Sunday, September 5, 2010

How to fix piriformis syndrome

Chances are you found my blog by doing a Google search for information about piriformis syndrome.  So many of you have done this, in fact, that this post is the number one result!  So, I feel a sense of responsibility for updating the post with newer information about how I fixed my piriformis syndrome (PS) and kept it at bay.  As luck would have it, I developed a renewed case of PS a few months after this post went up and lived with it off and on for over a year.  So here are a few new points I want to make:

** Update on February 22, 2014:

**1) I have a renewed sense of faith in gluteal specific strengthening exercises. I have gotten relief from more than just PS by doing regular glute strengthening work. For runners especially, I think these exercises are a staple in the battle to remain injury free. I do clam shells (see video in original post below), side leg lifts, hip hikes and wall pushes (described in this article). I try to do these daily. Patience is the key. I just came out the other side of IT band syndrome by doing these exercises, but it took four weeks doing these four exercises daily to start to see a difference.
2) This is a problem that tends to hang on and rest is not necessarily going to make it go away.  In fact, I have not met a single person suffering from this problem who was able to get rid of it solely by taking a break from running.
3) The key to treating this seems to be getting some sort of manipulative therapy like Active Release Therapy (ART) from a qualified practitioner.  A good massage therapist can help here too, but they need to be able to get in to the hip capsule if your problem is originating there.  This is a deep, deep place in your pelvic region that may make you blush when they go after it.
4) If you have adhesions in your hip and butt region (glute min/max, TFL, deeper butt muscles), your best friend should be a lacrosse ball.  Not a tennis ball.  Not a golf ball.  A lacrosse ball.  You should roll out the sore spots in your gluteal and hip flexor region in every possible direction with that ball: laying down, standing up against a wall, however you can get in there and break down the adhesions that are messing things up.
5) Be Patient and don't expect instant relief.  It took me months of self treatment, following 5 days of intense ART, to get this problem to finally
6) Sitting is the devil when it comes to PS. I have been using a standing desk for about 10 months now and believe this is part of the reason I am free from hamstring/piriformis trouble. Aside from getting a sports massage once every 3-4 weeks, I now do nothing else. No stretching. No foam rolling. No lacrosse ball rolling. As long as I don't sit for a long time. I start to feel piriformis niggles when I have been sitting a lot, usually driving long distances since I don't sit at a desk for very long. Standing desks are cheap. I got mine at Ikea for less than $100. It's a table top with some long legs attached. Basic and beautiful.   

Now back to our regularly scheduled program...

The original post:

A friend of mine, who also happens to be a Physical Therapist, sent me the links to a couple of YouTube videos yesterday.  In one of the videos (for ballerinas), a woman demonstrates the clam shell exercise designed to target a few of the muscles in the butt that can cause what's known as piriformis syndrome.  I have done this move before, but, after watching this woman demonstrate the right and wrong way to do it, I realized I had been doing it all wrong before.  The key appears to be in isolating the butt muscles and not allowing your quads and abductor to take over like they typically like to do.  It is such a slight movement, but when done right, burns the bejesus out of your butt.  The ballerina also demonstrates how to stretch the piriformis, though I pretty much have that dialed.  She also sent me a link to a basic abductor exercise.

Serendipity graced me with her presence during my YouTube visit, for I found a gentleman with a video entitled How to Fix Piriformis Syndrome listed in the "you might also like" section.  The dude is a goofball and appears to be filming this in a hotel room, but I'll be damned if he didn't have something good to share.  He demonstrates a little exercise that is an example of "neural flossing".  He says it is supposed to loosen the muscles along the length of the sciatic nerve.  I don't really buy his explanation for how it works, but I decided it was worth a try.  I actually felt a difference after doing it for the first time.  I also found a better explanation for neural flossing here.

After introducing these new stretches and exercises to my routine yesterday, my right leg felt so much stronger, albeit a little tortured, when I started my long run today.  I had 16 miles to conquer with 9 miles of pace work.  The 9 miles included:

3 x 3 miles alternating 10k effort and goal marathon pace every 400m without stopping during the 3-mile repeat, 3-5 minute jog rests between each 3-mile repeat.  

