piriformis syndrome

[todi]

How many of you have encountered it, what do you suspect caused it, and what did you have to do in dealing with it?

This is the first time I've encountered it on myself and I think it is the result of being too diligent in the correction of my posture in form work, trying for a deeper ma bo stance in ma bo stance training, trying for lower stances and slower movement in Tai Chi, and not mixing up my training routine enough. I train in Hung Gar by myself (up to 3 hours a day) and my sifu comes in for a few days every couple of months to load me down with forms. I end up practicing a lot of stuff in repetition with just a little variation during the week (been doing this for 2.6 years). I feel fine when I work out but then after I finish and cooled down for a bit, the muscle spasms and I get a deep pain in the butt. If I work out it's fine, if I sit, it's fine, if I squat it's fine, but if I stand in a static position.... that's when it really hurts.

I'm a PT but, unlike the other PT that frequents this forum, I work with people who are severely developmentally disabled in an ICF facility and I don't treat the general population with exercise related injuries. So the information is not fresh with me on a daily basis- I treat myself, I'm my own PT. I'm well versed on core strengthening, stretching and all preventive measures and I practice them but this particular problem has never surfaced in my 25+ years of exercising - even when I use to run 40 miles a week on top of everything. I've had low back pain that I got under control, proximal hamstring tendonitis on the same side as this piriformis problem that I got under control, but never have had a piriformis problems before. It palpates hypertonic and it's attachment at the sacral end is very tender to the touch.

What has been your experience with this in your martial arts training and what did you do to get rid of it? And oh, because I know I'll be asked, no, my iliotibial band is not too tight and I have good hamstring flexibility to that side. Currently, low back feels wonderful.... good for an active 51 year old man.

[FooFighter]

I do not know if would help you. This is a draft of an article I am working on for CST magazine which is posted on their forums:

"One of invisible bars of the cage that can limit your body flow is myofasica density. Myofasica density is a condition that can be caused by a numbers of things such as dehydration, nutritional deficiency, mental stress, excessive strain, trauma, and the lack of movements. This condition is usually manifested in the body as a dense leathery muscular strap or knots in a particular area. This condition restricts proper circulation, the removal of waste and toxicity, and limits mobility, which all contributes to your loss of vitality, strength, and flow. If nothing is done to treat this condition, then it may also create or reinforced other dysfunctional habits such as sensory motor amnesia, residual muscular tension, and fear reactivity. However, there are simple ways we can remove and prevent myofasica density. In CST and Rmax, we have many innovative programs to enhance one’s vitality, strength, and flow. However, I would like to give my opinions on how to resolve myofasica density to those who are not practicing Rmax and CST.

1. Go to an excellent holistic alternative health care provider who can assess your condition and provide the best general and specific treatments to remove any blockages in order to restore your vitality and flow.
2. Go to a licensed nutritionist who specializes in a well balanced diet (not a fad diet or selling multi-level-marketing based supplements) or start eating healthier by using your intuition. In many cases your body will knows what its need and do not need. The question is will you follow your body’s wisdom?
3. Go to a licensed Rolfer or get massage therapy done once every two weeks or more often if you can afford it. I prefer Tui-Na (Chinese method) bodywork.
4. Go learn to let go of stress through meditation, self help methods, prayer, power napping, time management courses, tai chi, and playing hide and seek. Try to be the predator and not the prey in hide and seek. There is less stress in being the predator, but it is more fun when you have a good hiding place.
5. Go seek out a proactive forum member who is also a CST instructor and learn more about flow and optimal performance or seek out a sport conditioning specialist or NASM OPT certified trainer who knows how to remove myofasica density.

One the best low cost manners to rid and prevent myofasica density is the daily practice of Coach Sonnon’s Warrior Wellness™, BodyFlow, Prime Your Energy, and Head Coach Dan’s mobility program. There are numerous positive comments of folks of all different ages, sizes, goals, and backgrounds who have benefited from these programs. If you have these programs and it is collecting dust, then dust it off and get started now. It is sad when people waste their investment in their own health and education. Please get support by making friends on the CST forums then make it happen, Captain. These programs helped me and I know it can help you. I have discovered a way to enhance these programs by developing a myofasica release method using Clubbells®, which worked very effectively on Ryan Murdock, CST and Editor of CST magazine, when I did his assessment at the Eta seminar.

(TO BE CONTINUE...) Sorry folks, I have to meet my girlfriend. I promise you that the Clubbell® myofasica release method will be awesome for your CST."

