Hip stretches - recover from piriformis syndrome and hard gluteal muscles

Question

Situation

Due to a one sided sport I intensely practiced for a good portion of my teenage years(rowing in a team with only one oar per person), I have ever since experienced an awkward tight feeling in my hip when I stand up in the morning. After intense exercises I regularly feel a burn radiating down my leg on the outside of my thighs. I extreme cases and when it's very cold, I have a tingling sensation in my toes that makes me want to kick and stomp everything - the pain is really not a big deal, it is just so annoying!

My very competent sports doctor diagnosed a piriformis syndrome. The radiating pain is caused by the muscle pressing on the Sciatic nerve. Unfortunately for me in addition to that, my entire gluteus is also extremely cramped up. My physiotherapist suggested puncturing the muscles with a needle that will causes the muscle to twitch and eventually relax. In my case the needles just bent.. this gives you and idea of how severely these muscles are cramped. The therapist said it is very unusual for these needles to bend, as they are quite thick.

I searched all over the place for ways to help my muscles relax: massages, needle therapy, ultra wave therapy, stretches, no running, more running, more bicycle,

Eventually I decided to take to extreme measures: at the local gym I used a machine to train external hip rotation with weights. I tried less weight and many reps until muscle failure/exhaustion, and I tried big weights with less reps, both slow and fast. I did this together with stretches and massages over 6 months now. It has become slightly better, but gluteus is still severely cramped, and in the meantime I have peaked on the weights (machine cannot do more than 110kg). I forgot to mention that I have no complaints whatsoever during activity, even under maximum loads.

My questions:

1. There is the possibility of injecting cortisone directly into the affected muscles, which makes them lazy as a couple of drunk cats. Increasing load slowly after the treatment, I should be able to rehabilitate the muscles. Does anyone have experience with this cortisone injection (or similar)? I have quite an uneasy feeling about it, not sure why.
2. Does anyone have alternative methods, procedures, exercises that could help me?

Thanks for taking your time and reading this, it means a lot to me.

Answer 1

One of the problems with competitive or repetitive sports on the growing body is that they can cause the body to grow with asymmetries. Young athletes who do not have knowledgeable enough trainers are likely to develop problems over time with muscles, fascia and joints as uneven strains are created. Now you are left with figuring out how to correct the problems and asymmetries.

Since you appear to have good medical care and are hesitant about getting a shot, you may want to check with your therapist about some of the suggestions below that worked for me. My asymmetrical sport growing up was tennis. Everyone is different, but here is my experience:

1. The cortisone shot worked for about 24 hours and then the pain/discomfort started to migrate and spread, becoming more annoying than my regular pain that I was used to having.

2. Physical therapy - My therapist explained that my SI joint was involved and that is why my muscles continued to overwork, trying to stabilize my pelvis. She gave me specific corrective/stretching/strengthening exercises, explained what to avoid, and did myofascial release work mostly following Tom Myers' Anatomy Trains work that addresses continuous areas of fascia (head to toe) rather than individual muscles. (When muscles contract they pull on the connecting fascia. A tight shoulder for example, may result in the opposite hip having a restriction via the fascia.) She also included tape, PRRT to relax the reflex, electrical stim to fatigue and relax the muscles, ultrasound to improve the circulation and mobilized some joint restrictions.

   My exercises - One exercise where you stand in the doorway with your foot on the door jam and isometrically contract your glutes began to ease the pain that I had for eons almost immediately (but not permanently at that point). I was amazed and paid attention to all the exercises she gave me to do as a home program. I wouldn't recommend trying them without your therapist's advice as they may not be right for you, but some of them were Don Tigny's SIJ exercises.

   I also did my own myofascial work with tennis balls and foam rollers to work on the glutes, piriformis and ITB between treatments. And I did the regular hip/glute stretches using PNF contract relax to stretch and release tightness.

Hopefully some of this info will help and you will find the right combination of stretching and strengthening exercises to balance out your pelvis and muscle tone. Good luck.