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Now we have 2 Davids. David, sorry to hear about your setback. I get really sore at that attachment of hamstring and butt. Actually before I stretch the piriformis, I first stretch the hamstring. But I have sure learned lots about not stretching a muscle too hard that doesn't want to be stretched, especially the piriformis.

And that brings me to the second David. What I have found about having botox for the piriformis is that I am kbetter able to stretch it without angering it. After I had my early botox injections I went to my physio who would ultrasound the area and then do a series of manoeuvers and stretch both the piriformis and the hamstrings as well as other muscles. I went 2-3 times a week at first. I do think that botox helped me but did not give me complete relief. I am able to walk further and sit longer and generally have better tolerance so that I may not have to lie down as early in the day. I do have a problem in the spine which could also contribute to my pain so someone who has only piriformis may get more relief. Unlike Donna, I never had a steroid injection until Dr. Filler just gave me one so I can't compare.

As for side effects I never got any except a little numbness in the leg which did not last. That is probably caused by the needle being so close to the sciatic nerve and the doctors always warn about that. My botox injections here in Canada were not guided and I never got more than 1 vile which is 100, is it cc's Donna. Dr. Filler gave me about 125 into the piriformis and 75 into the obdurator internus.

I do recommend trying it but Donna may be right, try the steroid first. For me the botox lasts about 3 months and I can actually feel the muscle tighten up and it becomes harder to stretch after the botox wears off. If possible get someoneto do it in a guided way rather than blind. Mine varied because they were not guided.

I have a friend who had botox and she was able to stretch it out and now she just has to be careful but does not have it chronically and she is running again. She is much younger than I am.

It will be interesting for me to see what Dr. Filler's image guided injection does. He told me that it may be about 4 weeks for it to give full relief. And there is the chance I won't get full relief anyway. Time will tell.

Hope this helps with your decision.

Shirley
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All:
Thanks for the thoughts so far on my condition.

1) Has anyone been to the PA location to have the MR neurography done?

2) When I attempt to do any stretching of my right hamstring, even gently, my buttock, leg and sometimes calf begin to burn like crazy a few hours later. PT says its pulling on the sciatic nerve. Anyone else have this?

3) Have any of your been to see a physiatrist (MD specializing in rehab)?

For me, using Ice on the area when at home, and a heating pad in the car seem to help me get through the day. I take Ultracet for pain and it helps but doesn't eliminate it.


Thanks
Mark
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Thanks for the info Donna & Shirley and the welcome David. I'll call myself aztec to avoid getting mixed up with David. Glad to add some testosterone to the mix. And I enjoy being in a room full of women (just ask my wife).

Anyway, just so you know I belong here, here is my story.

My allergist sent me to a neurologist to make sure my sinus headaches weren't caused by something else. Nothing there. Neurologist sent me to a chiro to work on the headaches. Second visit I told her my lower back was a little stiff from a massage the previous day. She did some adjustments & gave me a big handful of stretching and strengthening exercises to do, included the harder version of the PF stretch. That turned into a backache, after three weeks I quit going to her. Went to my family doc six weeks later when I noticed some burning in my left butt and a very slight numby feeling in my outer left foot. Regular family Dr was on vacation, the sub thought I might have PS. Rx'd PT for four weeks. The DX SI, PS, facet irritation. That wasnt bad until they had me do a bunch of stuff every day. PF stretches seemed to make it worse. After week 4 I said I'm going to the neurologist to get some tests run. He did a lumbar MRI, nothing other than some slight bulges. EMG was negative. Pelvic MRI was negative other than a spot on the right SI. Bone scan showed nothing wrong there. Whew.
He sent me to a Pain Dr. He gave me guided marcaine/cortisone injections in both SI's and the left PF. 3 Sets of injections and another month of PT. They provided about 3 hours of relief, until the marcaine wore off. He said because of that result he wanted to do RF ablation on the SIs.
I was nervous about doing that, so postponed it. Found out I had a hernia that needed repair, so I got that done. Two months later I decided to go to a Phys Med Dr. First one was a waste of time......Do I have PS? He said there are a lot of muscles in there, gave me some ultram samples, sent me on my way. I emailed Dr. Fishman (NY Phys Med guy & author of Sciatica Solutions) asking his opinion of RF ablation. He said try PT tailored to your needs first and gave me a Dr's name in Lubbock, I'm close to Austin. That Dr. gave me a name in Austin, so I went to see her. She mentioned PS, SI pain, ischial pain, tronchater (sp?). Another 6 weeks of PT, more hands on this time with some trigger point stuff - got worse with the home exercises but the trigger point stuff felt good. She had originally mentioned prolotherapy, then maybe RF ablation, but during my appt last week - she said not necessary to the prolotherapy, phys therapist said my SI was pretty neutral at all my visits.
My family Dr, the neurologist, and the phys med Dr. all said "I wish the pain guy would have just done injections in the PF or the SI and not both. My family Dr. said I might have some "weavers seat" - ischial bursitis also.
So I'm going back to the pain Dr tomorrow to talk about that, possible botox to the PF or one more block on the SI only to see if we can pinpoint what the problem is.
The phys therapist said my piriformis is defintely involved, my massage therapist said the glut minimus (sp?) is too as well as other tight muscles in the area.

