Has anyone else out there experienced this condition?
Is it one of the things related to PMR?
The Piriformis muscle is in the buttock area and causes pain as it contracts and spasms trapping nerves. It hurts when I stand or walk or do Physio for my hip. If it doesn’t go away it will stop me getting better fitter and more mobile. It’s really debilitating.
Why why why why why!!!!!
My hip is well on the way to healing. I am on 6mg of Pred. That seems to be holding off any flares at present. Though my neck and shoulders are stiff in the morning it’s manageable. Now there is this??? I walked better 4 weeks ago when I just got out of Hospital.
Any suggestions tips or guidance is most welcome.
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Estellemac
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I have no personal experience of this miserable sounding condition. But if I had a recent hip operation I would definitely ask my doctor if there was a link. Like a trapped nerve or something. Poor you!
Defo swished nerve it’s so annoying. I see the Doc Wednesday for this and post op Consultant the 1st. So I will get it sorted. After a year of the PMR and the hip it should al be getting much better. Bit of a set back.
Piriformis syndrome and myofascial pain syndrome are similar in effect - and both seem to be found more often in patients with PMR.
Are you SURE it is specifically piriformis? In piriformis syndrome the sciatic nerve actually passes through the middle of the piriformis muscle and spasm of the muscle pinches the nerve. In myofascial pain syndrome the muscles are "just" spasmed - and cause irritation of nearby nerves, not only the sciatic but also into shoulderblades and upper arms and neck.
Whatever - here I get physio appointments to have manual mobilisation of the spasmed muscles. Occasionally I get needling - subcutaneous injections of lignocaine or even just saline which stimulates the muscle to relax. In the UK I used to get a lot of relief from Bowen therapy - though it does need to be a good therapist. A few other people on the forums have benefited a lot from it too - although a few haven't. I definitely think it is worth a try - if it is going to help you know within 3 sessions. But a good therapeutic massage/sports physiotherapist is a good alternative.
Some good information here thanks. No I don’t know really for sure what exactly it is. Problem is I can’t walk properly as I can’t put pressure on that leg without pain. I can’t do the exercise to strengthen my leg muscles and I am less active than before my op. There is also my shoulder just as you described but I put that down to my crutches.
I should not self diagnose but I see the Dr on the 25th.
This is really valuable and will help my discussion then. I am just so fed up with pain. What next? Thanks for your support it does improve my thought processes and make me consider what help there is too.
I think the key is to get mobilized before putting pressure on the leg. Sounds like something is in spasm and not moving as it should. When I used to have piriformis issues some years ago I was given stretches to do. But with your recent hip surgery they may not be possible. My IT band would get very very tight. I stretched hard enough at one point to tear the lateral meniscus near its insertion of the IT band on the side of the knee. I should not have been encouraged to stretch that much until things were more mobilized. That's where massage and bowen therapy would come in. I also used to get cortisone epidurals into my lower back that were very helpful. Since I've been seeing an Osteopath and been faithful with Qigong exercises I've had no need of any medications or epidurals.
I used to have lots of myofascial issues in my head and neck. I was also given saline injections and they worked so well I was referred for Botox. For me, Botox in my trapezius and neck up and around the back of my ears worked wonders. I could barely drive safely because of restricted range of motion in my neck. Now I forget that I have that problem at all.
There is a way to the "other side". Please don't lose hope. Your piriformis issues are likely the result of the change in gait from your surgery. Things will sort themselves out.
PMRpro...At my health plan an anesthesiologist injects the botox. About 30 injections for me. Takes ten minutes. I can be s bit sore for a few days or a week, but what a miracle for me. Lasted 5 months. Not sure I needed it last time, but with PMR I figured whatever source of discomfort can be eliminated...I should jump at it.
I had "quaddeln" done this morning by a rheumatologist. He intended using lignocaine but took fright because of my atrial fibrillation, spent ages looking but couldn't find anything to say it was OK, so did it with saline instead which I have had done beore. I've found even that achieves a good result for some time. Forgot to ask him about Botox.
The injections with quaddeln are excruciating - but, bless him, he used a very fine needle so it was only 50% as bad
Now just the wait for the physiotherapy and massage/manual mobilisation!! Should get them for Christmas...
I can ask they can only say no. Might not need it yet still waiting for my scan an post op report. Everything might be just like this when you have two conditions each affecting the other in some way.
It was covered by my insurance, Kaiser Permanent senior advantage Medicare, for retirees. Never had it for my sciatic issues. Only for head and neck pain...Don't know if it is used for sciatic related muscle spasms.
