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Piriformis syndrome...please tell me your magic fix!

So heres me, early 40s trundling away, putting in bigger mileages than ever, getting pbs here there and everywhere. Big MTB rides/races, CX rides, best ever 50, 100 mile times on the road etc etc
I'll treat myself to a new bike I decide, maybe not a bad decision but certainly a painful one as it turns out...
I transferred the measurements as best as I could from my old Giant to my new bike - An Ultegra spec Merida Scultura.
First ride...hmmmm this isnt as comfy as I hoped, fast as f*ck, but not comfy. I'll try a new saddle I reckoned - Fizizk Arione, lovely saddle by the way.
Persevered but by persevere I mean keep banging the miles in while trying to ignore the pain. Tight inner right thigh, elastic band wound up tight tight...kept going, hmmm sore lower back after about an hour-ish, sore hip now too....kept going...
So after a few months of not very enjoyable rides and pain I went to see a local physio, who is great to be fair, piriformis syndrome... Which if you dont know what it is, it hurts...a lot at times. And supposedly very common among roadies and distance runners.
I've a load of stretches etc to do, changes to lifestyle - dont sit about too much, split long drives up, but its looking like a few months off the bike, I can still MTB as it doesnt hurt anything like so much on that as you move around so much more. The annoying thing is that I now get pain on the old Giant and the CX too which I never did before
What I'm looking for ideally is some magic way of fixing this and tales from you of how you did this and you were sorted after 10 minutes..no stories of woe please, I'm bad enough as it is...
Once I am sorted ( I will get sorted, please don't sow any seeds of doubt  11 ) I think I need to look at fit on the Scultura, which is an amazing bike. I know I tried to transfer the settings across but I now realise that the odd mm here and there makes a huge difference to angles etc. To be honest I did realise this then too, i just wanted to play on my new bike!
I know Retul and the like are supposed to be great but I just dont have £200 to throw at something like that and I'm not covinced its not something you cant do yourself with a bit of time and thought.
I think a lifetime of just jumping on new bikes with no issues and paying lipservice to stretching has finally caught up with me.
Joking aside though this is really doing my nut in, it will pretty much write off any hopes of racing I had for 2015. I'm a pretty grumpy chap at the best of times and this isn't helping so any advice or even just happy tales would be much appreciated.

If you're new please join in and if you have questions pop them below and the forum regulars will answer as best we can.

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heathcliff | 8 years ago
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I've been suffering with sore piriformis and hip flexors for over a year and originally got a bike fit in it's early stages  (Specialized BG Fit) which made no difference at all . There wasn't anything in the Bikefit that was at all revelatory . With a bit of research online and common sense saddle height, reach, drop  and cleat postition will comeout pretty similar .

I then spent many months trying to ride through the pain ultimately making it worse .  I would imagine the way forward would be to see a proper cycling physio who incoporates fitting, there are a few around as opposed to the High Street bike fitters .

Modern lifestyle sees many of us seated for much of the day shortening our flexors and weakening our core, glutes and hamstrings . 

Time off the bike, drastically reduced mileage, massage and lots of core work and stretching seem to be the way forward .

 

Good luck !  .

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slowclimb | 9 years ago
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Been for my Retul fit, mightily impressive. Picked up all my issues too and showed that I am basically a lop sided freak  4
I would heartily recommend it to anyone.
However... I now need a new stem, bars and a seatpost  2
The bars and stem are easy enough but I need a decent inline seatpost and I am struggling to find a decent one. The only one I can see is the Thomson one, I already have one on my old Giant and they are great. However my new bike is carbon and I want to keep it all carbon. Does anybody know of any decent inline carbon posts that wont bankrupt me?
Other thing that was good at the fit was the guy who I went to doesnt sell anything which makes it much more believable that I do need the bars, stem and post!

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Colin Peyresourde | 9 years ago
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Seriously check out the MWOD stuff. It's all free on youtube, and gives a great range of superb stretches. He has a book, how to become a supple Leopard.

Fundamentally we should all take efforts to do 'body maintenance' especially if you're spending long hours sitting down.

Testing your flexibility (or having someone assess it for you) is a great idea. We should all be able to undertake a basic range of movements through all of our joints, and if you cannot, it is likely that sooner or later you will ask a muscle or joint (or worse, your back) to compensate for the lazy/tight muscles. Just thing of your body as an extension of your drive train (because it is). You wouldn't allow your cassette and chain to wear out to destruction. Don't let the same be of your body - stretching is kind of like flossing/degreasing/regreasing the moving parts of your body.

