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Piriformitis (a real pain in the ...)

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PostPosted: Mon Oct 13, 2003 1:11 pm GMT +0000    Post subject: Piriformitis (a real pain in the ...) Reply with quote

Hey There Doctor Nolan

I hope life is treating you and your family well up there in Buckeyeland.

I went on a really long road ride 2 weekends ago and ever since then I have had a low grade, nagging pain that starts in the lower right lumbar region and goes down to the lower part of my butt. It doesn't hurt while I'm riding but hurts afterwards. It doesn't hurt to bend down and touch my toes.

I tried to go for a run and after 2 miles I got a stabbing pain in my butt and my right foot started feeling funny. Not painful but not good either.

I finally stopped riding and running because I was worried I was making it worse.

Is there any way to distinguish between a disk problem and a strained piriform?

Assuming it is my piriform, how long does it typically take to heal?

Am I slowing the healing process if I start riding? Will stretching the piriform and hamstrings make it worse or aid the healing process?

As always, thanks for your help.
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The Bike Doc

Joined: 08 May 2003
Posts: 1371
Location: Corpus Christi and Warda, Texas

PostPosted: Wed Oct 15, 2003 11:14 am GMT +0000    Post subject: Reply with quote


The priformis muscle arises from the inner pelvic bone under the gluteus maximus and minimus muscles (the cheek muscles of the buttocks). It inserts into the upper thigh bone at the hip (the greater trochanter). The siatic nerve runs under the muscle and emerges at the base in 85% of the individuals; with 15% of individuals the nerve emerges through the mid belly of the muscle.

Piriformis syndrome or impingement can occur in those 15% of individuals with the siatic nerver emerging through the muscle belly. This malady is heralded by local pain to the muscle area as well as referred pain along the tract of the siatic nerve into the thigh, calf and even foot. Treatment consists of physical therapy modalities consisting of stretching, heat, ultrasonic application and massage techniques. Occasional difficult cases may require surgical intervention.

Piriformis muscle strain is triggered by acute or chronic injury to the muscle from maneuvers that cause the muscle to shorten such as with extending (straightening) the hip and/or abducting (moving outward) of the thigh bone. This malady is heralded by local muscle pain deep in the buttock worsened with activities that are associated with flexing the hips such as climbing stairs, squats, sitting or pedaling a bike. Treatment consists of stretching exercises, massaging, ultrasonic or electortherpeutic treatments.

I would recommend an evaluation by a physical therapist to help you develop a stretching and treatment program. Your bicycle riding and running certainly can be aggravating your symptoms but with effective therapy and regular stretching you should get some relief and be able to return to your physical activities.

If you have persistent numbness, worsening pain or any weakness, you should seek an evaluation by your physician immediately and possibly get an expeditious referral to an orthopedic surgeon.

Paul K. Nolan, MD
AKA: The Bike Doc
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Joined: 17 Mar 2004
Posts: 239
Location: Woodlands, TX

PostPosted: Thu Apr 15, 2004 12:23 pm GMT +0000    Post subject: A Physical Therapist who knows cycling Reply with quote

Give me a buzz & I will give you contact info for my wife who is a P.T. in the North Houston/Woodlands area. She is the clinic manager for the Woodlands Spine & Rehab Center. When it comes to this syndrome she knows her stuff--as well as any other cycling related injuries!

P.S. She has been healing me for over 18 years . . .

Pedal for Peace
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