Now and Then: 7 Simple Steps for Managing Piriformis Syndrome

After 6 days in a row of pretty solid runs, including a 9 miler on Saturday and two post-night-out 5 milers that somehow turned out better than any in which I’d gone to sleep sober, well-nourished or early, I decided to sleep in on Monday.

Could I have run? Certainly. But between a mountain of work and last week’s piriformis scare, I figured that I’d take the drizzly dawn as a sign to stay in. No running, no living room workout, no sweat.

I knew I’d regret this decision midday and, in the words of Homer Simpson, “go something something,” and that’s exactly what happened — my energy levels began to dwindle and my mind began to wander. Exercise keeps me focused and awake; lazy mornings, while kind of nice at the time, render me lethargic and unmotivated. They really don’t benefit anyone.

I did want to take this opportunity, however, to check in on this small bout of piriformis pain I’d been dealing with over the past few days. Last week, I touched upon a minor concern with this recurring running injury—if you can call it that—and, although it was seriously bothering me for all of 72 hours, I really feel as though I’ve learned to manage the condition to the point that, if it does return, with foresight and intelligence, I can kick it within a few days. (Today’s awesome 5.75 mile run along the East River is proof of this, but more on that tomorrow.)

This is a big deal for me. Only a year ago this month, I signed up for my very first half marathon only to discover that I’d have to take a 4-week break from running. Simply
put, I was devastated. How would I train for my first shot at 13.1 miles in only 4 weeks?

While I was fortunately able to accomplish this feat and run my first half in 2:11 (my goal for the Queens Half Marathon was 2:10, so I was pretty happy given the extreme temperatures and yawn-worthy scenery), I vowed that I would never let such a manageable condition spin so far out of control ever again. With the right decisions, piriformis syndrome can so easily be maintained. With the wrong ones, however, you can wind up on the sidelines, blowing the little money you make in the first place on overpriced yoga classes, physical therapists and massage therapists. (Ok, the last one was kind of nice.)

What not to do if you think you think you have piriformis syndrome.

  • Don’t kid yourself. If you feel like your body is trying to tell you something is wrong, then it probably is. Run if it feels comfortable, but if the pain deepens, stop before it gets even worse.
  • Don’t believe for a second that your injury will magically heal after a day of rest or even a week. Sometimes you might need to just wait it out, but think about it this way; had I given myself a 2 week rest, I may have avoided the inevitable full month hiatus.
  • Don’t self-diagnose. I did this, and I happened to be kind of right. But by self-diagnosing, I closed myself off to the myriad other issues that piriformis syndrome might have been caused by (and consequently caused), like tight calves, quads, IT bands, and everything else.

How I’ve learned to manage my piriformis syndrome. **Note, I’m not a doctor. These are home remedies and tricks I learned by working with several professionals. If you’re really dealing with a physical injury, you’ll probably benefit from checking in with an MD, not just some girl who runs for glitter and stuff.

  • Book yourself a massage. I thought this would be too indulgent. Then a doctor — like a real, live MD! — told me to do it, so I felt justified. Just be sure to seek out a bodyworker who specializes in athletic injuries and has ample experience with trigger point therapy and myofascial release, not, you know, any old therapist at a spa.
  • Learn how to stretch. Pigeon pose is one of my favorite stretches to relieve the pain of piriformis syndrome. Other really great positions: seated spinal twist, figure 4 and simply stretching your arms over your head and reaching with clasped fists to the left, center, right, and back to the center.
  • Restorative yoga. I’ve never really looked at yoga as my workout per se, which is why I prefer classes of a restorative nature that enable you to stay in the same, stretchy pose for moments at a time. If you’re from New York, I highly recommend Jivamukti’s Spiritual Warrior. This class is also the reason why I’m able to do a headstand today!
  • Read a book upside down. This isn’t quite what it sounds like, but I’m dead serious about it. When I was first dealing with piriformis syndrome, I stopped by Tara Stiles’ “relax” class at her studio, Strala, in Soho. While there, I asked her what I could do for long-term pain management, and she recommended simply lying with a block under my lower back and “hanging out there” for a while. She even told me to read a book in this bridge-like pose! Hemingway, anyone?
  • Foam roll. Not only does sitting directly on the sore sports feel great, but the foam roller is incredibly important for all of the surrounding muscles, ligaments and tendons. For me, it’s of paramount importance that I foam roll my IT band and my lower back, otherwise, I ultimately feel it in my hips, sides, and everywhere else.
  • Locate your trigger points. Once you do, you can slowly knead into them using a tennis ball or your boyfriend’s (or girlfriend’s) fist, slowly decreasing the sensitivity of the area. A warning: This is one of those “hurts so good” circumstances. Brace yourself.
  • Strength train. According to my physical therapist, I developed piriformis syndrome because I neglected to cross train and, as a result, developed weak glutes. That’s why I’m so careful today to strength train at least once a week, and if I don’t, to do random leg lifts everywhere I go.
  • Listen to your body. I’m not even going to say don’t run, because I’d be a total hypocrite if I did. Last week, I felt the onset of piriformis syndrome and continued with my morning routine anyway. The difference, or at least what I think made the difference, was that I very much listened to my body. I took it slow, I aimed for dirt paths when possible, and I stopped to stretch multiple times throughout the run. It may not have been pretty, but it’s what had to be done.