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slowclimb | 9 years ago
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Yeah I think you're right. Cheers though it is weirdly reassuring to know that this is pretty common, especially as we all get.......er, more mature  39

Wee update though - I've booked a Retul fit for next week, I'll report back!

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slowclimb | 9 years ago
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Mudfish - cheers for all that, I'll look into it. Unfortunately I'm a long, long way from Brighton!
Crikey - I'll give that a go, but being Scottish I'll add in a recovery meal of deep fried mars bar and can of Irn Bru  21

Just been looking at new saddles in a shop in town, pretty impressed by the Pro ones (Shimano) anybody any experience of them?

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mudfish replied to slowclimb | 9 years ago
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Hey slow, I hope it helps. You dont want to get as bad as I did.
there are CST therapists all over The UK. Look at upledger for a list if you fancy it. TBH I think flexibility (and strength) is at the core of our problems. Weak glutes, weak adductors and tight psoas.
http://www.upledger.co.uk/therapists-scotland--n.i..html

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crikey | 9 years ago
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I do Northern yoga.
In a vest, with my pants tucked into my socks. I use a bit of old carpet instead of a yoga mat. We don't chant, we swear quietly under our breath and you're allowed to smoke your pipe during the relaxation session.
Try it, it'll make you bendier.

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mudfish | 9 years ago
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I had debilitating sciatica which eventually turned out to be piriformis syndrome. At first I couldn't move, then searing pain for a year, tough to drive, losing sleep, Beachy Head was looking tempting. Seriously. I thought the bikes were going on ebay.
Upledger Cranio Sacral therapy was the magic bullet. Not to be confused with anything else including the word "cranial". It took 11 months for my very experienced sports massage therapist friend (sadly she lives 500 miles away) to persuade me to try it as I am such a sceptic. First session really helped, I had treatment every 14 days for 6 sessions, then monthly for a while. Now, maybe every 8-10 weeks as maintenance, its magical. And it cost me for sure.
Hard massage like balls etc. On the glute didn't help, in fact a strong glute massage can irritate me (my piriformis, I'm told) and bring the sciatica back full on.
Pilates (Stott studio, not mat) helps keep it at bay for sure but wasn't curing it after 10 months. Nir was massage, stretching, local self massage with balls etc.
Keep the hip flexors (psoas) stretched, this is vital, cycling makes them tight and they connect to the spine near a lot of nerves. Thats no 1 for maintenance for me, learn some piriformis stretches, also vital. Near Brighton? I'll show you some (flatpedalthunder (at) gmail.com). Foam rolling is a must but careful on the glute as you can hit the sciatic nerve with roller or tennis balls etc.
My 2C, I think better flexibility will mean you're not so sensitive to bike fit.
Hope it helps.

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slowclimb | 9 years ago
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I have been getting a fair bit of buttock and upper hamstring pain too peterben ( all on the one side though)
I'll have a look at those lumbar extensions and sttetches.
I'm Scottish crikey, I don't think we're allowed to do yoga  1
I can drink more beer though  21

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crikey | 9 years ago
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Do some yoga and drink a lot more beer.

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Colin Peyresourde | 9 years ago
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http://youtu.be/Xcx9P5KFNk8

He has some other exercises too. You'd do well just to get into regular stretches and the MWOD YouTube videos have a lot of good stuff. He's a trained physio.

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peterben | 9 years ago
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Sounds more like an imbalance and compensation between adductors and Quadratus Lumborum. You don't mention any buttock or hamstring discomfort which generally signifies Piriformis syndrome. Also although you have been reasonably careful in measurements from one bike to another you still have to account for different bike shapes, an MTB is not a cyclocross is not a fast road bike.
Lumbar extensions to counteract the flexed riding position.

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slowclimb | 9 years ago
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Skew-wiff! Like I am squint! Thats exactly what I feel like too!  2

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mariekb1980 | 9 years ago
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im the same, my physio has said if there is no improvement soon (and im being dedicated with the excercises) then she is reffering me up for further investigation....

...I did some long rides last week and everything seemed fine, apart from, I was saddle sore (im a girl, work it out) only on the side where my hip/groin problem is, like there is more pressure on one side, like im skew-wiff or something!

and when I say sore, i mean, hyper sore.....  2

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slowclimb | 9 years ago
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Yeah think you're right Jimmy, its time for a new approach, I'm just not sure what!

I have had the groin pain before in the past when I TTed a lot. It just went away eventually without me really doing anything then, I am a few years older now though!  1

I think the Arione is the wrong saddle probably, its just too narrow. I'm not convinced the Fizik method going on flexibility only really works.

I did think about a Retul fit but they are quite lot of money and until I get on top of the injury I'm not convinced it would work properly anyway as it goes on range of travel etc, and I think mine would be compromised.