My symptoms? - butt pain - on the tailbones (ischials) tender in the piriformis area, mainly left side, burning in the left hams, a little in the right ham, burning in outer left foot, sometimes the soul of the same foot and some pain in a line that is probably SI related. Sometimes not bad waking up and for the first hour or so, gets worse during the day. I usually lay on my left side to sleep and I can feel burning in my outer hip, hams, and foot when I lay on that side. MOst of the symptoms are worse after sitting for awhile, better on standing -sometimes my lower back gets a little sore after prolonged standing. Geez.

This started last May-June. Previously I rode my bike 10 miles, took 3 mile walks, 6 mile hikes. 53 years old and I feel like I'm 75.

I'm about ready to go see Dr. Filler and see what he says.

So do I belong? <laughing>

Nice to meet you nice folks,
Aztec
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forgot to mention that I retired 4 years ago and was enjoying it very much until this stuff started. Probably couldnt hold a job right now even if I wanted to, which I dont.

Aztec
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Mark, just getting ready to close down my computer for the night but in answer to your questions yes , if I or the PT stretch my hamstring too far I get terrible burning later in the butt and down the leg. I find that I can actually feel the butt muscle pull when I stretch the hamstring. I have to be careful when the piriformis is very tight that I don't overstretch the hamstring.

I know of the Neurography Institute in Pennsylvania and Dr. Filler does interpret those also. I thought of going there also but decided I wanted the consult wiht Filler as well.

Yes, also I have gone to a number of physiatrist and the doctor who injects me here is a physiatrist. They seem to be nore knowledgeable and accepting pf piriformis syndrome. I would recommend that you see one if you haven't already.

That's all for tonight. Keep asking.

Shirley
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SittingPain _ Yes, the bit about the piriformis muscle was an important piece of missing information.

I agree with Scamp & Filler. Sometimes the pirformis muscle is in spasm because it is trying to protect the nerve or something else. Other times, it is in spasm from overuse or because of problems with other muscles.

If you can work out the muscle imbalances you have described through PT, and the pain goes away, you may be able to avoid surgery. Only time will tell. good luck, Mary
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Hey Aztec,

You and I sound like twins. Except I'm a girl. :) But sounds like we've been through almost the same thing. I just got done with ALL the diagnostics on my right SI and, yes, it's a culprit. Exploring and considering my options there. I do have the option for SI fusion and seeking my second and third opinions on that. I'm 28, btw, hard core rock climber (it's my life) and endurance athlete. Currently, I'm a gimp. I just hit the one year mark.

Your sx sound alot like mine. We all have different variations in our symptoms...it's crazy. I did do prolo. Didn't work. Have done everything else you have mentioned. Lot's of running around, doc to doc. I've gotten very good at firing doctors. :)

I cannot begin to emphasize the importance of diagnostic injections. Two blocks on my SI made it crystal clear to me that my joint is screwed up. And, like you, half the PT's do the usual joint motion tests and say, "looks good to me" and the other half (who spend more time pushing, squishing, pulling and assessing the mobility of the joint) agree that there is pelvic obliquity. All despite all the PT's and their opinions, the only way we were able to truly say it was my SI was the block. Pain went away for about 6 hours...both times I had the block. My butt pain and leg pain, however, stayed.

I love my PT's. I'm about to make homemade cookies for these people simply because of their utter devotion to try and help me. BUT, it's the diagnostic injections that have really steered me in the right direction. They at least have the decency to say to me, "wow, you're complicated, and we don't know if we can help you, but we'll try."

Welcome to the club of butt pain! You'll find so much help and support here. I need to go back and reread your last post...but where are you now with treatment, diagnostics, etc? You said that you had the PF and SI injections at the same time? I agree, gotta do 'em separately if you're looking into narrowing down the pain generators. Takes longer, but hopefully will provide better info. There are nine muscles in you're butt...and the SI just complicates the whole thing.

I'm about to go back and reread your posts to see if I missed anything.

Take care,
Julie
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LOL.

You're right Julie. We are, one and all, a real pain in the ass.

Very twisted mood today. Feeling much better and it's gorgous here for a change.
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Margie:

Is your flu gone? I just wanted to wish you good luck for Friday (in case the week gets away from me), I ll be thinking about you. Please let us know how it went as soon as you are feeling up to it. Try not to be too nervous ..easier said than done I know but it won t be as scary as your expecting, I promise!

David:

Glad to hear you have twisted moments and that you are feeling better.

Mark and Aztec:

Sorry you have to be here but glad you found us. Sounds like both of you belong here. I don t have anything to add to everyone else s responses to you guys. Just keep asking questions and I hope you both find some relief.

