Piriformis - Help!

[Philip Barrett]

My riding is being seriously compromised by Piriformis syndrome. I'm with a sports doc and in PT for this so don't need advice on treatment, more so, any shared experience specific to cycling.

Pressure on the Periformis area causes both localized pain and pain in my calf. Running does not exasperate the problem, in fact it seems to help! Cycling however is difficult & will leave lingering pain long after the ride. I've readjusted fit & seat height, my saddles are all Brooks B-17s and I stay focused on a spin rather than big pressure but nothing seems to help. Basically a bike ride sets any recovery process backwards.

I'm actually suspecting the seat, albeit it seems to support correctly perhaps there's just enough pressure in the wrong place to cause issues? Anyone's experiences around this would be very much appreciated as I've had to cut my riding time down exponentially and I find that (literally) depressing.

[Richard Rose]

Wow! I’ve not heard of this before. But, having had surgery for stenosis & resulting severe, debilitating sciatica I can sympathize. Surgery BTW was successful & miraculous. Reading now about piriformis prevention. FWIW, my very upright position on my Clem with B67 has been transformational. But that is a lot of pressure on the butt, so this has my attention!

Best wishes.

Sent from my iPhone

On Aug 5, 2022, at 10:02 AM, Philip Barrett <philipr...@gmail.com> wrote:



My riding is being seriously compromised by Piriformis syndrome. I'm with a sports doc and in PT for this so don't need advice on treatment, more so, any shared experience specific to cycling.

Pressure on the Periformis area causes both localized pain and pain in my calf. Running does not exasperate the problem, in fact it seems to help! Cycling however is difficult & will leave lingering pain long after the ride. I've readjusted fit & seat height, my saddles are all Brooks B-17s and I stay focused on a spin rather than big pressure but nothing seems to help. Basically a bike ride sets any recovery process backwards.

I'm actually suspecting the seat, albeit it seems to support correctly perhaps there's just enough pressure in the wrong place to cause issues? Anyone's experiences around this would be very much appreciated as I've had to cut my riding time down exponentially and I find that (literally) depressing.

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[George Schick]

Interestingly, I have either B-17's or a Flyer on all but one of my bikes and I ride them without issue.  The 4th one, however, has a Team Pro, probably the narrowest of the Brooks saddles and whenever I ride that one I begin to develop similar problems, probably piriformis or related.  Similarly, in the past when I switched one of the B-17's out for a B-17 Narrow I rode it for a couple hundred miles and just could not get past the same kind of discomfort as with the Team Pro.  So, there may indeed be something to this saddle type, width, etc. issue.

[Philip Barrett]

Thanks all, I was wondering about trying a B-67 but it's a major investment if I'm wrong! I guess I could do Amazon & return though.

[Wesley]

Sorry to hear it, Philip! Nagging physical issues are miserable. How many bikes do you own, and is there variation in your experience between bikes, or if you adjust your seat or handlebar height?

-W

[Philip Barrett]

Thanks & great question.

In an attempt to isolate this I've been staying on the Platypus only, it seems (maybe) that the Kona ULTD doesn't cause as much issue which makes no sense as it's a more forward/pressure on that area riding position so in the name of eliminating variables...

I've redone the PBH measurements just to check & elevated the seat slightly as stretching the Piriformis area is advised rather than "crushing" it with too short a stroke which makes sense.

[Richard Rose]

They are often on e bay. Got mine like new for $75.00!

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On Aug 5, 2022, at 12:42 PM, Philip Barrett <philipr...@gmail.com> wrote:



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[aeroperf]

As one also with stenosis (and L2 - L4 fused), I found that bending over just a little bit was better than upright walking.  So…biking!  But I tried 6 saddles on my Sam, and all of them hurt various places on my butt after a while.  Finally I got a Brooks B-17 carved.  After break-in and rolling down the edges of the carving with a light rasp, this saddle has been phenomenally comfortable.

On the other hand, I tried all 7 saddles on my road bike, and the Selle Anatomica Titanico X came out the clear winner, beating the Brooks by miles for long-term comfort.  Of course, that had to do with rider position.

What it taught me was that there ARE differences in seats, and you have to try a few to find out what is best for you on a specific bike.  If the B-17 isn’t cutting it on that bike, I’d recommend trying the B-67.  It is wider, at least.

Another recommendation:  My LBS has a box full of saddles, and is willing to loan them out.  Want to try a Serfas RX-921V?  Here, give it back in a week.  So get friendly with your LBS.  

One thing that I could wish for…
There are mechanical “bikes” out there, being used for fitting, that change the seat height, seat setback from BB, handlebar height and “set fwd” from BB, etc.  Probably 8 different lengths/sizes can be dialed in, including the pedal arm length.  As far as I know, they are scarce and therefore being used currently for the Pros, to size their bikes.

