Piriformis Syndrome.

September 25th, 2007 § 163 comments

In this entry, I am actually going to try to be both serious and informative. Hard to believe….but here it is:


In the past couple of years I have been in a hell of a lot of pain from what has recently been diagnosed as Piriformis Syndrome. If it sounds radioactive, it is. Not in a U238 kind of way but it radiates like a bitch and if you have never experienced chronic pain, do I not recommend it, even to those amongst us who profess to enjoy it. If by some chance, nature did not endow you with an ounce of empathy, this here: tear jerking, fist clenching, teeth gnashing, and all consuming pain, will make you wish you never existed. And the best part of it is, it’s on 24 hours a day, 7 days a week, and every sorry ass day of the year.

Why am I telling you this? Fear not, I do not need your pity or sympathy, even-though I’ll take your money, but if by some stroke of fantastic luck, you are reading this, and are sitting at home and contemplating the old adage, that dropping like a stone has its advantages, read these here phrases before you decide to leap off the ledge and into the bottomless pit (btw, in you are going to do it anyway, remember that you must jump from at least the 4th floor, to ensure a sufficiently traumatic death? .

As I was saying, in October 2006, I decided that I had had enough of this grief to actually do something about it. I went to see a MDs, and as it turned out, not just one but many. At the time the pain was severe but not yet devilish. I had just finished crossing the country and the Pacific several hundred times, in a three month traveling frenzy, which had aggravated my aches and pains enough to warrant a trip to the clinic. I started to believe that since I was spending all this dough on health insurance, why not give medicine a spin, no more barin’ and grinnin’…. let’s get some relief, you’ve earned it….

Long story short, the pain got worse and worse, the MDs got more and more confused as to why my supposed Sciatica had no visible diagnosis, no herniated disc or spinal stenosis. Hell, at this point, since we can’t figure this out lets shunt him off to the pain clinic; it’s what we do when our protocols are no longer useful and we’d rather not look into it, it’s probably all in his head anyway.
Being the type A that I am, and a strong believer in answers to everything, I simply refused to believe the way this was ultimately going. I decided to enroll my friend Scott, the MD, who one early summer day came bouncing out of the San Francisco mist to casually mention, that I ought to get Botox injections: ” I read a paper recently that Botox injections can be quite effective, if, as you seem to so vociferously believe, that it’s a muscular, not a skeletal thing”.
A quick search (Botox + Siatica) on the internet and there it was, the number three, the trinity(actually six). There are, in turns out, not two but three possible diagnosis for this wretched sciatic misery; and here is my word for it: Piriformis Doloris Vendictis.
I won’t describe it here, just go to these and the other links, I am so generously providing alongside this entry to remind you that medicine is protocol based; to believe in your instincts and listen to your pain, not the physicians who think they seen it all before; just another patient, like every other miserable wretched case before it.
My condition, it turns out, should have been well known to the MDs who treated me, it’s not that uncommon, but thanks to the time constrained and generally disinterested MDs who treated me, I was well on my way to rotting, alongside all the other unlucky corpses haunting the halls of the chronic pain.

Epilogue: I received a Botox injection in the Piriformis last August fourth, and am doing better. Not out of the woods yet, as a lot of physical therapy and possibly many more corticosteroids and Botox injections will be needed to deliver me from this nightmarish affliction, but at least now, it has a name and can be treated like the bitch that it is.

Below, are must reads, if you have any kind of sciatic like nerve pain radiating down your lower limbs. Even if your MRI shows signs of herniation or synopsis, as it often will; do not discount the Piriformis, and mention it to your MD, as a very real possibility. Send him/her the links and nip it in the bud, before it breaks your spirit, as it eventually will as the longer a diagnosis takes, the greater your chances of going insane in the membrane.

Take it from me, chronic pain is unmitigatedly the closest thing to absolute misery. If you have it, wether or not your Piriformis is the culprit, you have my deepest sympathies; I feel your pain, I really do mean it, even if I often profess to the contrary.


§ 163 Responses to Piriformis Syndrome."

  • Lisa says:

    I’m 53 and I have had extreme pain in my legs, feet, butt, and lower back and hips for the last 4 years. After several MRI’s, Nerve conduction tests, and neurological workups, a false MS diagnosis, my docs just said “can’t find a reason’ other slightly herniated L5-S1.
    I have even had a situation where my calfs would refuse to allow any weight bearing and I could not stand or walk for several hours. A couple weeks ago, I reached down to pick up a piece of paper and heard, “pop, pop then the strike of lightening that went down my lower back radiating down my hips. I could not move, stand, crawl, nothing. I h ad to call 911. Also had a little bladder control issue. The MRI showed some disk narrowing but no herniation then did a bunch of physical testing, not neuro testing. Moving my
    legs around and making me walk and bending this way and that which was impossible but they came up with the diagnosis of Piriformis Syndrome. About 2 years prior, (when started, I had fallen off my horse rather violently and broke 5 ribs. They gave me Valium for muscle spasams and motrin 800. It works, as a mask. But I need to function suring the day. I’m waiting for my pcp to refer to physical therapy. Any ideas of what could help more permanently?

