Desperate plea: what else to try for piriformis syndrome?

I know there are previous threads on piriformis syndrome, and I've read some of them, but I'd specifically like to hear from anyone who's suffered from it for a number of months but managed to recover from it (or at least keep it under reasonable control). 

I've had a problem with my piriformis for 4 months, and it gives me quite severe pain radiating down the back of my thigh and sometimes makes my leg feel 'dead'. I've had a lot of physio and massage, been doing the stretches every day, plus sitting on a hedgehog ball, and I recently added a daily strengthening exercise (a bit like the 'clam').  It is definitely better than it was, as I've progressed from being in total agony after even jogging100 metres, to managing 5 miles before the pain kicks in (provided I run at an easy pace).  I'm getting so frustrated with the slow improvement- does anyone have any tips?  For example, I do the stretches and exercises once a day, would doing them more often make any difference?

I get piriformis issues, more from walking - not so much from running (and using the elliptical / x-trainer machine). Running tends to loosen the piriformis up. Have you had *proper* gait analysis, at a university, by a biomechanics professor, not local 'specialist'? Excess pronation can cause PS. It could well be due to an anomaly in your gait. It could also be a muscle imbalance, e.g. strong flexors, but weak adductors.

edit - can you do straight-legged deadlifts or 'sumo' deadlifts? Start gently and build up. Also, how good is your core? 

Would one of you be kind enough to post a link to the 'clam' with a diagram?  I've Googled, but only find a stretch recommended by ballet dancers - is that the one? Thanks.

 (sorry to invade your thread, Vicki!)

I had problems with the piriformis and used to do these piriformis exercises 3 or more times a day, every day.  At the time, I was working from home, so able to do them as often as I could, so I just kept stretching.  I adapted them slightly so that I could feel the pull on the piriformis.

Clamshell glutes strengthener

I used this one (taken from bodycontrol Pilates), the trick is to lift the leg using the glutes and not the quads which is what most of us tend to do.  The advice given to me was to start with very small lifts, the emphasis being on getting right rather than massive lifts.

This isn't a brilliant film, but it's the only one that I could find that gives written instructions as well.  If you're good at it, you can add a band to make the glutes work harder!

I also did a programme of stretching other leg muscles so that they were all loosened in conjunction with each other.  I also had a series of massages where my fizz  really worked at that area - hurt afterwards, but it worked.

Sorry that you've got these problems, but hope it gets better, sounds as if it is, but just slowly. 

That's it, Is It Safe - the one that Jeepers links to above.

EDIT: Oh and the stretch on t'other link was also one given to me by my fizz.

What helped me the most was wearing Fitflops!  Don't ask me why but my pain disappeared 2 summers ago when I bought my first pair.  i didn't put 2 and 2 together until the summer was over and i was back in my usual boots.  I've now bought some Fitflop clogs for the winter to keep the pain at bay!  (but I have no idea if they work as a "gym" on your @rse as they claim!)

Actually, funny you should say that minardi as I found exactly the same thing and was wondering about posting that, as I did on another thread on the same topic.

I regularly wear orthotics in all shoes (over pronation) but found them excrutiating with the piriformis pain.  I'd ordered a pair of fitflops as I was advised that they were OK for over pronation and found that within weeks, the pain had gone.

Hi everyone

Thanks so much for your replies.     It looks like I should be trying a lot more reps of the clam for starters! Fitflops sound worth trying, although I wouldn't get away with wearing them for work.

Just before the piriformis problem started, I had a full gait analysis by a biomechanics bloke. I do over pronate, but it's much more pronounced on one side than the other, and my hips are slightly out of alignment so one leg is hyper-flexed and the other is slightly bent when i stand.  I have some custom-made orthotics but I didn't get them til after my piriformis started playing up.  They have certainly helped with the pain I got in the arch of the foot that over pronates most, so in the long run might help with piriformis issues.

For what it's worth, I have been told by Ceri Diss that, ideally, I should be analysed prior to recurrence, and post recurrence of a long term injury. I'm planning to get analysed by her in a few weeks time (when I'm back on my feet after effing swine flu - aaargh!). She's said not to do anything mad, training-wise, prior to analysis, so I'm tip-top. She'll then report on her initial findings. If the injury recurs, she then wants me back in pronto to analyse the injured gait. For what it's worth...

Do you do much strength training, Vicky? Lunges, squats etc?

Thanks for the clam link - t'will be integrated into my schedule :- )

Tsk! Straight-legged squats are the king of back strengthening exercises. However, some people just find them painful, so opt for sumo squats instead. If your piriformis issue is really bugging you, you owe it to yourself to have a couple of sessions of back-strengthening routines a week. There are all kinds of things you can do. 

edit - oh yeah, also do some glute stretches (inc. Jeepers' useful link). I was told to do the 'angry cat' stretch for my piriformis. It involves arching your back inwards and outwards. 

http://www.youtube.com/watch?v=WKs2KIzvbAo

Make sure to look at Lana's channel btw - she's a star. 

Here's my question for you guys, I do running to stretch out the piriformis muscle but it's really being quite hard on my knees.  Do you think an elliptical will give me the same helpful loosening/stretching effect?  I'm trying to research before I buy one, and I'm hoping you guys can help =)

@ Miss Neko

Training on an eliptical or stepper takes the impact out of the exercise - so could help with your knees.  It won't have exactly the same effects on piriformis.  When you take a step and your foot makes ground contact and pronates (you're supposed to have controlled pronation - natures way of cushioning impact), your leg will turn in slightly - making the pirformis muscle automatically fire up and stretch at the same time (eccentric contraction).

Interestingly that maybe why some of the people above stopped having pirformis issues when they stopped wearing orthotics or (probably) high arched or high heeled shoes - feet will have to pronate and supinate harder when walking, which in turn may work the hip muscles more. 

In answer to your question!   When working out on any machine you will have muscle activation and toning effect but without the 'impact' it may not be so profound as running. 

Thank you very much!