A very gentle, hands on therapy which releases tight muscles. I won't support some of its claims - but it has worked for me and several others. This is from my former therapist from when I live in Durham, UK, and explains a bit about it:
This particular therapist, together with her colleagues, provides Bowen for patients from the Durham University Hospital pain clinic - they are convinced!
Wow, PMRPro, that is important to know, thank you. I had put it off to the pelvic fracture I suffered, but maybe it's MPS, although my pain is only in the sciatica ..on both sides..
In any case, will try one of your suggestions.I know a homeopath here who does neural therapy ..I think it's line dry needling, only he uses lidocain. injections..or maybe both.
I hope our piriformis syndrome is due to PMR,Estelle, that would mean our pain is temporary ..till our PMRs make an exit.💮💮
Sounds like intramuscular stimulation - which one of my friends in the UK swears by and she has really bad problems. And here they call it "quaddeln" - which I have had several times with great results.
Piriformis is prbably made worse by PMR - but the propensity remains I suspect even without PMR.
I have, or something very similar - screaming sciatica from bum down into both legs at times, and other times not quite so intense but bad enough. Had it for quite some time before PMR but since starting on pred 2 months ago I haven't even had a twinge thankfully and hopefully it will stay like that!
Have you tried a hot water bottle on the painful bit of your leg? I have a similar problem and that works for me. Hope you get this sorted soon, miserable isn't it. Sympathy and good wishes. 💐
If you have a truly good physical therapist they can help with this. After major back problems and being totally and I mean totally disabled this was a problem area.
If possible I suggest deep tissue massage. It was a lifesaver for me. I'm seriously planning on trying it again to see if it helps now.
That's something your Dr will have to help you decide.
Deep tissue massage isn't always a good idea with PMR - it can make you feel as if you are flaring because it releases the same inflammatory substances from the tissue that cause PMR when they are systemic.
I haven't had piriformis syndrome diagnosed but have certainly had all the symptoms you describe. I'm at around the same level of pred as you and fairly stiff in the shoulders etc. The thing that has worked best for me is a physical therapy called 'anatomy in motion'. You can read a bit about it at findingcentre.co.uk. If you are in USA I don't know how many people there are trained in it so it might not be a helpful link. The therapy trains your brain to use your muscles differently through analysis of your gait and what I would describe as micro-movements. The remarkable aspect is that there is an immediate change from these 'exercises'. I found my piriformis problems more or less gone (at least very much more under control) after one session. The therapy has no impact on PMR but if, like me, your PMR has brought up a lot of other old injuries/bad habits to the surface, it can really help.
I have had this painful condition since August, it developed into Sciatica which was even worse. I started going to a private physiotherapist who taught me some stretches for the piriformis muscle. After a few weeks my appt with the NHS physio came through, but I am restricted to an appt every 2 weeks which is not enough. I am still getting pain in the left hip, groin and knee, worse first thing in the morning, but improves after 2 paracetamol and movement. Seeing him again this morning.
To add to my woes my cat had a hissy fit on Sat night while I was stroking him and bit my hand. So Sunday it was off to the Minor Injuries Unit for a Tetanus shot and Antibiotics. Did you know that if you have had 5 Tetanus shots you are covered for life? I have not been keeping count. Hope you get some relief from the pain as it is very debilitating. Good luck. Marci xx
Thanks Marci I am a bit restricted on Physio at present but co codamol does relieve some pain. My problem is I don’t want any pain!!! But I accept it’s all part of getting older and PMR. Grrrr!!! Talking to others suffering similarities also eases the mental pain. Thanks.
I'm sorry you are suffering in this way but, as it happens, Piriformis syndrome was thought to be the culprit before I was diagnosed with PMR. My physio was puzzled when I didn't improve. It started slightly to the side of one buttock (sitting was painful and getting up even worse) but then moved to the other side and other places thus prompting my GP to do blood tests etc. I'm sorry I can't be more helpful but your post really jogged my memory how it was for me in the beginning. I send my best wishes and I hope you get answers and improvement really soon
I completely concur with gannie, having been suffering from sciatica which settled into my piriformis for months before finally morphing into PMR with the typical bilateral pain which started behind my knees. I just got tireder and weaker for months before the bloods and my anaemia were recognised as symptoms of PMR. In retrospect it's no wonder the acupuncture, fentanyl patches and increasing amounts of gabapentin were not improving the situation.
That was back in January and since starting pred I haven't had a return of the problem, but at 7mg daily I am aware of lots of the other old complaints returning. So maybe it is the low dose that is causing your problem. Have you tried rubbing a hard rubber or tennis ball over the area? I hope you get relief soon.