I started my run at 9:48 and 75 degrees.  Yes, of course I would have loved to have started in the cool morning air, but I had an even stronger desire to get my beauty sleep this morning.  I started the workout on the track, since that's what my training plan called for.  However, I knew by the end of the first 3-mile block, that I needed to do the rest of this baby in the shade of trees.  The track was scorching hot.  So, I jogged over to a shady section of the American River Bike trail and ran the rest of the workout back and forth there.  It was a busy morning on the trail as I dodged bikers, runners and small mammals the entire time.  But, being in the shade was priceless.

My paces averaged 5:56 for the 10k effort and 6:12 for the goal marathon pace for an overall average for the 9 miles of 6:04 pace.  I was happy with how I felt and even happier that I felt absolutely no tightness or pain in my right leg.  Thank you Elissa and the odd dude filming himself in the hotel room.  I'll keep you posted on my progress with these exercises and my butt/hip/hamstring issue.

This was a 94-mile week and felt like nothing.  I guess I have 6 more miles to run tonight to complete the 94, but I have a feeling that will go well too.  I believe I am feeling the benefit of increased iron in my body and higher vitamin D levels.  I got my test results back on my vitamin D levels yesterday and they have doubled (from 47 to 92 ng/ml) since April when I last had them checked!

I have a key tough workout coming up next week (Yasso 800s on Tuesday) followed by a 10-mile race next Sunday.  While I'm still running high mileage (86 miles) next week, so won't be primed for a super fast race at that distance, it's the same mileage I was running last year when I ran this race.  So, it will be another good comparison for me on my road to Chicago.


  1. Jaymee, glad you felt good on your run!

    What have you done differently to raise the vitamin D levels? Do you take a supplement specifically for that?

    Speaking of Bart Yasso, we're having a half marathon here on base on 18 Sep and he's coming out to do a running clinic and be the announcer! Pretty sweet! I'll be hosting him for part of the trip, so it should be quite insightful.

  2. Hey Elissa,

    Thanks again for sending the links!

    I have been taking over-the-counter vitamin D pills (starting with 8000 IU for a couple of weeks and tapering to 3000) and spending short bursts of unprotected time in the sun. Unlike my iron stores, the vitamin D levels were pretty easy to raise.

    Say "hi" to Bart for me. Tell him I love his 800s;) I'm sure he gets that all of the time.

  3. Hi Jaymee,

    My name is Larisa. I feel like I know you so I figured I'd actually introduce myself. I call home Portland, OR (and NW Indiana while finishing Grad school the next few months). I have been thinking of attempting to break into the elite marathon field...I am nowhere near your level, but I did run a 2:57 in Chicago on my 3rd go around last year and I train like all hell. I digress...thank you for your insightful, humorous, commentary. I am an avid reader and follower of your blog, especially the posts which discuss some of the ways you/your coach structure your long runs.

    Saturday's 16 was interesting with the 3 x 3 miles alternating 10k effort and goal marathon pace every 400m without stopping during the 3-mile repeat, 3-5 minute jog rests between each 3-mile repeat. I will certainly pass that onto my Coach Larry.

    Hope to run into you in Chicago or at least get to see you while you rock the race.

    Looking forward to discussing running, my quest for the trials, etc. with such an inspiration such as you in the future.

    Take care. Happy training! All the best, Larisa

  4. Thanks for the links to those videos Jaymee. Quite timely for me as I think I may have piriformis syndrome - the symptoms anyway - sore spot and tight in the left butt/hamstring and now a "numb" left heel. I like the accent of the first physio ;) and have done a session of the neural flossing/stretching from the odd dude - really gets the spot.

  5. Larisa, Nice to meet you! Thanks for your kind words about my blog. It is really great to hear that you find it inspiring. Running a 2:57 marathon is a big accomplishment, and it sounds like you're putting in the work to get faster too. Keep believing.

    Ewen, Glad the videos helped. They're helping me too, though I'm starting to appreciate that they are going to be a permanent part of my routine. There are no easy fixes. I do the neural flossing during long meetings. I think I do it b/c it's so fun to tell people I'm getting in my daily neural flossing.