  • David says:

    After loads of sites , youtube stretching videos , deep tissue massages and even Tecar treatments , i came across this site which explain perfectly my pain . I have been feeling sharp pain in both sides for almost a year and as my fitness activity is swimming it hardly affect me but i realise that i cant walk more than 15 minutes and all the sharp pain,burning feeling , some numbness start coming . Its really worse on the right side as the sciatic nerve is badly attacked with all the pain it brings . Been to 2 phsios lately , one just massaged the hard and stiff glutes/priformis but after just n hour i was back to square one . Stiff hard buttokcs muscles , pinched nerve , tears……standing on same spot for more than 5 minutes its like a miracle . Now im seriously considering visiting an Orthpediec surgeon / MRI option to try to state clearly from were this hell erupted.

  • Doris, says:

    We need more reply from people who have tried Botox, since it seems to give some relief.

  • Laura fatemi says:

    Was wondering if anyone has experienced numbness and loss of feeling in the foot from steroid injections. I just had a shot this morning and am experiencing the above. The dr. Said it will go away and is normal, but I haven’t found anything mentioned on the internet to suggest this is so. Would appreciate your thoughts.

  • Mike says:

    My story, like everyone’s story, spans several years worth of heartache, anger, depression, and anxiety. Shortly after graduating college, I developed terrible pain in my buttocks, groin, scrotum, and hamstrings while sitting. It’s been so bad that I spend nearly all my waking hours standing up to avoid the pain. Driving, dinner out with friends, even sitting around watching television are joyless chores to be endured. Every day, I become a little more frustrated and unhappy and I feel a little less human. I wouldn’t wish this on anybody. Five independent doctors were unable to determine the cause; they diagnosed me with conditions as various as “prostadynia” to “chronic pelvic pain syndrome” to “proximal hamstring pain syndrome.” I was adamant that I was suffering from some kind of pudendal nerve entrapment somehow related to my piriformis but nobody believed me. Finally, I found an expert on piriformis syndrome, a physiatrist in Manhattan named Dr. Fishman, who took my case and sent me for a magnetic resonance neurogram. The neurogram confirmed that the S2 and S3 nerve roots are hyperirritated as they cross underneath the piriformis muscles bilaterally. Now I had a diagnosis, but I did not yet have a cure. Steroid injections into the muscles did not help. Botox injections did not seem to help either, although I’m only ten days in and I’ve been told it can take several weeks to work. I don’t understand why, if the problem is so obvious, don’t the conventional treatments have any effect? The next step is surgical resectioning of the piriformis muscles. I’m hesitant to have surgery because I don’t want the problem to get worse and nothing seems to have worked so far, but I don’t think I can live like this much longer. The mental aspect of this illness is crippling. There doesn’t seem to be any reason to continue on. Pain management doctors are useless to me — I don’t want to manage this, I want to cure it. I can’t even bring myself to see a psychologist because I didn’t want to become one of those impossible cases whose only option is “learning to accept it.”

  • Lisa says:

    Does anyone know a doctor in the boston area that does Botox for piriformis syndrome

  • Clarissa says:

    Read this string and identify with you all. Horrible debilitating pain for many years, gradually getting worse. I’ve had Botox twice, each time x-ray guided and such sweet relief for some months. It doesn’t last for ever and you need to do physio to extend it but I would definitely recommend it from a good pain relief specialist/neurologist. I had mine in London and Botox is very expensive with some insurers not paying but go for it if you can.

  • Scott says:

    Well it’s been awhile and I think good news is happening my Botox injection seems to be helping a lot. I still have terrible pain when I walk but the sitting and standing pain has gone from a 8 to 5, oh my God that’s better. I can actually golf without pain pills during but still need to take a couple after the game . I know it doesn’t sound like much but hey I think I just left hell and half way to Heaven! I am doing some PT and it seems to help on the second issue of a complicated Piriformis and a abductor muscle located on the outside of the buttocks, I forget the name of the exact muscle but the Doc juiced it with a steroid that helped a little for a little time but it got me through for some physical therapy. We found an interesting dilemma my right leg is shorter by 2 inches than my left, so I have been self correcting for years, and that’s what has getting my left ass all f***ed up so it is going to take a fare amount of months to get this back to somewhat normal and I walk now with a 2 inch lift in my right shoe. I hope you all are getting some where with your problems but after 7 going on 8 years of popping pills just to get through the day I have a sense that hope can turn into real relief. Happy Easter to you all

  • Stephanie Sharpe says:

    I am in the UK and after many years of paying privately for Botox (about every six months) to relieve medically diagnosed Piriformis Syndrome, I now can’t get a “Botox in the buttocks” as my amusing sister would sing to me. Apparently, Botox is being too widely used, this must be some EU ruling surely.

    I have gone from being a fully-functioning 40 something to a limping, leg dragging, sleep deprived zombie at no cost to the state, but every cost to me personally. No other remedy has worked but the Botox paralysis of the muscle worked for me for about six months at a time at a cost to myself (this was never state-funded) of about £1,200 per annum. It would be good if this were after tax deduction but, in common with others’ whose stories I have read, I know we would give almost anything to be able to move, sleep and have a normal life.

