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Carina McDonald
05-22-2010, 06:11 AM
I came into Crossfit 5 weeks ago suffering for ages with horrible back pain left over from a car accident. 5 weeks later I've made amazing progress and am not in pain daily anymore :) However, another old issue has resurfaced

- sciatic pain (which I haven't experienced in about 3 years). I did Murph on Tuesday in quite a bit of pain and since then I haven't been able to squat because of sharp nerve pain in the knee.

Sought treatment with my ART/Chiro and it is classic acute piriformis syndrome I've scoured the boards and have looked at all of the stretching, foam rolling, tennis ball techniques which I am employing daily (chronic inflexibility is my middle name). I've modified my WODS to avoid squats for now.

What I can't seem to find are a good collection of strengthening exercises specific to piriformis syndrome. I suspect for me it's due to years of imbalanced muscles. Before 2006 I wasn't into many sports but since then have been running regularly ( 4 times a week, 6 k each time).

Any great resources/links would be much appreciated. Feeling rather frustrated with this setback just when I thought I had got the back issues under control!

Cheers,

Carina

Ben Schill
05-22-2010, 06:49 AM
Carina -

Let me guess: You sit at a desk for most of the day, too (I'd be really surprised if you said you didn't).

I have this pain come & go with me too. Most recently last February through September, then it subsided in mid-Sept with some specific therapy, and now it's rearing its ugly head again.

The therapy that worked (for me):
1. Getting the inflammation down for a good week - in my case, the chronically inflamed muscle was creating the pain down the leg. I take fish oil in the morning and at night, and eat clean, but it wasn't enough for this. My doc prescribed what I called the "super cocktail" of 800mg of motrin three times a day to keep the anti-inflammatory in my system at that high level. He also had me take a mild muscle-relaxer as I lay down for bed for those same seven days.
2. Massage therapy - on the fifth day, I went in to have a 5'0' 110lb miracle worker massage my sore (left) side for one continuous hour. I walked out of there feeling like that lion who just had a splinter removed from his paw - but I stayed with the two remaining days of motrin/relaxer.

I didn't take motrin again until one week ago - that's eight months of Main Site without pain killers (BTW, I'm 32).

Other thoughts:
- Eating clean goes a LONG way for inflammation: Meat, Veg, Nuts & Seeds, Some Fruit, Little Starch, No Sugar is the best place to start if you haven't already, and I'm not trying to insult your intelligence there, just mentioning it in case you hadn't heard it.
- When sitting, don't let your pelvis "spill backwards" as some folks might say, i.e., don't let your tailbone tuck under/sit up straight.
- Make the Clean/DL/GHD part of your daily skill work.

Sorry it's not more clinical. Would be awesome if some Physical Therapist CrossFitters could weigh in (Kelly Starrett maybe?).

Best of luck.

Carina McDonald
05-22-2010, 07:36 AM
Thanks for the advice Ben

I first developed piriformis syndrome in University when I spent long hours on in a chair studying. I always found dedicated stretching & ART would get things under control. Mine definitely flares up with stress too. Final exams were always a *****.

I just finished grad school (defence is next week) and started a full time desk job. I could feel everything getting extremely tight with CF over the last 2 weeks and didn't jump on it with increased stretching, before it got this acute. My stress levels are pretty elevated with this defence coming up (I've REALLY struggled in WODS the last week or so).

Really good point you make with the clean eating. I've started taking calcium and fish oil each day and I'm on a prescription anti-inflammatory for my back. I'll be more disciplined with taking that and daily icing.

Just need those exercises to incorporate at home. Just read that runners and bikers are very guilty of PS.

I'm starting to feel bad constantly needing modifications to the WODs. At first it was the back, that got sorted, and now it's this! But I guess CF lets you figure out what is wrong with your body and then work out all the kinks!

Carina McDonald
05-22-2010, 07:39 AM
As for the pain, some nice burning muscle pain throughout my hips (especially feel it with external rotation), aching sciatic pain through the hamstrings, which turns to sharp/burning pain behind the knee (popliteal is really flared up also) then back to a deep ache down along the lateral side of my leg, about midway. ROM on knee extensions sitting is pretty terrible, can only get to about 45 degrees.

