Piriformis Sciatica

I’ve been going through piriformis/sciatica issues for the past year. It was a one time event in mid-Dec ’16, when I tried to do some fast intervals and immediately felt it in my butt. It took about 2 months before I was able to even start easy, short runs, and at that it still hurt. Finally, I realised that the pain was not due to some muscle or ligament or bone or joint issue, and that I was not really injuring myself. So I just kept adding a little bit of frequency to my runs, and persisted with the stretching and strengthening program I developed for myself. Now, 11 months later, I’ve been pain free there for a few months, but it still hurts if I sit wrong or for too long, like in a car or airplane.

The piriformis is a small muscle in the mid-upper part of the gluteal region. It helps to externally rotate the leg. Imagine lying on your back, and lift one leg, slightly bent at the knee, a few inches off the floor. Then, keeping your knee in the same position, rotate your foot to the outside, left foot clockwise, right foot counter-clockwise. That’s what the piriformis does. It’s a small muscle, but gets a lot of use especially while running, so it can hypertrophy, or enlarge. Not a bad thing, except that a major nerve to the lower limb, the sciatic nerve, runs through it. A swollen piriformis can pinch and irritate the sciatic nerve, leading to all sorts of potential problems. Pain in the butt, pain down the back of the leg and the outside of the calf, weakness in the calf muscles are the major symptoms.

For me, it was first just pain in the butt, which over time grew less and less, until it was just pain when I sat down, like to write at a desk, eat dinner in a restaurant, drive a car, watch TV, ride in an airplane. Like I said, a pain in the butt. But the worst thing was, I was afraid to run.

Every time I ran, it would hurt there. So I tried running “through” it. Not good. I tried walking for five minutes, then running slowly a minute. Still hurt. Finally, I just stopped running, mostly cause I went skiing, and then on the three week Cuba bike trip. But I searched for ways to fix the problem.

I went through a lot of suggestions for stretch and strengthening, and eventually I learned which ones were working for me:

  • Tailor’s stretch: sitting on the floor, heels together, pushing knees to the floor 30 seconds, dynamic stretch
  • Sit up’s, 30 slow
  • Single-legged hip raises: lie on back, one knee drawn up, other leg straight out. Keep that leg straight and aligned with my trunk, I push my hips up using the bent leg (heel on the floor). 20 times each is hard work!
  • Single legged side leg lifts, focus on feeling the upper part of my butt work. I do this once x 30 with straight leg, once x 30 with a bent leg.
  • Clam shells, again feeling small muscles in my butt working. 30 x 1 each side
  • Single leg semi-squats, 30 each leg.
  • Runner’s hamstring stretch, calf stretch, quad stretch

This takes me about 25 minutes each morning. It also seems to help with the recurrent upper hamstring tendonitis I was getting from 2014-2016.

I was able to run a fast 5K yesterday at the Gig Harbor Turkey Trot, and today I don’t have butt or hamstring pain at all. So I think the problems are behind me, but I will still do my 25 minute route 5-6 days a week. And I will still be very careful with adding back distance to my runs, and speed to my workouts.

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