Daily Mobility Exercises by Dr. Kelly Starrett Forums General Dread Piriformis – but way more confusing..

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    • #71004
      AvatarShannon cupp Cupp


      A desperate attempt for any help.  I’m getting panicky and lots of anxiety from an issue I’m having because IT HURTS BAD.
      The problem: leg syndrome for 3 weeks.  Specifically, for the first two hours that I am awake each day, I have SEVERE, debilitating pain in my right leg.  It’s a shooting, stabbing pain that seems to be in my right flexor wad/glute/IT band, and proximal Anterior Tib.  I have ZERO back pain, no numbness, no tingling, no weakness.  This leg pain makes it nearly impossible to walk for nearly 2-3 hours after waking and is breathtakingly painful.
      When did this pop up: normal every day life is happening.  3 weeks ago, I wake up, can’t walk.  It’s been a downward spiral since.  3 weeks later, today is the worst it’s been so far.  I Olympic lift, CrossFit, coach, beekeep on a daily basis.  
      What makes it worse: Sleeping.  Sitting.  Walking.  Every morning as I rise from bed it’s a nightmare.  After I rise from bed, if I flex my “GOOD” leg with my knee extended (aka walk), holy jumpin’, it causes serious pain (12 out of a 10 scale) through my right side.  If I flex my “GOOD” leg with my knee flex, no pain.  When I extend my “BAD” leg out on a normal walking step, I cannot straighten my leg without pain.  So, basically, the only way I can walk is with tiny, baby steps.  Another random position that light me up includes stooping down to get into a car (global flexion), and toes to bar (global flexion).  
      What doesn’t bother it: hip hinge, squatting, running, basically exercise minus walking.  
      What makes it better and how I’m attacking  the issue: standing, moving, and Advil (I HATE Advil, I understand the dangers, but right now, I have to live my life, and it’s the only thing that makes the pain bearable as it covers it).  Immediately upon waking, I begin a project to reanimate my body.  I start with t-spine double ball smash and foam rolling.  Then some intense glute/flexor wad smashing.  I find the trigger points to be unbearably painful.  I contract/relax on them.  Then I move to a banded ext. rotation stretch to hit the ext rotators of that right glute.  I contract/relax.  I then hit a sequence of hammy stretching with some flossing and contract relax, followed by calf/ant tib smashing on a PVC pipe and a bit of IR work on that leg.  Then I’ll do some air squatting, rowing, jumping with voodoo bands on.  This all takes about 2 hours as I have to coach classes in between.  For the rest of the day, I have ZERO pain and I can exercise, walk, etc. to my hearts delight.  Happy times.  But then sleep has to happen.  When I awake, the beast has returned. 
      What the pros tell me: I have seen 2 chiros and 2 massage therapists.  Chiros see no back dysfunction besides maybe a little ant t-spine rotation.  Right hip is posteriorly tilted, and they have seen “weakness” in the opposite glute.  All have found gigantic balls of tension in the glute/piriformis/flexor wad.  Each one tells me it’s my “good” side that is causing the problem and my right side is hanging on for dear life.  Adjustments and massage have had zero effect so far.  My chiro told me to lay off stretching and exercise.  That was 3 days ago, and it’s gotten worse every day.  Massage people tell me “I’m hanging on to stress.”  Despite being informed of this, the pain has not resided.
      I have been watching MobilityWOD since the beginning, I have reviewed 101 videos looking for clues and new ideas.  I have been working hard on this problem.  It’s only getting worse.  My confusion is the pattern of the pain striking when I move my opposite leg, and also how the only relief I can get is caused by hard exercise.  The less I exercise/stretch, the more painful it is the next morning.  I cannot get this damn piriformis to relax!  
      Sorry for the long story, but I’m hurtin’ over here.
    • #74880

      Are you addressing up/down stream of this?
      Are you doing mobility work more than once a day?
      Shorter sessions more times throughout the day will help.
      This isn’t a new situation for these muscles and tissues it needs shorter time between sessions.
      Constant reminders throughout the day are needed.
      Here is another way to hit it
      If you aren’t seeing improvements you need to relook at how you are attacking it.

    • #74957
      AvatarFrank M Poveromo

      hey scott, hope you’re doing better. this problem seems to be pesky. i’ve met a few cyclists with a similair issue. it seems like a no brainer, lots of piriformis stretches to release tension on the nerve but it’s not so simple. this is the only one where yoga and stretching aren’t really helping, sometimes the lacrosse ball makes it worse. lying down hurts so how do you rest this guy. i watched kelly’s video on piriformis syndrome and it makes sense to wind up more and stretch more. but still not seeing great promising results. in my case i suspect bursitis because i feel pain mostly  on the lateral portion of the  hip but i feel a tight not in my piriformis as well. any suggestions would be appreciated.

      i would just say people out there stretch your piriformis preventatively when it gets to this point it seems like hell.
    • #74974
      AvatarKatie Hemphill

      Hey Scott,

      It sounds like loaded hip flexion is what provokes the pain early in the day, is that correct? (You used some kinesiological terms in your post, being a coach and athlete, but let me know if you need clarification on that.)