I hope this helps....

Yours in CST,
Bao

[todi]

Thank you for the response, FooFighter.
Structural work would probably be a good way to tackle it... I was a practicing massage therapist before I went to PT school at the ripe old age of 42 and I'm trying to reconnect to that side of my life as it did have value. I could use someone that knows their way around the postural muscles and do some myofascial release. Also, when it can take it, a good elbow in the piriformis.
One thing you hit on that I feel is definitely a factor - dehydration. I work out out doors in the afternoon and it's been extremely hot, with heat indexes of 105 to 110 (today). I try to get up early in the morning but I can only fit about an hour work out before work and I do the heavy stuff in the afternoon when it still hasn't cooled enough. Muscles don't work as well, or fatigue quickly, in this heat. Slow twitch fatigues and the fast twitch try to take over the responsibilty of stability.
I've never had this problem before but it is close to being as debilitating as low back pain. What I kind of feel is that upon getting on top of one problem causes a related one to appear that was hidden before. I need someone to deconstruct my left side from thoracic on down and start motor re-learning to move as it was meant to: from initiating muscle sequences from the stabilizers on out to the movers.
What I understand about this (and some doctors I understand don't consider it real) is that PS is a RSI that is hard to control. I do know that my butt hurts right over the location of the priformis with some swelling..... I'm sure the other external rotators are involved as is the hamstrings, glutes and whatever. Stretch and then Strengthen (should have that tattooed somewhere).
I wish I could work on myself as I could start the deconstruction process and get it healed but the most I can do is roll a tennis ball under my butt and that isn't quite the same.
I have found a man that teaches Chen Style Tai Chi in the park at 7 a.m. on Sunday mornings. I met him last week: I introduce myself and explain that I'm a student of Hung Gar. He looks at me and asks, You study Hung Gar?" Can I ask how old you are?" I tell him I'm 51 and he lets out the loudest belly laughs I have ever heard. He's suppose to be an acupuncturist so, when I meet him in the park for a lesson, I'll see what he can offer. I will try to find a good body worker as I think that will be important for me to carry on as a over the hill Hung Gar student.

[FooFighter]

todi,

It was my pleasure sharing what I know. Please call me Bao (its my real name). "FooFighter" is just a cyber screen name. Thank you for reading my article and seeing some value in it. Perhaps structure or somatic work might be the answer. I wished you lived or work around my area (NYC) then perhaps we can work together to help recover your problem.

If you want to do recover from your condition and increase your martial art performance, then I highly recommend Coach Sonnon's Warrior Wellness http://www.rmax.tv/warrior.html, Be Breathe http://www.rmax.tv/bebreathed.html, and lastly (opitional) Bodyflow http://www.rmax.tv/kinetic.html. I truly believe these Rmax programs can help you because I have seen the results.

Since you were a practicing massage therapist before a PT, then maybe you will have to revist that area and have an excellent massage therapist work on you, brother. When I am finishing my "myofasica release clubbell method" article I will make sure to send it you so that you can get around the postural muscles and do some myofascial release on yourself.

I wish you best in your process of healing and self discovery with the Chen style Tai CHi and Hung Gar. By the way, you are never too old to study anything. However, you can greatly benefit from softwork because of your wealth of experience in hardwork (Hung Gar). If I can do anything to help you, please feel free to PM me.

Yours in CST (circular strength training),
Bao
BaoTran@CSTCOACH.com

[Vajramusti]

Sounds like some good advice from Bao and Chris.

Competent tui na is much better IMO than standard massage treatments
and standing relaxed in positions where there there is no pain is a good supplement IMO again.

Todi- I have lived in many places including Tallahassee. Count your blessings in summertime- the heat and heat related deaths ---much worse in Phoenix than in Tallahasse.

joy chaudhuri

[todi]

Thank you all for the valuable and extremely intelligent responses. The PT profession is in need of more practicioners such as Chris. Believe me, there is so much "Shake and Bake" PT in this town.

Chris,
I recieved your last pm and I agree with entirely - your right about the assumptions on posture and such. I use to get sick of hearing about asymetrical shoulders in massage school as a need to work on the psoas. Counterstrain - it hit me last night as I went to bed frustrated because of the pain and the paresthesia in my left leg. I thought, "you idiot" and put the muscle in a lax position and went to town with eschemic compression on the trigger points. It always amazes me to feel a muscle finally let loose and lengthen back out. I've taken a couple of days from training until the muscle heals and that makes me anxious but it needs to be done.