I think it is the low dose I was managing on but the operation has triggered a flare up. Gone up to 10 and I will see what the Dr says Wednesday. Though he doesn’t understand PMR and seems reluctant to ask those who might? I will persevere with my plight though as I shouldn’t have to put up with this considering science and medicine we have available today. Each response gives me hope for pain a free solution thanks.
I broke my pelvis around Christmas of 2016. Very recently, less than a month ago, I started with bilateral piriformis syndrome.I researched it, and it seems like its a common, long term secuela from hip and pelvic fractures.
Looks like that for me. I had buttock pain before PMR and just put it down to arthritis. It did go with steroids once that was diagnosed 3 months later. It does look like a common complaint amongst those with PMR. I just hope it doesn’t go bilateral. I trust you are fully recovered from your pelvis injury that must have been painful. Has the piriformis gone now?
It took almost a year to be pain free from the broken pelvis...I had a fracture in the sacrum and in the pubis...horrible pain that was not diagnosed till two months after the fractures happened! Apperently they were due to osteomalacia ( I had vitamin D in the single digits ) just recently I've developed piriformis pain, which seems to be a common long term effect after a fracture in the pelvic/ hip regions..Feel happier after reading PMRpro's opinion that it could be due to PMR since that would make the pain a temporary thing instead of a chronic effect of a fracture.
PMR has so many variables, it's so confusing..for me, it's been a year and I'm still such a beginner at it...still never sure whether symptoms are due to DOMS , a flare, pred whitdrawel, or something new. I never thought of myself as a slow learner before PMR😲..
I think the having it as a follow-up to hip/pelvic injury/surgey is the effect they have on gait and the back muscles. Tremendous amount of stress put on the muscles and they rebel.
You have had a complex game to work out Gaijin - not just you being slow!!!!
You were right again, PMRpro..my complaints lately were due to over working the muscles..here I thought I had a new condition..LORA or something...but now I'm fine without having altered my pred dose. I still don't know how people with PMR on here that exercise with weight machines and other things, do it. My muscles cannot withstand anything but walking on level ground and not too far. I guess it's enough to keep my muscles from athropfying...Ive had to cut out the swimming as well, as it was causing shoulder and back pain.
It could be me over doing the hip Physio rather than PS? Now I think about it more. Those muscles have been idle for so long they are rebelling again the exercise. Perhaps not a new problem just expecting too much after the traumatic intrusion of surgery. It’s not half as bad today but I have done nothing for 3 days either and took NASAIDS and paracetamol at 4 hour intervals to keep levels up in my system.
I find that I continuously make the mistake of overdoing and not even realizing it until after I get the pain...PMRPro must be saying, "I told you so" repeatedly 😂😂
spine-health.com/video/piri... Very clear account, n.b. nerve does not have to pass through the muscle (in 15% of the population it does) I have had this in either hip but fortunately not in both at the same time. Manipulation of the sacroiliac joint helps mine I doubt it would ever have been diagnosed if I was not able to go private. Ten years ago the GP tried to say I had arthritis despite having full range of movement and two subsequent visits to NHS physios failed to elicit any diagnosis.
Funny isn't it - I've been told in the past by UK doctors and physios there is nothing wrong. To be fair I had 2 UK physios who DID get it right. But here in northern Italy - no explanations required, no question at all and appropriate manual therapies approved.
In my 20s I was dismissed by an approx 80-year old doing a locum that there was nothing at all the matter with my back on the basis of x-rays. I suffered for years until I had a whip;ash injury which sent me to an orthopaedic doctor in Germany. Who examined me and then took x-rays with me standing up. Even I could see the scoliosis being made worse by spasmed muscles. He nearly got it sorted but we returned to the UK - where I spent the next 20 years trying to manage it myself having been sneered at by a physio. Then came PMR...
I damaged my hip in an accident in a military vehicle but was 19 so ignored it. At 32 I had an MRI scan showing damage to the coccyx after childbirth (quite common) but that was in Germany and dismissed over here with no investigations. So was my arthritis. The focus here has always been obesity causes all back pain. Seems something has to give before it’s accepted as a problem hence the surgery and now Steroids delaying the recovery and healing process.
Yes - if you are overweight too many healthcare professionals in the UK feel empowered to tell you that is why you have a problem. Even when someone skinny might have the same thing. I have had far better care in Germany and here - and it makes me spit when I hear all the claims that "the NHS is the best in the world...". It isn't any better than most of the rest of Europe and considerably less functional at present. Don't get me wrong - I would defend the NHS on my deathbed - but the politicians are using it as a football. One that now has a big puncture in it.
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Piriformis Syndrome with PMR
Feels like carpel tunnel syndrome 
Update: Myofascial Pain Syndrome
Why are docs so eager to get us off prednisone?
