fan of chiropractors, but I managed to find one of the sort who does mainly deep tissue massage ("rolfing") and very minimal adjustment ("back cracking"). Seems to really be helping.
posted by lonefrontranger at 3:09 PM on April 30, 2010

I also have horrible piriformis pain from lumbar compression, probably caused by running on asphalt and wearing 10-year-old orthotics. I've swapped out for new orthotics and given running a break, as well as worked with a PT to do all kinds of core strengthening exercises for abs and psoas. All that, plus beating myself back into junior high ballerina posture, has made a huge difference in my day-to-day pain. I have yet to start running again with any kind of regularity, but I am cautiously optimistic.

Also sometimes I randomly have to punch myself repeatedly on the ass. Clearly recovery is a work-in-progresss.
posted by elizardbits at 7:02 AM on May 1, 2010 [1 favorite]

26.2 had it: his therapist most likely did trigger point massage. The reason stretches do not work is that a trigger point in a muscle means it is already stretched. So yes:
- rest 2 weeks
- trigger point massage (not funny to get)
- yoga or other stretches
posted by Eltulipan at 1:59 AM on June 16, 2010

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