Case Summary  |  Piriformis Syndrome

I am a long-distance runner logging between 40-60 miles of running per week in the context of training for half-marathons and full marathons. In the context of training for the San Diego Rock and Roll Marathon 3 years ago, I developed a worsening chronic pain/ache on my left side that raided from my buttocks, to outer hips to outer upper leg, and even skipping down past my knee joint to my calf and feet. The pain alternated between a constant deep ache (as if the bone hurt) to searing, burning pain as if my leg was on fire. Originally misdiagnosed as simple sciatica, the repetitive use injury was later correctly identified as piriformis syndrome, in which the piriformis muscle of the buttocks becomes chronically inflamed and in tetanus and can entrap the traversing sciatic nerve (and other nerves that course through it).

Diagnosis was made via a combination of physical examination, nerve conduction studies, MRi examination, and diagnosic injections of anesthetic performed under CT guidance. Ultimate treatment included systemic steroid administration and injection of a cocktail of steroid, anesthetic, and botox directly into the piriformis muscle, again under CT guidance. Pain lessened within 24-48 hr of surgery and remained at lower levels. Rest from running and maintenance therapy with non-steroidal anti-inflammatories was also prescribed, with return to activity preceded by physical therapy and a fair amount of massage, pool work, stretching, and strengthening exercises.