T Nation

Piriformis Syndrome/ITB/TFL/Calf Pain


#1

I know no one likes reading long posts so I’ll try to keep this abbreviated but I also want to provide adequate details for the most help, be patient please, I’m desperate!

So last August(2015) I had an incident while skydiving (it was my 20th or so jump and I suck at landing) I couldn’t get my landing flare right and this time the wind picked up perfect and slammed me into the ground, hard, on my right side. In the moment I was unable to feel my legs for about 15 seconds, but the long term I had a badly bruised tailbone and massive muscle soreness and bruising. As far as I could tell within 6 weeks I had healed and was able to continue skydiving and exercising tentatively within the first week after I hit the ground. I stayed away from barbell squats and anything heavy until I was sure there were no real threats but was back up and running in no time. Since the day of the incident I had a weird feeling in my right glutes… Almost as though my muscles weren’t quite connected, possibly a partial separation, something like that. But flexing my left glutes offers me a far greater response than my right side even today, particularly in my medius.

Flash forward to around June 2016. I had started pushing more in my leg lifts around April, but had only increased from about 135# squat/DL to 225 at my max. Starting June I started to get severe pain down my right leg. Once the pain blossomed into what I have today, it essentially perfectly reflected sciatica- dull ache and shooting pain down my leg from the middle of my butt down to my knee, calf, Achilles and ankle. I stretched and rubbed and rolled and stretched again and did some therapeutic exercises… It got so bad I couldn’t lift anymore. Lifting didn’t make it worse, I just couldn’t bear weight on my leg without pain. I couldn’t not bear weight without pain. I existed in a state of constant pain.

I finally got a referral to physical therapy. I’m in the military, so unless I fight really hard or have a special situation, I have to go to the clinic on my base. My first appointment with my PT had essentially given me what I already knew: I had Piriformis syndrome. Since the pain started in my glute and I have zero associative symptoms with any spinal injury, it was obviously the problem. She started my on essentially the same program had given myself: tissue massage grouped with strength exercises, ice, heat, etc.

After four sessions I had zero progress. I stopped going. I know this isn’t the right thing to have done and I should still be working the program, but I started doing some more in depth research into body mechanics and what causes Piriformis syndrome and it took me to this site, which provided me the first relief I’d had in almost 6months. An article here identifying Piriformis treatment taught me more about opposing muscle groups and tension relief. I started figuring out what other muscles in my leg might be causing my Piriformis to lock up.

I rolled out my TFL and my IT band and I could feel my Piriformis release instantly- it was like I had been holding my hand over an open flame and as I yelled and complained someone came over and took my hand off the fire. It blew my mind.

For weeks I rolled my leg out before and after every workout, and whenever it started feeling tight. The pain was banished to the past. I started lifting heavier this last November and the atrophy that came with the Piriformis syndrome started correcting. As long as I continue to roll out the side of my leg and lift maintaining a focus on stretching and added more adductor/abductor exercises, I keep it on the back burner.

The last couple weeks it’s starting to get inflamed again. I’m continuing to stretch, I’ve started doing yoga regularly, rolling, and keeping my strength up (I currently can squat 275 for 5 and am working on a 315 PR, I DL 335 last week, along with a consistent diet of accessory exercises, SLDL, RDL, extentions, curls, single leg lifts, lunges, calf raises, etc. Etc… I have severe tightness in my hamstrings and calves as well as an inflamed achilles, along with Piriformis tension and pain, and since I identified my TFL and ITband as the original culprits, they have started to ache as well. I’m getting bruising on the side of my leg from the frequency and amount of pressure I have to put in order to release it every day and I have to roll out my calf now on top of this, it gets so tight sometimes it feels like it’ll snap.

It’s not unsustainable, for now. But I fear being placed in the same situation as I had a few months ago where my muscles atrophy and I lose my ability to lift legs. Everything is connected, I learned the truth to that so fast in this journey. If you have any ideas, or experience in this matter, please reach out to me. I’m afraid of being someone else who has to constantly manage their pain for the rest of their life. Thank you in advance!!


#2

I thought I had this also. Same tightness in hams, glutes, IT band,
After 4 months of stretching every way known to man, I went and had an MRI.

Turns out my L4/L5 have a severe bulge (into spinal nerves) and S1/L5 was depleted of the gel inside.

I would try to get MRI, if I were you.


#3

You’re right, it would probably be worth it. My doctor told me MRIs are useless since everyone probably has some sort of questionable something to be found in an MRI. My back feels totally solid though… What has your prognosis been since, if I may ask?

Thank you!


#4

I don’t really understand your Dr’s advice. This is coming from a person who had visited a doctor maybe 5 times in the last 30 years prior to this.