Steven Low
05-22-2010, 12:38 PM
Carina -

Let me guess: You sit at a desk for most of the day, too (I'd be really surprised if you said you didn't).

I have this pain come & go with me too. Most recently last February through September, then it subsided in mid-Sept with some specific therapy, and now it's rearing its ugly head again.

The therapy that worked (for me):
1. Getting the inflammation down for a good week - in my case, the chronically inflamed muscle was creating the pain down the leg. I take fish oil in the morning and at night, and eat clean, but it wasn't enough for this. My doc prescribed what I called the "super cocktail" of 800mg of motrin three times a day to keep the anti-inflammatory in my system at that high level. He also had me take a mild muscle-relaxer as I lay down for bed for those same seven days.
2. Massage therapy - on the fifth day, I went in to have a 5'0' 110lb miracle worker massage my sore (left) side for one continuous hour. I walked out of there feeling like that lion who just had a splinter removed from his paw - but I stayed with the two remaining days of motrin/relaxer.

I didn't take motrin again until one week ago - that's eight months of Main Site without pain killers (BTW, I'm 32).

Other thoughts:
- Eating clean goes a LONG way for inflammation: Meat, Veg, Nuts & Seeds, Some Fruit, Little Starch, No Sugar is the best place to start if you haven't already, and I'm not trying to insult your intelligence there, just mentioning it in case you hadn't heard it.
- When sitting, don't let your pelvis "spill backwards" as some folks might say, i.e., don't let your tailbone tuck under/sit up straight.
- Make the Clean/DL/GHD part of your daily skill work.

Sorry it's not more clinical. Would be awesome if some Physical Therapist CrossFitters could weigh in (Kelly Starrett maybe?).

Best of luck.
This is pretty good.

Make sure to start increasing your mobility in all the joints above and below....

ankles, knees, HIPS ESPECIALLY, low back, t-spine


This will likely help you as well (read all 5 parts) wfs
http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/

Carina McDonald
05-22-2010, 01:00 PM
That article was a great read. I'm learning a TON about the body through CF and addressing all these "kinks" and issues that have bothered me for years. I think that's one of the great things about CF, it forces your issues/weaknesses to the surface and forces you to correct them. The only frustrating thing is constantly having to ask for modifications/substitutions :/

Last week (Before the PS became so acute)
I was having real problems with my knees tracking inward on squats, I was having real difficulty staying on my heels, along with foot cramps during class and at night, as well as a really frustrating time with my balance during lunges during warmup. This article really highlighted how closely everything is connected and made me realize all those little warning signs were pointing to things being out of whack.

Steven Low
05-23-2010, 12:05 PM
Yep. Take some time off to let yourself heal if you need to and do a lot more stuff focused on mobility/massage/rehab work.

Then you can work your way back into exercise.

Ben Schill
05-28-2010, 11:08 AM
One other thing that I forgot to mention that worked for me:

If you're a "side sleeper": Put a fairly puffy pillow between your knees - it relieves tension that side sleeping puts onto the hip complex, and will keep you from feeling like you got hit with a bat on that sore Piriformis first thing in the morning.

Hope you're feeling better.

Christopher G. Woods
05-28-2010, 04:20 PM
Before 2006 I wasn't into many sports but since then have been running regularly ( 4 times a week, 6 k each time).

This is the part of your post that shot off alarm bells in my head. Unless you are a competitive distance runner, that's a lot of volume-especially if you are doing that in addition to regular CrossFit WOD's. If you enjoy running, and your affiliate doesn't do it enough to satisfy you, then check out CrossFit Endurance (http://www.anaerobicendurance.com)(wfs). CFE's programming focuses on intensity over volume, which will give you faster gains and eliminate the unnecessary where-and-tear on your body.