Vajramusti,
Your comment on standing in relaxed positions makes more sense to me now after my 2nd lesson with the Chen stylist teacher in the park at 7 a.m. this Sunday. I finally started to get a glimpse of what "sinking down" means, something that my Hung Gar teacher has been stressing for awhile. He had me stand in a posture that is counter to what I always thought was "correct" posture. He wasn't pushing "bad" posture on me, he was showing me "relaxed" posture. After standing there for over an hour working on the concepts he gave me, I felt my muscles truly loose tension for the first time. I am indeed a baby in martial arts but finding something that will keep me entertained the rest of my life because I'll never master it is very gratifying.
Believe me, people in Tallahassee want to feel that they are singled out for having the worse heat. We like to complain about the heat and humidity as if no one else experiences it. I have certainly read about the heat related deaths in Phoenix and I know our heat pales here in relation to that.
Oh, by the way, you know my Hung Gar Sifu, Tony Brown, as I read some posts by you on him in the past. Thank you for the support you expressed for him during his tsunami relief efforts in these forums. I see him about once every couple of months and he will be visiting me again in October after he returns from Norway. He is truly a remarkable person and I am grateful for the fact that he has again agreed to teach me after so many years. He knows I'm hopless but he still gives me the same dedication and concern he shows all his students. There is a lot to be learned from him.

[Vajramusti]

Todi- that is exactly what I was talking about- and I am glad that you have a Chen sylist to show it. Who is his taiji shifu? Small world that Tony Brown is your hungar sifu- he is a good person. Say hello to him when you see him. You know that he was caught on national Indonesian television teaching and doing hung gar in Bandra Aceh(sp?)

My youngest son was born in Tallahassee. My late wife was a Muscogee Creek- culturally the same people as the Seminoles. Most of the old place names in Florida are in her language. My wife was quite active in the Tallahasse community.My office was on the 5th floor of the Bellamy building on the FSU campus -many moons ago. I used to work out and spar in a gym somewhat behind the building.
regards, Joy Chaudhuri

[todi]

see, IMHO, the hardest thing about letting go is that we're afraid that we won't be able to get it back together again...for me, everytime I successfully self-manage a little issue, it's showing me another way to work with others

Exactly. My biggest problem. I have no problem telling others they need to take a break and heal but I have this block that is what you described; I'm scared that if I stop for a few days (or week if need be) I'm going to lose too much and have to start all over again. It is self defeating thinking as all I do is push myself into a bigger problem. I need to get over that.
Your suggestion of branching out to splitting out my week to do some ortho work is well taken and something I will need to do before I get totally burned out. The population I work with is not for everyone and I'm sure that most young, idealistic PT student (who thinks their going to get out and work with professional atheletes after their board exams) would be horrified if they saw that this was also part of the PT profession
Thanks very much for your input.... I might send you a pm every now and then to get a suggested reading list what's new and current.

Vajramusti,

It is indeed a small world. My father who taught at FSU in the early 70's also had an office in the Bellamy Building. I think, if I remember correctly, it was on the 5th floor. He was head of the American Studies Program until about 1976.
I met Tony Brown in the early 70's and studied for awhile under him before he left town around 1979. I had lost track of him for over 20 years but never forgot what a dynamic teacher he was and the impact it had on my life at the time. It was certainly one of those pivital moments in my life; training under him nudged me into a different direction than the one I was taking at the time, something to my benefit. I re-connected with him in 2002 and he and his extremely talented Hung Gar practitioner daughter, Naomi, came and visited me for New Years. I had always regreted having stopped my martial arts study and when I met up with him again I didn't hesitate to ask him to get me started again.
I recieved almost daily reports from him while he was in Banda Ache and when he returned, I listened to numerous stories and looked at hundreds of pictures- it was totally unreal. It was hard on him, I could tell, because he had experienced this thing and then came back to the States where people didn't seem to want to hear about it.
Sorry, I didn't get the name of my Tiji teachers shifu, I had to hunt high and low to find this man as there is very little TCMA done in this town and, with a few exceptions, it's all chain style karate studios and such. He studied in San Fransico in the 70's after a career as a karate fighter. He doesn't bother trying to attract students because he says that no one wants to put the effort and they end up leaving. He doesn't care. He keeps me so occupied with just learning how to stand that I don't have much other conversation with him.
I will tell Sifu you send your regards, I had mentioned to him before that you had shown support in these forums for his efforts and he spoke highly of you.