Shirley:

Any call back yet? It can be quite frustrating but I d suggest you call them if you haven t already!

I m still plugging along over here. Working more and it is taking a bit of a toll. I m trying to space it all out but have some returning pain. It s so hard to take it easy this long (only 6 weeks but I gotta make some money). I really want to start walking for exercise but I m not sure if I should. Oh well, we ll see how it goes I guess.

Leesa
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Easy there Leesa. As one who knows, go slow. You are doing so well and that's why you want to start taking off. Problem is, using essentially your words, you've had some returning pain so your body is talking to you.

Contrary to my personality and history, I've learned that no pain/no gain does not apply while recovering from this surgery.

So, listen to your body. It knows what it's talking about and GO SLOW. Otherwise, you will simply go temporarily backwards and then be frustrated. Better to just hold in place until your body says proceed without pain.

Done preaching but I'm the id**t who has ignored this sermon so many times over the last 3 months that is nearly laughable. Sort of(the laughable part).

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How are you feeling now? I am going to see Dr Keppler in Cleveland on Thursday and just wanted to know how your doing after surgery..I have been suffering a year with piriformis syndrome and have done everything from therapy to injections and still no relief.
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David:

I know, I know, I know (said pathetically).

Thank you, I appreciate it.
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Margie, will be thinking of you and look forward to hearing how things go.

Leesa, hang in there. So sorry to hear that you are having trouble--don't let that company you work for push you around--yes, you are right, it gets tiresome siiting around and of course you have to have money to eat but jsut listen to David and take care of yourself. I think it is pretty natural to push ahead when you start to feel a little kbetter and then have to take a step back--but just take that step back for now and before you know it you will be able to take 10 steps forward and 1 back and then 15 steps forward and one back and so on,so on,so, on. Am thinking about you.

Aztec, will have more to say to your story when it isn't so late my time but we all welcome you to our butt pain club. Are you still thinkingabout having botox?

David you sounded a little down after stumbling over your pup--hope you are better

Oh yes, Leesa--no Cece never called so I emailed Kim the admin. assistant and she said Cece never came to work the day she was supposed to call meand she (Kim) apologized for any inconvenience it may have caused me. Somehow I think it shouldhave been Cece who should have apologized for never calling. So Kim kind of said we will just skip this appointment and reminded me that I had another one that is if Cece is around to call. Makes you a bit cynical about this telephone appointment system.

It's late and I'm off to bed. Bye for now.

Shirley
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I live in WV and am traveling today for my first appt with Dr. Keppler today. I have been in pain for 12 months and have tried injections, physical therapy and have had several MRI's to rule out my back and hip as the reason for my leg pain. Everyone who had had piriformis surgery with Keppler how are you doing after surgery?
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Hi all!

Thanks to all my well-wishers. I'll admit to being a little nervous. Had my pre-op appt. yesterday at UCSF with the anesthesiologist. Had to fudge a little when she asked if I was, at the present moment, ill. I'm just on the tail end of this flu/cold thing and I felt justified in my response of "Nope, I'm just fine!" because I'm certain it will be gone by Friday. (Fingers crossed!) I promise to jump on and let you all know how I'm faring as soon as I'm able. Please note that I'm normally a very good speller and am very conscientious about punctuation and grammar - former school teacher that I am. However, I'm not sure how I'll behave on drugs so I'm setting forth this disclaimer in advance! Up until this point I've managed 11 years of PS with small amounts of Neurontin and a TENS unit. Dr. Barbaro has made me promise I'll take the pain medication he's going to send me home with. So just in case I become a little more entertaining........you'll know why!

New David (Aztec): Egad! Everything you're saying is everything I've been through. Your story couldn't match mine any more perfectly with regard to symptoms. As far as the botox injections go, my personal opinion is that they were a waste of time. I had three rounds over the course of about a year and the minimal relief I got from them could have been imaginary. I'm quite good at "hoping" various treatments will work so I could very well have imagined that the teensy little window of feeling better was a result of those VERY EXPENSIVE injections. I think others have gotten a bit of relief from them so perhaps you will as well. (And hopefully you, too, Shirley!)

Mark: I absolutely agree that stretching your hamstrings will exacerbate your symptoms. Works for me every time. Unfortunately I had a PT who convinced me that if I just did it more often for longer periods of time it would eventually go away! HA!

Original David: So sorry to hear of your setback. Take it easy on that puppy! He's only doing his job. They're supposed to be totally underfoot! Hope you're better soon.

Leesa: I know I'm going to be just like you....chomping at the bit! I'm not good at taking it easy. Thank you for your kind words. I'll try not to get too freaky thinking about the surgery. Actually the part that's weirding me out the most is knowing I'm gonna be lying there on a table in my birthday suit with my fanny pointed to the ceiling for all to see! Frightening! :oops:

Julie: See ya soon!

Okay, enough babbling. G'nite!

Margie

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