That pain in your butt and leg may be piriformis syndrome

In Provence, France, I smiled for the camera but I was in intense pain

I was on a plane trip to France in 2001 when it first happened – sitting there in coach, halfway over the United States, I felt pain and numbness of my entire right leg, from ankle to mid-butt. By the time we landed in Nice, I was almost in tears. Our weeklong vacation was marred by the constant, irritating pain I felt – it kept me up at night, and I couldn’t enjoy our sightseeing. I dreaded riding in the little European car we had rented.  The return flight to Phoenix was no better, even with a change of planes in New York City, and it took me several days to recover from the pain.

Flash forward a few years – while working full-time in 2006 for a client here in Arizona, the pain returned. My right leg felt so numb that I kept turning to look at it closely in the mirror at home, expecting to see blue, purple or even green veins from the sensation that there was no circulation in the entire leg.  But the leg looked normal.  I could not find a comfortable position to sit or lie down. The pain increased over the next few months but I continued to endure it, not sure what was happening.

The diagnosis

Finally, the Monday after Thanksgiving in 2007, I returned to work after a week’s break and, only two hours into the work morning, felt such intense teeth-biting level of pain in my right leg that I had no choice but to leave work. Completely frustrated, I finally scheduled an appointment with my doctor. He ran the usual MRI tests to see if there were any herniated discs, but my spine came back “perfect.”   Nerve tests also revealed no nerve damage.   After listening to my symptoms — numbness down the entire right leg, a burning hot core of pain in my right butt, and unrelenting intensity, he concluded after some thought that it must be piriformis syndrome.

The piriformis muscle tightens around the sciatic nerve, causing intense pain

If you work in a profession that requires a lot of sitting time, such as high-tech, call centers, or even truck driving, you might someday find yourself in the same situation. There is a muscle in your glutes called the piriformis. In a certain percentage of the population, the sciatic nerve runs through the piriformis muscle instead of around it.  If the piriformis is compressed continually over time, typically from a seated position, it can end up in such a clenched state around your sciatic nerve that you get to the point of no return — the nerve pain is sudden and intense.  Getting that muscle to release is impossible, as I found out the hard way.

How do you avoid this problem? Simply, don’t let your business passion overtake your common sense. For my entire career, I have sat at a computer, usually so engrossed that I failed to get up and walk around and take breaks. This characteristic became my downfall when I launched my own business in 2001. It meant I no longer had corporate meetings to break up that day, and I could sit happily at my desk typing 8 or more hours daily. When I temporarily left my business to work full-time for a client here in Arizona, I was also sitting eight hours a day, working on public relations and competitive analysis — all extremely computer-intensive.   Think of cement trucks – the barrels are always moving so the cement doesn’t harden.   You need to keep moving. 

 I’ve had other friends complain of the same numb leg symptoms when they have sat on long international flights. Still others who like to run long distances experience similar symptoms. In fact, I found a forum online full of people with the same issues, most of whom have had piriformis syndrome for years. We are all confounded by this malady and searching for the magic bullet.

The last 26 months have poised an interesting dilemma for me. I had to leave the client and take time off to recuperate.   I had to deal with the knowledge that I no longer could work full-time in an office situation and continue my career down that path. I had to deal with the strange embarrassment of carrying a pillow with me wherever I went. The first year, I was not even able to drive and had to lie down in the back of my husband’s truck while he drove me everywhere.  The only funny thing was when I would pop up to talk when he was stopped at a light , much like a corpse popping up out of a casket. It always startled the drivers next to us.

I tried everything

All this because I was too committed to my work.   The best selling authors and speakers all talk about having passion for your work; I doubt any of them mention the dark side of too much computer time.   I had many people offering suggestions, all well meaning friends who confused the problem with spine-related sciatica, a different animal entirely and much easier to diagnose and treat. For the last two years, I have tried all of the following with no luck:

• steroid/cortisone shots
• acupuncture
• physical therapy
• heat therapy
• ice therapy
• electronic stimulation of the muscle
• piriformis “stretches” (lie on your back with your legs in the number 4 position)
• Vitamins E, D, B1, B12, C
• meditation tapes
• magnetic patches
• yoga
• chiropractor
• massage
• lidocaine patches
• personal trainer to build up adductor and abductor muscles
• Cymbalta (often given to diabetic patients for nerve pain)
• Trameel
• muscle relaxants

How I treated it

I tried all of these remedies, with no improvement. So, I did the only thing I could do – I stood.   For hours.   I watched movies at home standing up. I practiced cooking recipes because I could do that standing.  To pass the time, I bought a Dymo labeler and labeled everything in the house that didn’t move.  I typed standing up. I met friends for dinner at bars, so I could stand at a bar table while they sat on a high stool next to me.  Try standing for an entire meal at a restaurant  — I had many people offer me chairs, not realizing that a chair was the last thing I wanted. I stopped going to movie theaters, no long car trips, no conferences.  When I absolutely have to fly, I always take Southwest and spend most of each flight helping the attendants hand out snacks and collecting trash to avoid sitting.  In summer 2008 when I had to fly east, I was in so much pain that I flew in three segments over several days, staying with friends along the way:  Phoenix to Omaha, Omaha to Chicago, Chicago to Providence.  

When I have a long sitting situation coming up, I now take two pillows and a couple of Lyrica pills.   I still end up paying for it with pain for several days after, but it’s the only way I can get through unavoidable situations that require me to sit. 

My trusty "tuffets" - 2 Wal-Mart pillows

After two years of standing and giving my piriformis as much freedom as possible, I’m happy to say that if I’m extremely careful, I can maintain an almost normal life. I still take my pillows with me everywhere, and they are definitely well traveled.   One unexpected result of all this standing — I went from a size 8 to a size 4.

Check out these resources on piriformis syndrome

If you’re having pain in your legs and you are in an occupation that requires you to sit quite a bit, whether on plane flights or in an office environment, here are a few resources to check out.   The best time to take care of the symptoms is before or as soon as they start — if you let it go too long, you might end up like me, buying pillows at Wal-Mart.  

http://en.wikipedia.org/wiki/Piriformis_syndrome - Wikipedia definition

http://www.youtube.com/watch?v=DuxclPpwTLQ - YouTube video by Dr. Aaron Filler in L.A., explaining the difference between spine-based sciatica and piriformis syndrome

http://www.runningforums.com/Piriformis_release_surgery__anyone___-t19559-0-asc-0.html - Started in May 2004, this particular section of runningforums is where people with piriformis syndrome share their challenges, pain, surgery results, and other solutions

Graphic can be found at www.return2fitness.co.uk