I would pay someone $100/hour (the cost of only one good saddle) to set one of these up as my current bike and let me try various saddles in various positions.
It took 4 years of riding to find the right saddle for me for the Sam.  Maybe I could have done it in a couple of hours with one of these devices.

Perhaps your sports doc will write you a prescription to cut your costs to find/try one of these mechanical fitting machines.  Take a big bag of saddles to try.

[Jim Whorton]

Another thing is just giving yourself plenty of time to heal.  I had an awful bout with piriformis syndrome--in my case the cause, I think, was a combination of a lot of jogging and a lot of sitting in a chair.  Stretching did not cure it, rest did--but stretching has kept it from coming back.  Right now I am riding a Clem H with a Brooks B17 and it's fine for me, but I seem to have learned how to stretch and when, to keep the problem from recurring.  Good luck!  It can be agonizing.

Jim in Rochester

[Philip Barrett]

Thanks Jim - you were doing the simple stretches only? My PT recommended those (which feel good) & the lacrosse ball direct massage which seems to make things worse.

[Nick Payne]

On Saturday, 6 August 2022 at 1:26:16 am UTC+10 George Schick wrote:

Interestingly, I have either B-17's or a Flyer on all but one of my bikes and I ride them without issue.  The 4th one, however, has a Team Pro, probably the narrowest of the Brooks saddles and whenever I ride that one I begin to develop similar problems, probably piriformis or related.  Similarly, in the past when I switched one of the B-17's out for a B-17 Narrow I rode it for a couple hundred miles and just could not get past the same kind of discomfort as with the Team Pro.  So, there may indeed be something to this saddle type, width, etc. issue.

I have B-17s on a couple of bikes, but over the last few years I've started using the Berthoud Vars/Aubisque/Mente saddles on new bikes that I build. The Vars/Aubisque/Mente have exactly the same top (5mm wider than B-17),  and I find them most comfortable saddles I've ever sat on. In descending order of price, the Vars has Ti rails and can be disassembled if parts need replacing, the Aubisque is the same but with stainless steel rails, the Mente also has stainless steel rails but the top is riveted on.

XXCycle seems to have about the best price on them.

Nick

[James Whorton]

Philip, the stretch that has worked for me—I’ll see if I can describe it—it to sit on a chair with my back straight, cross my legs so that one knee is in the air, then bend forward and twist my shoulders towards that knee, so I can feel the tight muscle stretching. I do this usually at night or whenever it feels tight, but not when truly sore.  

Oh, and I also moved my computer to a standing desk.  

Jim 

On Aug 6, 2022, at 6:06 PM, Philip Barrett <philipr...@gmail.com> wrote:

Thanks Jim - you were doing the simple stretches only? My PT recommended those (which feel good) & the lacrosse ball direct massage which seems to make things worse.

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[Philip Barrett]

Mine is similar, except on the floor, good old Iyengar twist. Like you, seems to work without making anything worse.

I did the same for my computer too, I have to recommend the Monoprice electric sit/stand desk - less than $200 and a very substantial piece of kit.

[Philip Barrett]

Well the doc reviewed my MRI and says stay off the bike for awhile until things clear up. Not good, but it makes sense & I trust her as she's a sports doc not just a GP. Luckily I can still run but being off the bike for an undetermined period of time is a big hit to the physical & mental well being.

[George Schick]

After reading all of these replies (along with your original post) I'm strongly suspecting at least an IT band problem, especially if she's recommending that you stay off the bike for a while, but you can still run without problems.  I had similar issues ~40 years ago and discovered that, though I didn't recognize it at the time, it was in fact an inflammation of the IT band.  I originally thought it was a knee problem, especially bursitis, but having since been married to a professional massage therapist (just one small step below a physical therapist) I've come to realize that it was likely an IT band issue.  I solved my problem back then in two ways: 1) in colder weather I applied some Cramergesic with a wooden applicator (popsicle stick), wrapped a layer of Saran Wrap over that, and covered that with a loosely wrapped Ace bandage using an up-and-down and crossways technique, and 2) carefully played around with my saddle height, eventually finding that I was riding with the saddle in too high a position.  Supposedly, common cycling knowledge - at least among the racing crowd - is that knee pain is more likely to occur along the outside of the leg if the saddle is too high and on the inside if it's too low.  

[Philip Barrett]

The full diagnosis is that the Piriformis inflammation is putting pressure on the Scatica which would also cause very similar symptoms to those you describe with the IT band plus extending all the way to the front ankle which mine does. My calf hurting is actually the 1st indicator I have of what's on its way. I also have no knee pain (the only bit that doesn't hurt right now!).