Have you ever dealt with a recurring injury? What was it, and how did you learn to manage it on your own?


24 thoughts on “Now and Then: 7 Simple Steps for Managing Piriformis Syndrome

  1. We definitely need to catch these injuries before they become a pain (literally!) My physiotherapist was my best friend for a while when I had IT pain. I was so determined to go for a run that it was only after I really couldn’t run that I realized how much of a pain it was.
    I’m all for foam rollers (I even take it travelling with me) and cross-training and trigger points to keep things mobile. I call it “delicious pain” because you know it will be better, later.
    Happy running.

  2. I have a constant struggle with foot pain from a sprain 2 years ago… It means for me that I cannot run many days in a row and I learned this the hard way. The good thing from this is that I took up cycling and love it! This also leads to a happy foot because of the no impact! 🙂 hopefully you can keep that piriformis feeling good!

    • That’s awesome that you found something you can do on those non-run days! All I have is strength training, which sometimes activates the piriformis muscle anyway. I’ve heard great things about cycling though, must try!

  3. I had a nasty bout of ITBS last October after running a half-marathon. It was so discouraging! I ended up taking about six weeks off from running (since it was the beginning of winter, the timing wasn’t as bad as it could have been).

    I manage it now by using a resistance band and doing side steps, etc. after each run. I also do a lot more pigeon pose. But my #1 prevention technique is definitely my foam roller–the best $40 I’ve ever spent!

    • Ugh the worst! Hope you’ve been ITBS-free since then. The foam roller is definitely amazing, though there are definitely times it just sits in the corner of my living room. For some reason, it’s tough to actually get on it! Pigeon pose is one of my favorite positions in the entire world. Hmm, resistance bands are an interesting addition. Something else I can do in my living room. I might need to add this to my repertoire, thanks!

  4. I am currently experiencing an injury in my lumber spine area with the sciatic nerve – going in for an MRI. My body seems to respond well to massage therapy right now. Just hitting the middle lane as far as exercising right now. Thanks so much for sharing this information – timely for me right now. Have a Great Day:)

    • Oh no, good luck with your MRI! Hopefully it’s nothing that a few more massages and yoga poses can’t help. Crossing my fingers for you!

  5. I struggle w/the piriformis stuff too. I actually hit your blog when I was looking for people who might have recurring issues w/piriformis syndrome + have the magical healing experience I have had on both sides (15 miler = magic cure; so confused!). Here’s my Runner’s World post that I literally just posted, if you are interested. I seriously don’t get it. I am getting better at maintaining/minimizing the issue (when I got it right sided, it took me 5-6 weeks to heal; this time, it took 2…). My fav stretch is the standing stretch, where you prop your leg up sideways on a waist high table/whatever, and bend over. I also do the cross legged stretch sitting, the nerve flossing thingy, and the pigeon pose, to name a few more. I roll my butt on a ball (tennis/baseball, depending on the issue), etc. You know the drill! It literally is such a PITA!

    • Isn’t it weird how the strangest things can bring relief…like, say, a long run? I think it has something to do with running long after actually taking care of the issue by foam rolling, icing, etc. You really do live and learn though; I have the same thing. I was benched for a solid month, whereas now I can minimize the pain within a couple of days. Yoga is my go-to!

      • I agree completely! I need to definitely incorporate more yoga into my week, though – there are so many poses that are helpful w/the piriformis issue!

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  8. Thanks, really useful advice. I have to get a roller and a tennis ball. Lying in bed now having tried lots of stretches for glutes and hips which i will keep doing every day but the burning pain needs rolled over by a roller or ball for sure
    I don’t exercise at the moment i just walk as i don’t have a car. I was spinning up until 4 months ago and have always had pain in hips but have only really started getting the pain deep in my glutes. It must be from sitting at a desk and not exercising. My hamstrings and feet are so tight even though I’m fairly flexible and have been stretching few times a week my hamstrings are super tight and reaching my toes is a killer.

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  10. I have had this pain for several years and it is a royal pain. In my case it was because of Guillian Barre and the weakness it left me. It has not been easy to live with but stretches and deep tissue massage has been very helpful. I can’t run yet but I am hoping to do so in the future. Thanks for sharing your great tips!

    • You’re very welcome! I still deal with it. Barre movements where I have to lift my leg/glute over and over tend to trigger it for me, but I just love the class to much.

  11. My running Buddy and spouse took a spill off the steps of our new home, treated lumber with morning due on a little algae might as well have been ice… anyway she seemed to heal from that classic warner brothers up in the air and land on butt fall. Then 4 weeks later, a spasm in the Psoas (we think) occurred and it evolved into acute middle glute pain. Tonight we researched due to 8 weeks having passed and only minor relief from pain killers, physical therapy (which is helping).. but still HIGH pain after standing and working as a Personal Training.. no lifting just standing. We found that blunt trauma CAN cause this BUTT PAIN known as Performis Syndrome.. we found your post.. a runner.. and my sweetie visibly relaxed knowing overcoming this can be done (though how long???) We will keep you posted. I have asked her to resurrect her own blog CARDIO-KNITTING and start talking about this… She has ran 7 have marathons, one marathon, and two 30ks all in her 40s, She’s 50 now and again your post has given her HOPE. Thank you!

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