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Jimmy Ray Will | 9 years ago
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Me again... have you identified why the groin muscle/tendon is so tight?

I am sure it will be the key to your back problems, but what is causing the tight groin?

Will stretching the problem really solve the problem without understanding what is causing the problem?

You will have an alignment issue somewhere, maybe muscular, maybe skeletal, but at a given point you will need to think about stepping up the level of treatment.

You have been seeing your physio for a while now, and it does not sound as though he/she has really cracked it... for me, I'd suggest it was time to start looking down a different route of treatment.

As an aside... I have stopped all stretching, instead focus on range of movement and core strength exercises. Muscles don't tend to tighten up if they are not looking after an existing problem IME.

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aslongasicycle | 9 years ago
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I have a shed load of back problems and my piriformis tightening is a sign of worse to come, so I back off.
I stretch. I do core work. I do weights. Use a roller and ball. I swim. I have a non-aggressive position. I have Fizik Aliantes on all my bikes.
And life is better than it was. And I ride more.
Don't take it lightly!

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slowclimb | 9 years ago
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An update for you all...
Seem to be getting the piriformis pain sorted, its sore the last few days but thats because I had to drive 800 miles in a couple of days last week I think. I know what causes it and what to expect at least now, and how to manage it.

However..... we (me and the physio) now think it has all been caused by an unbelievably tight right groin muscle/tendon, it really is like an elastic band waiting to pop. Before the pain from the piriformis was pretty much all consuming but I think this is the root cause. A mate had similar issues and he said the phyio used her thumbs to help release it which was excruciating! I am now trying to spend as little time at the physio as I can too as it really, really adds up!
I know that this is pretty difficult to stretch properly as its so narrow its easy to cause more damage by stretching too.
I've tried foam rollering it but its actually pretty tricky there.
Do any of you have any experience of an injury there, and what did you do to remedy it?  7

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slowclimb | 9 years ago
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Yeah the saddle one is funny one, my concern is I was getting pain on the saddle that came with the bike - a Prologo Kappa Evo so I think although the Arione maybe isnt the right saddle the issue might be tad more deep more seated (no pun intended  1 )
I think once I get the pain itself sorted I reckon a bike fit is in order.
I'm at the physio again tomorrow, I'll keep you posted!
Thanks again too you all for the input, it really has been a help.

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Jimmy Ray Will | 9 years ago
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Last shout for the ALiante... the Charge Spoon is built on the same chassis shape as the Aliante, just using plastic resin rather than any fancy carbon stuff.

Good luck with getting it sorted.

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notfastenough | 9 years ago
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I feel more comfortable in jeans on an Aliante than in good quality bibshorts on an Arione. The latter is horrific for me.

Re the Charge Spoon, you can customise to get the right look:
http://custom.chargebikes.com
That said, a saddle that is great on the MTB may not be so on a road bike, as you lean forward more and (ideally) rotate the pelvis more.

I paid £110 for my bike fitting from a guy at manchester velodrome if that's accessible to you.

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slowclimb | 9 years ago
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Thanks again, with the saddle the real nippiness started as soon as I moved to the new bike so I reckon a bike fit may well be the way. I do reckon the arione maybe isn't the right choice anyway.
As I said too - I've spent much more than even a top end bike fit getting physio, add in the mental torture of a few months off the bike and it's not good!
Davey - ironically I've used charge spoons on the mtb for a few years and always got on great......they're just not bling enough to put on my shiny new carbon bike  1
It is interesting like a couple of you have said to look back through to what I think caused it. Thinking about it it all really started when I started to fiddle with my seat height for tt-ing about 3 years ago! I should just have left alone  2

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Daveyraveygravey replied to slowclimb | 9 years ago
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slowclimb wrote:

Thanks again, with the saddle the real nippiness started as soon as I moved to the new bike so I reckon a bike fit may well be the way. I do reckon the arione maybe isn't the right choice anyway.
As I said too - I've spent much more than even a top end bike fit getting physio, add in the mental torture of a few months off the bike and it's not good!
Davey - ironically I've used charge spoons on the mtb for a few years and always got on great......they're just not bling enough to put on my shiny new carbon bike  1
It is interesting like a couple of you have said to look back through to what I think caused it. Thinking about it it all really started when I started to fiddle with my seat height for tt-ing about 3 years ago! I should just have left alone  2

Not bling enough?! I know what you mean though. The two demo Fizik saddles were fluoro pink so you wouldn't just not take them back to the shop, so the Spoon looked "normal" and right as soon as I put it on. My next bike will be bling too, but I'm torn between something Arione-like in looks but it has to be more comfy...