After MRI at a dedicated spinal / joint clinic (about 30 doctors and hospital), I did the prescribed exercises they gave me for 2 months. These were a touch different than the stretches I was already doing. With no relief and having taken a 250ct bottle of ibuprofen over the several months, I got an injection in the spine.

Felt great for 2-3 days, started hurting again and I waited it out rather than getting a follow up injection. After a couple of months I no longer felt the pain at all. Back to exercising, but not willing to dl or squat any longer, since I didn’t repair the actual structure.

Your spinal column is the foundation of moving, carrying, lifting, and protector of the CNS. Why risk it?

Best luck for your recovered health.

PS I never had pain in the spinal area or back - it was glutes, hips inside and out, down the legs.


#5

Unfortunately the overall attitude at my clinic is pretty much the same, I’ve been misdiagnosed and left untreated for several other illnesses and fortunately it was never severe enough that I couldn’t figure it out myself, but at the same time we’re so obvious to me it was exasperating. My mom is a nurse and my dad is a PT so growing up with them gave me what I feel is an above rudimentary knowledge of medicine and the body, not to mention I do plenty of my own research. But they’re almost offended by any talk of outside opinions, online research or suggestions to my own treatment and care. The pain right now is intermittent and luckily it leaves entirely by the middle of my DL and Squat workouts once my legs are tired and my muscles totally engaged and loosened up. My operation schedule the next couple months is exhaustive but I might stop by a civilian chiropractor in the next couple weeks and see if they have an opinion about my spine that won’t cost me too much. It wouldn’t be impossible that I have some lower spine damage from the impact, my x-rays I had the day after we’re stone cold normal but that doesn’t mean the discs didn’t deflate or otherwise become affected over time.


#6

Dude, the same thing happened to me I think…When you sit for a while or lie down etc you cant walk without severe pain? Cant bent over and strectch the leg etc? Tho when you have walked for about 5 min or so it get better?


#7

I can’t really make a connection between being sedentary/sitting or standing long periods versus exercise. It just hurts, sometimes it’s tighter than others. It’s usually improved after stretching, rolling and exercising those muscles, but not always. I have noticed more recently that my Itband and my hammies on my right (affected) leg pop when I stretch them, it’s like they’re trying to shorten and I have to keep up with my stretching to keep them long.

I’ve been traveling a lot, and will continue to do so in the next four weeks but after that I plan to hit up a chiropractor to get my back looked at. I took a week off last week when I was in California and realized how much I’d been overtraining, so as much as I hate it I’m going to start incorporating rest days into my life where I’ll probably just do yoga or cardio.


#8

I know it’s been a long time but for archives sake if anyone finds this post in the future I have a beaming prognosis. My TFL and IT band still get tight on occasion but I continue to stretch and lift heavy (I recently hit 315 on squat and 375 in DL, my squat keeps getting better since I moved the bar farther down my back) and any pain and tightness I get really feels like my body telling me I need to stretch more. It gets exacerbated from a current increase in running and hiking but the more I work the easier it gets.

I think I had such massive atrophy from both my injury and attempts at healing-by-inactivity that I just needed to find the right amount of therapy, accessory exercises and heavy lifting to engage my glutes and effectively activate my lateral muscle groups in my legs to improve strength and achieve muscle balance. I also go to yoga classes regularly. My back is stronger than ever and none of my symptoms come close to being spinal, I never got an MRI. It’s not impossible that I have a ruptured or irritated disc, but I have zero side effects and will continue to be careful and keep my back strong to prevent any future injuries.

I am a firm believer than inactivity is the worst thing for your body and for most injuries (obviously acute injuries or anything that will continue to cause damage are exceptions) but allowing muscle atrophy will only cause more work for you in the future and will make you not want to work for it. All of my injuries I’ve had in my life have only returned when I quit being active, and have always improved and ceased to exist with consistent, heavy, and intense weight lifting. I feel like my best self. Thanks for your input!


#9

Hi I just joined so I could make this first post . I am now 45 , when I was 27 I suffered from sciatica . After 2 years of Physio and pain killers I received the op to solve the problem. Glad to say it worked after a lot of pain and more Physio. Anyway a few months ago the sciatica pain returned!!! I was in bits , I can’t go through all this again !!! I went to dr ,more pain killers !!! I would wake up fine but within 5 mins of getting up pain would come in my butt. Ok now the good bit … someone at work recommended a chiropractor . I had never been to one but was willing to try anything. … FANTASTIC is the word I can use , she was fantastic. After a talk she said good news I don’t think it’s sciatica, I think it’s PIRIFORMIS SYNDROME and it’s treatable. She explained what it was then gave me treatment… stretching,heat ,massage , then what changed my life … she used a needle to manipulate the muscle!!! It was a strange sensation but it’s worked I was basically pain free for the week then saw her again this time she used more than 1 needle at the same time . I WAS CURED!!! ok this cost me £50 then £35 but to be pain free you pay anything.

