Stubborn case of

Question
QUESTION: Hi Nick,

 I have a righteous case of the "dreaded runner's butt" (piriformis syndrome) that WILL NOT GO AWAY. I have tried everything.... piriformis stretching,  foam roller, massage... in addition to butt pain, I also have pain in the hip flexor and right where the piri inserts on the trochanter.

The stretches and foam roller relieve the pain for about a day, but it comes back. My doctor says stay off it for a week (but then immediately acknowledges he knows that ain't gonna happen). Would accupuncture help? Exercising in the pool?

Oh... a little about me... 65, female, former personal trainer (NASM).

Thanks in advance for your help. I'm at wit's end.

C McM

ANSWER: Colleen, thanks for reaching out to me. I find this issue fun to work with. (Obviously not fun to have!) Go see a doctor of physical therapy. I have great success with these patients that seem to be like you, however, it is difficult to do in writing.

A little education on DRB.
- It is often mis-diagnosed. Physicians often say to anyone that has pain in their butt (not that is a "pain in the butt") that they have piriformis syndrome or sciatica. They then try stretching and foam rollers to no avail.
- You very well could fall into an extension or flexion directional preference Treatment Based Classification. (A PT can figure this out.)
- You may benefit from specific hip strengthening exercises (clamshells, bridges).
- You may also benefit from dry-needling (western acupuncture).
- You should be able to feel better quickly with proper treatment. My goal is to have patients leave with less pain than they come in with.

Good luck and if you need more direction or help to find proper treatment then don't hesitate to write back!

Again, this is treatable. Don't stop working at it until you find the right person and treatment to help it.

---------- FOLLOW-UP ----------

QUESTION: Nick,

Thanks for the info. No, it really is piriformis syndrome. My doctor (who has a sub specialty in sports med) actually performed the standard resistance/ ROM tests. Imagine that.

I already do bridges (single leg as well as standard, plus some w/heels on swiss ball)., so I'll give clamshells and other glute strengthening exercises a try. And acupuncture.  I can live without running, but it's beginning to interfere with my weight training (lower body).

Answer
I'm glad to see you're still exercising as well as running. I should have expected this since you're a personal trainer. (BTW, I really like Dr. Michael Clark's NASM CPT. He is a physical therapist so it biases me towards that one. I have NSCA's CPT though.)

I definitely still  recommend searching for a physical therapist in the area that has OCS and/or SCS as a part of their credentials.

This is treatable. Don't give up!

Don't hesitate to follow-up with another question.