Bob

[Buddy]

I've had PS for a couple of years. Very tight IT band. I've had chiro, ART, Do triggerpoint on myself, had TCM acupuncture. The only thing that does more than temporary relief is triggerpoint acupuncture.

[SBonzak]

I've had PS for a couple of years. Very tight IT band. I've had chiro, ART, Do triggerpoint on myself, had TCM acupuncture. The only thing that does more than temporary relief is triggerpoint acupuncture.

I have found that traditional acupuncture combined with triggerpoint and motor point work, with PNF stretching and range of motion exercises at home work very well in my practice. It seems like a combination approach is necessary for most chronic tightness problems. Motor point acupuncture seems to give some of the more dramatice effects, though.

-Steve

[todi]

Well, I knew somebody else must be dealing with this. The part I don't like is the "chronic". This morning was the first in about 3 weeks that I finally felt some relief - not cured mind you - but it feels better. I've cut out some kicking routines I had been doing and as I stated before, I do eschemic compression to trigger points in the muscle belly followed up by piriformis stretching. I do that whenever I get a chance during the day and at night in bed. Seems to be the key right now.

[Buddy]

So there is no cure?

[todi]

So there is no cure?

Buddy,

Good question. All the info I find on it has been vague so far. As cjurakpt has pointed out, not everyone is comfortable even using the term "piriformis syndrome" as a diagnosis. I use the term because my piriformis is tight, hurts, and causes compression symptoms to the sciatic nerve but I know there is much more involved than just that. As I stated earlier, I came to this forum because I in my field I deal with a population that gives me no hands on experience with exercise related ortho problems. I've had my share of back and knee problems but they have been managable. This problem I'm totally unfamiliar with.

My gut level answer is, yes, there has to be a cure but it isn't simple and since it's a movement problem, then for each individual the cure might be slightly different. Changing a life time of incorrect movement pattern because of some learned compensation after some earlier injury is not easy. It makes me grimace when I read of people continuing to train with inflamed knees or shoulders as I know that they can't do that without compensating somewhere.

If I come across some decent info about it, I'll be sure to post about it. In the meantime, I'm curious, what do you think brought your's on?

[Buddy]

Hi todi,
Thanks for your PM, I thought I would answer here. While I don't know what might be the original cause I suspect it was at least aggrevated by buying and driving a manual transmission. I also have a lot of tightness in the gracsillus, sartorious and TFL.
Buddy

[todi]

Buddy,

It sounds like you have more involvement than I do. If you've gone to an M.D., I'm sure the frst thing they would have done, or want to do, is clear you for disc problems. I know if I went to an M.D. now at my age and described the pain pattern I have, I would immediately be referred for an MRI after x-rays. Then I would get that patronizing, "you know, your getting older and you can't do what you use to do.... maybe it's time to think about doing less" which is bull because as I realized last week, I had more exercise related pain in my early 20's as I do now in my early 50's. Here is an interesting thing I found related to "piriformis syndrome" and unnecessary spine surgery when the problem was in fact "piriformis syndrome" it also details a treatment being used to deal with it. The problem is it doesn't tell how to prevent it, unless I ddn't read deep enough into it: http://newsroom.eworldwire.com/wr/020305/11339.htm

The second link is in the form of a Microsoft Power Point Presentation so I hope you have that installed on your computer. It is a fairly comprehensive presentation of what what muscles do what and what happens when a compensation pattern takes over in functional movement. You have something like 29 muscles on each side of your pelvis that control, or create functional movement, strength, and stability. When one gets inhibited, or gets used for more than it was intended because another muscle is inhibited, then you get pain syndromes. http://www2.sjsu.edu/depts/hup/grada...0Stabilization

In my case, I found something interesting related to my "piriformis syndrome". In my old Kendall text book, Muscle Testing and Function, he writes about the pirformis and sciatic pain in standing as a cause of the piriformis actually being stretched rather than constricted.

I still have pain but not as bad. I cut back on some exercises I was engaged in too much, like practicing Hurricane kicks and doing other kicking exercises in a forward line across my yard. When I feel the muscle acting up, I stop what I'm doing. I hope the info I'm relaying to you helps you some.... I don't know about others but uncovering a compensation pattern on yourself without help is pretty frustrating.