My legs have been pretty heavy this past week. My runs have been tough and my last road ride on Friday morning left me with some soreness that I’ve not experienced before. I knew I was going to be in the car all day Saturday so I was looking forward to a day of rest.
Apparently 14 hours in the car wasn’t exactly the kind of day off that my legs needed. I woke up Sunday morning with a terrible pain in my left hip, buttock and shooting down my left leg. By now, most of you are probably thinking that I have a lumbar disc/ sciatica problem. While that is a good thought, I’m here to tell you about what I think the real problem is: Piriformis syndrome.
Piriformis Syndrome, or PS as I will heretofore refer to it as, is the condition usually afflicting athletes such as runners or people who sit a lot. I know…damned if you do….damned if you don’t! It’s caused by inflammation of the piriformis muscle which is a hip stabilizer deep in the buttock region. When this muscle becomes inflamed it can actually impinge upon the sciatic nerve causing symptoms that are very similar to lumbar disc degeneration.
When I palpated my ass through my lycra spandex cycling kit this morning I could feel a knotted muscle and there was a definite trigger point that caused shooting pain down my leg. Otherwise, most of the time the pain is nagging and seems to be aggravated by lateral hip and thigh movement. Sunday afternoon I was out in some moderate surf playing with the kids at the beach and I could tell every time the waves shifted me to the left and required resistance. It hurt. Not terribly but noticeable.
So why am I pouring all this out in my blog. Trust me, I’m NOT looking for sympathy. It’s more of a PSA. Judging by the number of lumbar spine and hip films I read each week, these are common presenting complaints by patients to their doctors. A suspicion of lumbar disc disease usually exists and an imaging workup will ensue. This could involve xrays, CT scans and even MRIs. This is expensive and involves radiation exposure.
I know, I know…I shouldn’t be discouraging medical imaging. After all that is how I make my living. But I actually care just a little about you guys. So here’s the deal. If you are an active dude or dudette and have these symptoms keep this diagnosis in the back of your mind and mention it to your doctor. If he/she is not a sports medicine physician, then they might not be keyed into it and will go down that path of lumbar radiculopathy. That can lead to expensive diagnostics and treatment.
It seems the treatment for PS is actually pretty conservative. It is recommended that the offending activity be curtailed first and foremost. REST. Ah…well….if you are reading this you might be an endurance athlete and we don’t do rest well, do we? Anti-inflammatory medications might also help in acute flare ups. Direct massage of the affected area can be helpful. Sometimes the piriformis muscle can be palpated as an over-contracted ball of muscle in the buttock region. Direct massage or using our great friend the foam roller could help. There is also some stretching that can be done to alleviate the symptoms. If you are not comfortable massaging your own ass you can always call this guy.
Otherwise some alternative forms of treatment such as osteopathic or chiropractic manipulation might be of use. I can tell you that 5 minutes of self massage really provided me some relief before my ride this morning. The point of the all this is that if PS is really what you are dealing with and not lumbar disc disease then you shouldn’t need a bunch of expensive tests and treatment.
Anyway, I hope my sore ass and thigh have helped you understand a little about the little known entity that is Piriformis Syndrome. Keep it mind (or your doctor’s mind) if you are having butt pain and shooting pain down your thigh and leg. Stay well my friends!