Ian Nigh
05-30-2010, 12:15 AM
+1 on cutting out the running, or at least dialing it it way back. What is your reason to run this much, how does it fit into your goals?
I suffered with piriformis syndrome for months, but one visit to Michale Leahy (inventor of ART) fixed me up for good!

I also addressed my muscular imbalance issues with Bulgarian split squats and one legged deadlifts. I still do these lifts once or twice a week as they have been so useful and made me alot stronger. I am now doing 80kg on the Bulgarian split squat and 95kg on the one leg deadlift, but obviously started way lower than this.

The first thing I noticed when I started incorporating these lifts was how much they improved my balance. They also fixed my leg length discrepancy which the doctors had told me was congenital!

Carina McDonald
05-30-2010, 07:16 PM
I've taken up the advice re: side sleeping with a pillow, definitely takes the edge off things first thing in the morning. Surprised re: the running, but I guess that volume does add up over several years. I've cut it way back over the last few weeks. Have a 10k coming up next weekend and I've hardly trained for it, but consistent crossfitting seems to keep me at a decent 5km base without needing to train more than twice a week. I'm hoping it's enough but I'll fit on an extra run or two this week to 'test the ground'

Piriformis is coming along with ART and lots of icing/stretching. Hoping I'll be back to those squats soon!

Steven Low
06-01-2010, 06:44 PM
Here's a bit more I wrote up that may help you if you aren't doing some of this stuff already:


Piriformis syndrome is a bit tricky from what I’ve seen.

Sometime it’s actually the piriformis pinching down on the sciatic nerve, but sometimes the complications occur much higher up in the chain in the lumbar spine or SI joint. Length length discrepancy or rotated pelvis may be a good thing to check for as well (in regards to SI joint and such).

Check to see if they have tight hip flexors, rectus abdominus, quadratus lumborum, or paraspinals & erectors. Mobilize these muscles too and you might get some better results.

Also, I would also check how well they internally and externally rotate their hips. If one side is tight and affected that can tell you something as well.

Also, get the glutes firing correctly with bridging, etc. so the hip doesn’t have to have the piriformis lock up on you. The only reason the deep muscles such as piriformis get tight is if there is a problem stability-wise with the whole lumbo-pelvic area. It’s like the rotator cuff muscles and scapular muscles locking down the shoulder after something traumatic or instability from weak posterior scapular muscles.

Let me know if this helps any of your clients. Always looking for feedback on to what tends to help and what doesn’t because it’s sometimes a bit different from person to person especially with hip/pelvic dysfunction.

Carina McDonald
06-03-2010, 11:33 AM
Thanks for the extra tips Steven - I'm learning a lot from your writeups.
I'm seeing a great DC/ART/Graston provider right now who's doing a great job fixing me up - it's been really interesting to see where the problems are and uncover new issues.

I had piriformis flare ups before the MVA, but when it happened I had my left foot resting against the foot plate when my car was impacted, and I braced so I'm sure that didn't help things on the left side, which happens to be the worst off. Found out that the pain radiating down my leg wasn't sciatic - it's actually shin splints - graston is helping those BIG time and turns out my popliteal muscle behind both knees is pretty bad. Some serious profanity came out of me when those were worked on. Hip Flexors are strung tightly too.

Piriformis pain is down about 50% with 3 treatments so far, 2x a week. Have done lots of rolling, stretching and icing and I completely cut out running. I was Crossfitting 4 or 5 times a week but both the trainer and my therapist are advising me to take a longer break healing time & treaments in. I really hit the wall in yesterday's WoD and My T-Spine and Mid back are pretty flared up so I think I am going to take their advice and take the weekend off.

Have a 10 k on Saturday so it should be interesting to see how things hold up! I'm really curious to see how I perform - haven't trained for this one at all but have the 5k base down with a month of 4x a week crossfit.

Steven Low
06-03-2010, 01:49 PM
That's good that you're learning something useful. :)

If I were you I'd drop the 10k completely and even some of the CF. It's hard to let your body heal when you're doing a lot of that stuff.

Even if it's not aggravating your condition it can be prolonging it.

But yeah you are improving pretty well it seems so that's great. I guess go with what works...