Piriformis syndrome
Running & Fitness

Running with Piriformis Syndrome

Gisgie Dávila Gendreau
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Even a twinge of pain can set this fearless (read: pig-headed) runner off immediately into the first four stages of grief: denial, anger, bargaining and depression.

So a year ago when I had severe pain in my left butt cheek that radiated down my leg, I was in a panic. But instead of doing what I needed to do to heal, I spent about nine months in a loop that kept me from the final stage: acceptance.

Spoiler alert: you don’t have to suffer like I did.

When I started this crazy cycle, I was training for my first half marathon and ramping up my mileage with gusto. The diagnosis from my sports medicine physician’s assistant: piriformis syndrome.

The piriformis is a muscle in your butt near the top of the hip-joint that is key in stabilizing the joint when we walk or run. And because the sciatic nerve runs through – or right next to – this muscle and down the leg, when the muscle spasms, it can compress the nerve. Translation: when the butt muscle is irritated, ouch!

The culprit? Typically, it’s over-use, according to Dr. Mark Russell, an orthopedics and sports medicine specialist with Bronson Healthcare in southwest Michigan. Too much running, for example, and not enough cross training to give those muscles a break and to help build core strength.

So what’s a runner chico or chica who has muscle pain the gluteal area to do?

Sometimes, Dr. Russell said, it can be as simple as getting different running shoes to accommodate the runner’s gait. A gait analysis can help, he added, if you want to make sure you’re picking the right running shoe. He also recommends runners stretch before and after runs, and warm up before running.

Treatment typically starts with physical therapy to stretch the muscle and exercises to strengthen any weakness in the hips or other areas that could be contributing to the problem. Cortisone shots can help with the pain as can anti-inflammatory pain relievers like Naproxen, heating pads and the dreaded “R” word: rest.

Some doctors have had good success with Botox shots, Dr. Russell added, with surgery usually only done as a last resort.

My current doctor, a manipulative medicine expert at Michigan State University whom I adore, also recommended I spend some quality time with my foam roller and a tennis ball on the ground, rolling each on the areas that hurt the most. Yeah, it’s about as fun as it sounds.

If you have been having similar pain, here are some tips to get you from denial to acceptance and back on the road quicker:

  1. Don’t ignore the pain. If caught early, Dr. Russell says, piriformis syndrome can resolve in as little as six weeks.
  2. Don’t self-diagnose. Several other things, including a labral tear, a jacked-up sacrum (doctors call that sacral torsion) or a herniated disk can also cause pain in that general area. Only your health-care professional can rule out other causes.
  3. Don’t ignore your doctor’s advice. Do what he or she tells you, even when he or she says the dreaded words: take a break. Dum-dum over here waited until she could barely walk before doing as she was told and is just now getting better.
  4. Don’t skip a step. If you’re not putting in the time to recover, you’re just not going to get better no matter how many specialists you see.

As for me, I only got better when I accepted that this was something that needed attention. I had a diagnosis from the beginning, but I just wanted to do what I wanted to do. That didn’t work out so well.

Contrast that to the past three months, when I have been doing exactly as I am told. I am doing my stretches; getting re-acquainted with the foam roller; using a heating pad when things flare up a bit; discovered yoga and Jillian Michaels workout DVDs for core strength; and am resting when my body complains. And – wait for it – am feeling well enough that I am running again.

In fact, just a couple of nights ago I had one of the best runs I have had in months. One of those runs where I was thinking about everything but running. Not about hurting. Not about when the run would end. And most definitely not about stopping.

Dare I say that I’m back? The next few weeks will tell. In the meantime, I’m signing up for a half marathon this fall, just in case. But should I notice any pain, I’m taking care of the bottom line first.

9 thoughts on “Running with Piriformis Syndrome

  1. Story of my life! I had been trying to figure out what was wrong with me for the last 3 months. Dr’s and ER thought I was depressed and it was is my head. Here was a blog post I wrote seeking answers.


    Eventually I was diagnosed with Fibromyalgia & Piriformis Syndrome in my body. As well as Bilateral Scalene Trigger Points and Sacroiliitis…. all because I ran a full marathon and a week later a half marathon.

    I knew I wasn’t crazy, we’ll, I am, I am a runner, BUT I knew it wasn’t in my head!

    Mrs. Fabulous

  2. Injury is a part of running for a lifetime and you’re absolutely right about not ignoring pain. Like ever. I had this same issue when I first started running b/c I basically did too much, too soon with very little cross-training. Now? Cross-training is a huge part of my running plan and I see a big difference!!

  3. Thanks for the comments. I have a hard time admitting that I need to take a break. But things just get worse, don’t they? Here’s to more listening to our bodies!

  4. Hi Butch,Thanks for the question. I find that isuses of pronation and supination are caused mostly through wearing structurally supported shoes and heel strike. Since the heel is a hard and round bone, the foot will roll either inwardly or outwardly depending on whether you have muscle imbalance causing inward or outward rotation at the knee.Since the forefoot is flat, there is less roll that takes place through the foot. By adopting a forefoot strike gait pattern, you should have significant change or elimination of pronation and supination. I don’t consider being flat footed to be an issue. I believe it is a man-made-up diagnosis. We come in all shapes and sizes. Some people have low arches, some have high. I believe this is the way we are designed and the design is not flawed. If you have pain with your feet, it has more to do with postural dysfunction and imbalances in your body, especially in the arches of your feet. There is a small percentage of the population that may have true structural isuses with their feet. For these people the use of orthotics is beneficial. But they are a tiny fraction of the populace. The rest of us just need to move differently.Here is an article I wrote awhile back that goes into heel strike compared to forefoot strike in more detail.Jesse James Retherford

  5. I have 10 days left until MCM and my Piriformis injury has returned 2 weeks ago. I have cut back my running, continued stretching, had 3 dry needle procedures and several massages. I have one more massage scheduled for the thursday prior to MCM, all I can do now is hope that I can get through the 26.2 with minimal discomfort. If any has any ideas that may help let me know….Deb MA

  6. I’m struggling with this now . How long should I rest? And what is ok to do for exercise to keep up the cardio that doesn’t irritate it? I’ve tried a few things but it feels like I’m aggravating it. I’m stretching and have been seeing a physical therapist for about3 weeks.

  7. Where I live I have no choice but to run serious hills. I run them 3 days a week and use an elliptical 3 days. One day Sunday as a rest day, I walk 2 miles. When I do the elliptical a little dull pain but continue as usual. The other day I got 6.1 on run and had to stop. Question, can running too many hills and inclines cause this syndrome and what if I drove to a relatively flat area and only ran hills once a week? Plus, I just turned 66 on April 18th.

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