Help with piriformis, and possibly more

by SB


Came across your site and have the following for the last 6 months or so. Have visited two physio's with the following condition. This has all started after I pulled a hamstring playing softball. Active runner (<10m/wk) and cycler (50-100m/wk)

1. buttock pain, stabbing, then radiating down leg after sitting for extended period of time, usually greater than 30-60n min
2, back of thigh pain
3. occasionall leg tingle (depending which way I strect

first doc said hip injury(weakness on left leg), looked at me, had me walk 10 steps and gave me a prescription for pain killers, orthotics, stretching and PT. Also wanted to use a specific set of shoes, pusrchsed at specific store, and only use his recommended PT. Didnt buy the story, got a seocnd opinion.

second doc said hip injury (weakness left leg) to go with PT, increase strength training more along back and core as well as left side. did that for almost 6 months.

With both docs flexibility was there, no pain during tests, just weakness. Both saw an MRI of lower back, nothing out of the ordinary. I feel better since this started, yes. But I have plataued and still get pain while sitting. Getting up makes it go away within 30 sec or less. both docs said piriformis syndrome.

Current state
I can still bicycle for 1-2 hours and usually no pain during ride, but get the burning, stabbing pain in buttock afterwards (2-4 hours later after exercising) Power is still there, but usually can feel tightness during hard applications. running is a little worse, probably because of the impact, but still can get 2-3 miles on occasions. i have stepped it down and run a mile, walk, run, etc to break it up. During workouts I feel very good doing most exercises, though some the buttock and hamstring area is tight(good mornings, lunges). Still, nothing that stops me from working out as the pain is low and usually only the 1st rep or two. I've stopped stretching and increased meassage, primarly into trigger points which has helped. Can definitely tell I have been holding onto some tension and have alwasy had that issue. The weird thing lately that is again when sitting for extended periods of time and when I pull my head down, I feel a tingle, like an electric shock near my sacrum? (just where the buttock spilts), inside of thigh, and then down to arch of my foot. Never painful, just a tingle. If I try to do it agian right away, doesnt happen. 30 minutes later, i can recreate it. Just weird.

Thoughts on this? I really would liketo get my activity back to where it was before injury in terms of distance, but i am not pushing myself. I still workout 5X a week to staty active, but am having difficulty on what the next step is. Am considering seeing a chiro as well.



Hello SB,
This mistake was not to see a chiro first! This is now chronic and likely to be difficult. My rule of thumb: if any condition is not responding well, within 3-4 weeks, I would recommend a second opinion. I have no beef with you seeing medics first but you waited too long, but anyway that's history, and sealed in concrete.

I say this not by way of reprimand, but for the next time you have this or another condition. Once you know you are not getting better, move on...

Two interesting features:
That tingle and pain in the leg when you flex your head and neck is called Lindner's sign. It's a classic nerve impingement sign.

The question is which nerve. Initially it seems your symptoms were Sciatic nerve related, but that tingle in the inner thigh suggests a Femoral nerve problem now. You can have both.

The test for the sciatic nerve is routine, and you can do it yourself. Go to the Search this site feature at C-H and type in Slump test. Let me know what the result is.

The test for the Femoral nerve is more difficult and you can't do it yourself, plus it's a difficult test to interpret. Ask one of the physicians treating you to do it if they haven't already.

One more simple test for you: if you bend forwards, is the one leg much tighter than the other? And if you bend backwards? Sideways? Do any of these movements produce back pain, tightness, tingling in the leg?

One other condition to be considered is Maigne's syndrome (see C-H). It's an impingement high in the lumbar spine affecting the superior cluneal nerves that supply the skin over the buttock. It often goes with a leg length inequality that may be the underlying problem.

The long and the short of it? You need a good thorough chiropractic exam to decide where the underlying problem is. There are plenty of chiros in Illinois, I know, I did my training some thirty plus years ago in Lombard.

Do your homework: don't go to the chiro with the biggest sign. Talk to friends and family, your doc.

I hope this contributes.

Dr. Barrie Lewis

> > Help with piriformis, and possibly more

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