    I had that opportunity for a few years but now it is denied me due to regulatory issues. Very weird that if I were more concerned with the wrinkles in my face than the inability to walk to work, I could apparently have the cosmetic treatment denied me for my health and well being!

  • Randy says:

    Because it is often a diagnosis of exclusion and the fact that many ortho surgeons either ignore it or don’t even believe it exists, it’s hard to get a diagnosis of PS. Downright Hard. My symptoms began in 2003 as electrical pain in my left foot. Thought I went to the best doctors in LA, did all the MRIs etc., no one could find the problem. I was given Neurontin, for which I am grateful, but for ten years the pain got slowly worse and I was careful not to miss a does of 3 X 600 a day.

    Then out of nowhere I began to have electrical shocks running down my left leg. The foot pain soon more than doubled, making it the central focus of my existence. The pain had been sustainable for 10 years, but no longer.

    So back to the experts who simply did all the tests that had been done before, and still no diagnosis. But because of my pain level, a spinal epidural injection was tried. No luck. I went to physical therapy and the guy assigned to me said that what was confusing everyone (including him) was that no one presents with just sciatic foot pain. Such a unique case would be hard to diagnose. But, we did all the physical therapy work as if “spinal stenosis” was the best guess. No progress. I got myself a inversion table and hung upside down daily for weeks. No relief. Went to an Acupuncturist. No help at all. I took the maximum dose of Neurontin for some relief and spent most of my time lying down. But want kind of life is that?

    Then one day my therapist began to look elsewhere. He pushed hard on a lump he found in my upper butt and said “Does that hurt?”. “Yes, like heck” I replied. Bingo. That’s when I decided to pursue a whole new set of doctors and pain specialists. All I wanted was a stupid Pirmiformis Injection. But no, we had to go through even *more* tests. Finally when there was no stone left unturned my new Surgeon relented to ordering the injection I had asked for in the first place. Even the Pain doc, just before the injection, implied that this probably would not work.

    But It worked.

    It’s been 10 days and my pain level is still down about 40%. I know the relief will only last a month or two at best. I know I’ll probably need to move on to botox and a ton on physical therapy. But at least now I will get a true diagnosis when I return to my new MD’s this week. Gee, what does a guy have to do around here just to get a simple shot in the butt?

    I write this for those who suspect they have this stupid syndrome but their doctors don’t. Do whatever you have to do to either rule this puppy in or rule this puppy out. I now have relief, hope and direction. I’ll be able to discontinue the antidepressants I needed to keep me going these five months. I’m grateful to the patient forums like this and all the great information available on line. And especially to Allen who found that sore spot deep in my upper butt. Way to go Allen!!

    Happy Easter to you all as well. This is my own personal resurrection.

  • Mike says:

    Hello all,
    After 15 years of all the symptoms you have all faced. I have just self diagnosed myself with Iliopsoas Tendonitis. Google it and see if you have all those symptoms.

    I am currently trying to find a qualified physiotherapist in Calgary to fix me. It will be tough as this is rare, but not uncommon.

  • Colin says:

    I have been a forklift driver for about 10 years. And sitting on your bum for that long with a very uncomfortable seat., Caused me to get Piriformis Syndrome. I always complained about the pain in my butt but the doctors said that it was my bad back,
    After seeing a specailist he confirmed it as Piriformis Syndrome. Most GP’s don’t know what it is… and always you have a back problem. Like the reader the pain is like a knife in the ass and not taking it out.. I feel for all of you people who have Piriformis Syndrome.

  • Maritza says:

    I had a car accident over a year ago, the next day I started feeling this pain and numbness going down my leg but mostly from the knee down to my toes. My knee was swollen and bruised so I decided to go to the doctor to get my leg checked out. It was very hard for me to walk and I was not able to straighten my leg because the pain was unbearable. I get to the ortho and after several test he found nothing and we both were very confused because my knee was still swollen and bruised. After six month of trying different things including physical therapy 2 times a week I was sent to a spine and back specialist.

    When I went to this specialist office I was seen by his PA, she was very helpful at first. She even found the problem right away. She diagnosed me with Piriformis syndrome. Me not knowing what it was I asked for more information. She explained everything to me and what the steps were to relief. Well to my surprise I was sent for my first injection the following week, I had relief for a day or so then back to pain which was to be expected. But no complete relief. I went back to the doctors several times after that I have had 3 more injections since then. With no relief, I have become very frustrated. I can’t sit for too long I can’t stand for too long I have a hard time walking and to top it all of I sprained my ankle on my other leg. So I is really impossible for me to walk know. I have gotten to the point that I don’t know what to do my insurance will not cover the botox because it is to expensive and now I am being referred to another doctor. I really thought I was alone, but now I see that there are many people out there with the same problem as me. I do not wish this pain on anyone not even my worst enemy. I sure every single one of you find relief soon including myself.

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