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Daveyraveygravey | 9 years ago
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Would also recommend a bike fit, had the Spexialisedyone at £120 (plus 110 on shoes and 70 on bars etc..) It isn't cheap but all the things that used to make me want to,stop riding are gone. As someone else said it is a lot of money in one go but over a lifetime on the bike it's peanuts.
Also tried both those Fizik saddles as part of the fit, the Arione was agony but I stuck with it for 10 days and about 200 miles because the expert recommended it. The Aliante was much better but had a Charge Spoon at home and that for me is better than either Fizik. If I could I would try some more, saddles are very very personal and what you and I might find torture others might find perfect.

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Daveyraveygravey | 9 years ago
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Would also recommend a bike fit, had the Spexialisedyone at £120 (plus 110 on shoes and 70 on bars etc..) It isn't cheap but all the things that used to make me want to,stop riding are gone. As someone else said it is a lot of money in one go but over a lifetime on the bike it's peanuts.
Also tried both those Fizik saddles as part of the fit, the Arione was agony but I stuck with it for 10 days and about 200 miles because the expert recommended it. The Aliante was much better but had a Charge Spoon at home and that for me is better than either Fizik. If I could I would try some more, saddles are very very personal and what you and I might find torture others might find perfect.

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Swami Dave | 9 years ago
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Get fitted - I'm in the process of recovering from my second discectomy due to poor fit and riding through it. It's not been fun.

A point on the Fizik saddles: the widths are all much the same (143 or 146 from memory) it's just the shapes that are different. Spesh and Selle Italia offer measuring services which will give you a correct width and are worth looking at.

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slowclimb | 9 years ago
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Thanks chaps, I think you have all made some very valid points. I think the thing about being a chain of events really, like a lot of us I'm sure have always been pretty poor at stretching and ignoring niggles. I think its all just caught up with me. I've had ridiculously tight IT bands for going on for 10 years, inner thighs probably started to tighten up around a year ago and I think the new bike has just created the perfect storm  2
As far as the saddle goes I did the Specialized sit bone mat thing a few years ago and got the 143mm Toupe which I always got on great with, I did even move that onto the new bike after a few rides but I think the damage was done by then. the Antares seems to be the Fizik around that width - 142mm.
Looks like a bargain Arione going on eBay soon...
You don't realise how much time you spend either thinking about bikes, how/when to get out, what kit to buy etc etc until you cant!
I will get this thing sorted though!
The moral of this story though is - don't ignore niggles and if you're under 40 start stretching....now!  4

Now..... does anybody have bombproof formula for seat height that takes into account femur and tibia/fibula length and crank size?...

Jimmy - you're right about private physio, the guy I see is great and has an amazing CV but the cost does add up. Ironically I have already spent way more than the cost of even a retul bike fit on physio!
And I have just done an IT band foam roller thing on a borrowed roller from the physio....  20

Poptart242 - I looked up and tried that floss the nerve stretch, that really does seem to be an effective and pretty easy to do stretch, think I'll keep at that, ta for that.

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mariekb1980 | 9 years ago
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I can 100% sympathise with you, ive been suffering with it since august, its stopped me riding, running, circuit training and generally keeping on top of myself.

I think im getting somewhere then im back to square one, im seeing a physio on the nhs now after I ran out of cash going private and shes great and has given me stuff to relieve the symptoms, but also by addressing the problem.

Mine is down to weak hip flexors, so ive got a rigourous routine of foam rolling my IT band, (when that’s tight, it pulls on everything in my butt) trigger point therapy with a hard rubber dog on my butt and a whole heap of strengthening and stretching excercises for my core and hip and hamstrings. Looking back a year from now, I stopped doing hip adductor and abductor excercises in my core routine then started to suffer with my hamstring, and then it spiralled form there.

Its making a difference, just this week I can sit at my desk without that dull toothache in my butt, can walk without limping and ride.

Foam roller on your IT band, do it now!

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Eebijeebi | 9 years ago
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As a long term sufferer, thigh muscle, hip and lower back doesn't seem right for Piriformis Syndrome to me (not problem on a bike btw). I'd look more towards the bike fit etc which would be good news.
have you actually been measured for saddle with the cushion thingy?

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notfastenough | 9 years ago
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Flexibility (as per the Fizik test thingy) is only part of the issue with the saddle - your sit-bones should be the part of your anatomy bearing the weight on the saddle, and as such Fizik offer three widths; Arione, Antares and Aliante (in order of width, starting with the narrowest). I don't know if this would exacerbate your problem, but I wouldn't be surprised your pelvis was dropping more on one side due to a narrow saddle and associated lack of support.

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