PMR and Piriformis syndrome

[Croft9232]

Hi Everybody,

I have my first appointment with a Rheumatologist on Monday after diagnosis May 19.Currently on 10mg ,however I have increased today to 12.5 mg to see if it will make any difference to my pain in my buttock/ back/ leg!

I have now read numerous articles and posts etc saying that PS may be linked to PMR in that its inflammation and in a large muscle. My pain has definitely been worse since onset of PMR. I also have never had a clear dx, its been going on some 5 years mostly burning pain in leg ,previous tests inconclusive ,MRI showed no sciatic nerve impingement. It is now at the point where I have leg weakness..it gives way upon standing/ walking. I take 600mg daily Pregabalin to help with the burning pain.

Sorry to ramble on..I will be telling my Rheumie that my PMR is under control, I have just had a wonderful 6 weeks in Australia and New Zealand with family on holiday. Just this awful PS or sciatica to tackle!

Any advice as to what to ask him regarding this? I have a limp too which makes me feel older than I am and slightly embarrassed.

Regards to everyone on this wonderful forum,

Margaret.

[SheffieldJane]

If you haven’t already,a good Physiotherapist may be able to help with specific stretching exercises, massage and stretching out the muscle. My husband has been treated for similar. One exercise has him lying on the floor and drawing his leg up to the opposite shoulder. Ice and heat can help too. His physio is also knowledgeable about PMR. I have seen her too. As you’ve suffered so long, I think you need to be guided through these exercises. I believe it can be a PMR “ add on”.

Was 10 mg your start dose? It’s pretty low. 15 mg - 25 mg is more common and I would have expected more relief with this chronic inflammation. I hope your Rheumatologist appointment is helpful. Good luck!

[jinasc]

I had Piriformis and suffered for 5 months earlier this year. I eventually resorted to Acupuncture, cleared up with six or seven treatments, he also added cupping of which I had never heard - found it it is older than acupuncture. I found him through the registered association.

Just thought I would tell you ............

[Croft9232 in reply to jinasc]

Thank you both for your replies..yes I do stretching exercises and have seen both a registered physio and had remedial massage all over the years.

I started on 15mg 5 weeks then 12.5mg same , its only since I went to 10 mg that I feel the PS / sciatica has been worse.Its so frustrating when there is nothing to see on MRI or other tests, though they were done 4 years ago now.I didn’t realise how many parts of you can hurt with one condition!

Hip too!

Thanks again for your replies, much appreciated.

[Purplecrow in reply to jinasc]

Same experience here...I love my acupuncture and chinese massage😁

[Daisyfield]

I had PS for about a year before onset of classic signs of PMR...and I do wonder if it was brewing and connected. I found it hard to drive for more than an hour...a pain in the bum, literally. Since steroid treatment the PS as pretty much resolved. I'm on 9mg at mo.

But I do feel leg weakness at times..and the other day I had to move quickly out of the way of a bike, and almost fell...it was as if my mind knew what to do but my legs couldn't catch up.

[PMRpro Ambassador]

Piriformis can cause severe sciatica - and it won't always show in imaging. Doctors put far too much emphasis on lab and imaging results - to compensate for their lack of clinical skills.

You need a really good physio or therapeutic massage therapist - ideal would be a sports injury expert. Think major tennis players And there are fewer side effects than with drugs ... But that just deals with the effect - you need a bit more to sort out the cause and while any physio can help the symptoms it takes a good one to sort it entirely.

[Marcy47]

I suffered with PS in my left leg and buttock when trying to reduce below 10mg. I was referred to a Physio who gave me exercises to do which did work eventually but it took a long time. I found heat pads tucked in my trousers while at home helped and large doses of Paracetamol. Hope you find help with it as it is very debilitating, I had to use a walking stick for a while to get around. OK now except for pain in left ankle, think I spent too long walking around Salisbury on Friday!

[clieder]

I had a bad bout last year that involved PS, but the primary problem was S1. I tried therapy for the PS. No impact. First ortho I was referred to ordered an injection in L5. No joy. Contacted my first choice ortho and she dx S1 and ordered therapy by someone specifically trained in S1 and, at one point, got it all under control, but it recurred with a vengeance. She then ordered a steroid injection in the L5/S1 that settled things down. I still had to increase the pred all the way to 20 and come back down slowly to get rid of the PMR flare that accompanied all of this. None of what was going on showed up as significant in the prior ortho's x-rays or MRIs. It was significant to me! If your pain is primarily in the back of the thigh, the other symptoms you describe are the same as what I experienced. She went right to it based on the location of the pain. Here is a description of the joint: spine-health.com/conditions...

I hope you can get some relief. It is a whole different kind of pain and, when added to the PMR, is pretty disabling. They feed on each other, it seems, so it helps to eliminate one if possible.

[Canary77]

I also started with ps although I didn't know it at the time. I quite quickly developed PMR and had great success on prednisolone. I then had 2 hip replacements in quick succession, (wondered if connected?) followed by severe piriformis syndrome. My physio treated me with deep frictions, which I recommend to you. It cured mine. unfortunately I had a flare up of PMR and had to jump up to 10 mgs. and am struggling with all associated symptoms including irritated piriformis. I have slowed my activity right down to control things which I find frustrating. Good luck.

[Croft9232 in reply to Canary77]

I wonder if I will get some answers tomorrow seeing a Rheumie for the first time ever, hope so or at least elimination like not having RA which I do not think I have. Deep frictions sounds interesting, may I ask what it is?

Many thanks for your helpful reply .

[PMRpro Ambassador in reply to Croft9232]

I suspect it may be another term for trigger point mobilisation where very local attention is paid to particularly painful points.

[Croft9232]

Thank you so much everybody, I have a few new questions for the Rheumie tomorrow.

[Canary77]

deep frictions are best described as deep massage over the painful spot. Good luck with your appointment and I hope you get some answers.

[ralinn52]

I use a compression wrap sleeve, helps alot for leg/piriformis areas.

[Croft9232 in reply to ralinn52]

Thanks everyone.I am interested in the compression wrap sleeve idea I had a look on the internet and saw they are for the thigh.?

Is yours?... my real pain area is in the buttock so do you think the thigh compression would help that area?

Thanks again,Margaret.

[PMRpro Ambassador in reply to Croft9232]

There are also versions for the lower back.

[Croft9232 in reply to PMRpro]

Yes I saw those too..will get one of each perhaps.

[PMRpro Ambassador in reply to Croft9232]

Beware of using them too much - that leads to further weakening of the muscles being supported which isn't helpful. Suitable exercises to strengthen them might be a good idea - but I would ask a physiotherapist.