      Reading your post makes me suspect your rectus femoris is part of the issue. Is getting into a coach stretch position (hip extension with knee flexion) problematic for you?

      Also, just to clarify, what specifically implicates the piriformis as the source of the issue for you?
      Again, for clarification, you don’t recall anything unusual about the days leading up to the onset of your symptoms? No traumatic episode, no change in training, no grievous movement errors?
      Apart from the chiro’s and MT’s, have you seen your physician? It would be good to rule out leg cancer and other non-movement-related issues.
    • #75029
      AvatarShannon cupp Cupp

      Hi all,

      Thanks for responding.  I wanted to give an update to respond to you all, and also to give some feedback in case someone reads this thread with a similar problem.
      Quick review: a little pain/leg tweak feeling devolved into crippling and debilitating chronic leg pain (a deep throb), and then morphed into also crippling back pain.  It was mysterious because it started so slowly and for 2 months had not symptoms of back dysfunction.  
      What I’ve found:  After 3 months of worsening pain, I tried conservative care (aka rest/super-light activity, PT, chiro, massage).  I got a lumbar MRI on Monday July 28.  I’m seeing a spine specialist August 4th, but from what I can gather from my chiro, my own eyes, etc. it looks at L5/S1 I have slight narrowing and a small bulging disc.  The pain this has causes is mind-boggling/life-changing, but that’s for another discussion.
      What I’ve done so far: In the past week since receiving my MRI, the boat has turned around, and I think I’ve actually improved just a bit using: rest/light activity, chiro, and trigger point therapy.
      I think the key here has been my work with the trigger point therapist.  She found a “perfect storm” or dysfunction in a multitude of muscle groups/fascial trains.  QL, psoas, glute min/med, quad, and TFL have created a hell of trigger point pain, and by addressing these trigger points through massage, I’ve seen a decent reduction in pain and regaining some ROM and strength.  Whether or not the disc is actually bulging, the pain is coming from these trigger points, and not dealing with them would lead to constant, and long-term pain.
      What this turned out to be is hip dysfunction.  If you know your KStar, you know about the 4 horsemen of the hip: QL, rectus femoris, psoas,and illiacus.  Well, as it turns out, this Mr. KStar knows his shit, and he was spot on in my case.  Each one of these muscles was chock full of trigger points, forming a classic referred pain pattern.  It’s been an adventure to say the least.  
      The moral of the story is:  guys, if you have pain, seek out a trigger point specialist.  
    • #76119
      AvatarRoss Petrone

      Thanks for the newsfeed on this topic. I’m experiencing the same stabbing pain as described, only after foot and ankle reconstruction with a tendon transfer from my left calf to the inside of my left ankle. I ruptured a tendon 6 cm into the calf muscle, so another tendon is now attached in tandem. I am in so much excruciating pain all of the time and refuse to take narcotic pain medication or muscle relaxers, because I don’t want to become a prescription drug addict. I’ve tried four rounds of P/T, OTC topicals and RX topicals, Epsom Salts, ice, heat, stretching, the exercise ball, swimming, ballet exercises in the pool, hydrotherapy , trigger point, and of course Advil and Tylenol P.M.

    • #76120
      AvatarRoss Petrone

      The only relief that seems to take the pressure off and make the pain more bearable is walking with a cane. The medical bills are eating me alive and I want to get back to work full-time, but it’s hard to find a job when your limping or walking in with a cane for a job interview, so I just grin and bear it. My husband still expects me to be able to physically accomplish all of the household tasks I did before and work. That will never change, and I can no longer afford to pay people to help me with what I cannot physically accomplish around the house. Please don’t advise me to ask my husband for help as it takes an act of Congress to get him to change a light bulb. I’m 52, but my body has betrayed me and I feel like I’m 102. There’s no real quality of life left, especially since I was so active before the surgery I wish I’d never had. I’m in 10X more pain after the surgery which was 2 years ago and have had more problems post-op than pre-op. Reading, art, and studying are my outlets. Trigger point helps, but if I can’t work, I can’t afford that luxury . Yes, we have insurance and the total spent after insurance has been over $15K. I just want to be able to do housework and work 40-60 hours again.

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