  6. I've had strain in my Glute or peraformis. Some massage helped but what also helps is a golf ball rubbing the sore area. It is a target trigger massage. You can buy really cheap golf balls at, which is a great place to buy used golf balls

  7. Thanks for the funny, I've just developed symptoms of PS, driving me nuts, and found that hotel guys video today and YOUR BLOG and I have to agree that the hotel guy's stretches made a huge difference in one try as well.


  8. Hi Jaymee,
    I love your blog! I just developed piriformis syndrome after a very long trip to Brazil. I have a half marathon next weekend and I'm running Philly on the 18 th of November. I took this week off running, did you ron with piriforms? My AT is away anf I'm climbing the walls here!!!
    Thanks and happy running

    1. Thanks, Maryro! Sorry you have piriformis syndrome. I did run with it. I think I mentioned in the update to this post that taking time off from running doesn't make it go away. You really have to work out the adhesions that are causing the problem by using a lacrosse ball, roller and/or going to see a chiropractor or massage therapist that does active release therapy. It will be stubborn and running might exacerbate it without the treatments above. Good luck to you!

  9. Thanks for the info on piriformis and how to fix it! I've heard of it before but never experienced it myself until the last few days...

  10. Hi Jamee,

    your post was very helpful
    I have PS , do you have squats and lunges as part of your work out routine , will they help ?


  11. Awesome advices Jaymee. Well written and helpful information for PS sufferers!

  12. You got me! Googled "pirofrmis treatment" and landed here...I've dealt with minor PS issues for the past year or so, but it wasn't until my half marathon last Saturday where it really became an issue...back pains, pains shooting down my leg, the whole 9 yards. I could barely walk my hamstring was so I took a few days off, rode the bike, did yoga, did all those Pilates exercises, got a massage from an excellent therapist, rolled around on a tennis ball...and after a week I was able to run 4 miles about 90% pain free. I've never tried to neuroflossing, though I have done that cross legged stretch before.

    Good luck and thanks for posting!

  13. OMG im so happy i found your blog, only in the last month have been experiencing this PS, after 3 years of running non stop it finally got me. My'n is a dull pain and its in my buttock and if i stretch it shoots down to the high hamstring, and when i run the both the dull pain and the top of the hamstring hurt. I was terrified at the thought of having to stop my training, especially when i have a half marathon coming up in 4 weeks.....I have been getting a massage by a therapist (not sure what kind of massage she does) but she is unhooking all the tight muscles that have twisted my pelvis and when she is happy my pelvis is in place and aligned, she is convinced the pain in my buttock will go away....i have my second appointment next week, i had to give it a rest before going back for 2nd go as my hips are so bruised, tender and swollen from the massage, it looks and feels like i have been beaten up with baseball bats.....
    thank you for posting your blog as now i feel confident about continuing running....i would rather run in pain then not run at all, it would be more painful to not run at all....

    Good Luck and thanks again :)

    1. Hi Paree, I do agree that this is indeed a great post. PS struck me and the only enemy for me is the time. Last 2 weeks I've been doing a lot of stretches, on complete rest and onto NSAID's dose for 3 days. I have an ultra run coming up next week. I hope you found a solution for the PS - How long did it take to recover completely? do you have any other tips to get rid of this completely?

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  16. I have googled PS a thousand or more times in the past few months. Your blog is the only thing that has given me hope. Yes, that dorky guy in the hotel room was one of the first videos I found on the subject. Lol! I haven't tried what he recommended. I suppose I will now. I have found with my training that when I attempt to run at a faster than easy pace, I get a PS "flare-up." Today's workout (30 minute tempo run) I only had mild pain, and for me, mild pain is good. I just want to run so much faster, but I feel as if PS is the only thing that is holding me back. Thanks again for this blog!

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  18. I like your blog a lot. Its informative and full of information. Thank you for sharing.

  19. I am about to do my first marathon in 5 weeks and have got this PS. it is so sore. Has there been any updates to this blog? Also the amount of different opinions is mental.

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