I really hope this long story can be of some use to you and give you hope because trust me I know … Martin


#10

Hey thanks! Great story. I always have chiropractics in my mind in case it ever gets worse but like you stretching, ice, and ultimately strengthening my legs and glutes helped so much.


#11

I admit that when posting people should read to what they’re replying to completely. I read your posts there this afternoon and I plan on re-reading them later on considering I am tired and going to bed soon.

With that said, I recall you said that some people think MRI’s are wastes of time. They aren’t. Something like 40+% of people walking around with spinal abnormalities, and likely shoulder abnormalities as well, that are asymptomatic and do not cause any pain or dysfunction. In those cases, the abnormalities are simply left alone. However, in the case that there is dysfunction, such as loss of bowl and bladder, drop toe, loss of strength, and so on, then people damn better get an MRI to see what’s causing these problems so they can get on the path to recovery.

I have been physically active (not just weights), since I was twelve years old and I am 37 now, soon to be 38 years old this summer, and I suffered from my first injury this past Fall after all this time. I herniated discs L3-4 and L4-5. My pain started in my back and because I was preparing for my first contest with a damn harsh prep, because I wanted to be shredded, I thought my intermittent back pain was simply being caused from the large amount of activity I was doing and that it would subside after the prep was over. Well, back pain dissipated and then came on sciatica two or three weeks before my show. Considering I was likely running on adrenaline and out of my freaking mind, the nerve pain was not so bad. After the show, when all was settled… oh boy, did my nerve pain become uncomfortable. That’s when the MRI showed my results and I have been seeing my physiatrist ever since the winter. I went to PT twice per week for a few months and now I see my PT’s twice a month just to appropriately progress in my exercises and gauge my function. So I do two workouts with them per month and I do the other five or six lower body workouts per month myself. My nerve pain is SLOWLY going away. I take gabapentin and I’ve had one epidural shot. My physiatrist is very conservative and will only provide more injections if needed.

Damaged nerves can take a VERY long time to heal, more than a year in some cases, which is likely what the case is for me. I am not a surgery candidate (thank god) and I have no dysfunction. But nerve pain is not only uncomfortable, but damn bizarre! It’s the strangest alteration of sensation I’ve ever experienced. It has driven me to tears on several occasions, but again, it is improving.

On my third stab at doing trap bar deadlifts this past Spring, I did 265 for 18 reps and held back although I felt like I could have gotten a few more. That’s certainly not an amazing feat for a man of my weight and height but it shows the progress I’ve made considering I was using 135 in my first deadlift session. In the winter, most of my exercises were non-compressive (NO squats or deads of any kind), such as exercises with bands, cables, and bodyweight. We are slowly progressing to more conventional meat head/gymrat/bodybuilder exercises with more compression (e.g., trap bar deadlift, goblet squat, front squat, RDL, etc).

I hope you do not have a disc injury but just because someone doesn’t have pain in the back, doesn’t mean they don’t have an abnormality. My herniations are still recovering and all my pain is in my legs, as is the case with many people with herniations. No to little back pain, but pain elsewhere, considering the nerves that run from the spine and into the extremities. And as I said, people can have herniated discs with no symptoms at all. So you will not know if there is or is not an abnormality with no MRI done.


#12

Thank you for your response, I’ve been pain free for nearly a year now so this post is almost moot. However I’ve used this experience to launch my reasoning for continuing to be active and lift (within limits) through injuries, especially with back and leg injuries, because muscle atrophy alongside an injury can compound it.
Unfortunately I’m active duty military and getting referrals for immediate medical issues is difficult enough for me, I couldn’t even get my doctor to refer me for a general allergy test because I don’t have any acute symptoms. So unless I complain of a chronic injury and they rule out any other option, an MRI for any purpose is not in my future.
I like to think my piriformis syndrome was a reaction of an acute injury (skydiving) combine with inactivity and muscle imbalance over time, causing a chronic issue. I’ve been powerlifting since last November, and the only remaining symptoms I have are my right leg being a bit tighter and responding to isolating exercises and stretches a bit more to my left, which continues to leased as I force myself to take the time to warm up and stretch more. I have only gained strength (in the 100s of pounds in the last year now). I wish I had the money to get an MRI out of pocket, but at this point I’m thankful that I don’t have any injury requiring one, I suppose.
I appreciate your doctor being conservative with medication and injection treatment, I don’t believe pain management to be effective as it doesn’t allow you to feel the full effect of injury, to allow you to properly assess your limits. I hope you can continue to train and reduce your symptoms over time. Having come from an active background and continuing to stay active imo is the greatest advantage we can give ourselves in overcoming sickness and injury in general, and understanding the limits of our own bodies and what is good pain versus an incipient injury is super important.