Member Case Study: Piriformis Syndrome

author : AMSSM

comments : 1

Rolling, icing, A.R.T. and P.T. No running, now what? Piriformis Syndrome has been ongoing since July, is there any one out there who has any other suggestions?

Member Question from Wildred

Rolling, icing, A.R.T. and P.T.  No running, now what?  Piriformis Syndrome has been ongoing since July, is there any one out there who has any other suggestions?  Do I just learn to live with it?  It's not so bad that I can't bike or swim.  I have not run since December, but am hoping to start up again in April.

I have been running for many, many years so I don't think it is a shoe related issue.  I did try a different pair of shoes after being fitted at the running store.  I did just have a professional bike fit so I am hoping that might make a difference too.  Our weather is just starting to cooperate in terms of being outdoors on my bike.  I am also thinking of a running analysis to see if I can pick up anything that I haven't already tried.  I get the feeling that it is something that just is not going to go away.  I haven't done ibuprofen so maybe I will try that too.  How much and how often should I take ibuprofen?

I have my own roller, and I have been very good about using it along with the P.T. home exercises.  I am doing better but like I said I am not running.  When I start running again I will have to be diligent about rolling and icing and just hope the pain does not FLARE up.

Wondering if it will ever go away?

Answer by David Carfagno DO, CAQSM
Member AMSSM

First off, I applaud you for trying some of the treatment modalities you've mentioned.  Let's begin with defining Piriformis Syndrome.  It's a rather uncommon condition that likely gets over-diagnosed and overlooked equally.  The piriformis muscle is one of six external rotators of the hip.  It tends to compress the nerve called the sciatic nerve which comes off the lower lumbar spine.  I typically see the syndrome in someone who has a history of trauma to the area or repetitive injury due to poor pelvis and core control, and thus over compensation of the piriformis muscle.  The physical exam is usually very helpful in making the diagnosis but sometimes further testing is needed.  Diagnostic imaging can include an x-ray of the hip and pelvis, an MRI of the pelvis (to rule out a soft tissue mass possibly impinging on the sciatic nerve), or an MRI of the lower back (to rule out disc problem).  In some cases, nerve studies may need to be done to confirm.

Once an accurate diagnosis is made, treatment starts with a course of anti-inflammatory medications along with physical therapy, which includes stretching, resistance exercises, foam roll, and ultrasound. The goal of PT is to reduce the compressive effect on the sciatic nerve.  An injection of cortisone into the piriformis muscle may be necessary which is often performed via ultrasound guidance.  Rarely, surgery is necessary but may be the last option if all conservative measures have been exhausted.  In respect to ibuprofen, you can take 4 tablets 3x a day with food (provided you have no risk factors for stomach bleeds or kidney problems).  However, NSAIDs such as ibuprofen will not help solve the root of the problem.

David Carfagno DO, CAQSM
Scottsdale Sports Medicine Institute
www.scottsdalesportsmedicine.com

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date: May 21, 2010