Brian Schiff’s Blog

So, have you ever experienced pain in the buttock that radiates down into the thigh? Maybe even felt some numbness and tingling? Recently, I was contacted by an experienced marathoner who has been plagued by pain in the buttock and posterior thigh.  He self diagnosed himself as having piriformis syndrome after doing some research on the Internet.  So. what is piriformis syndrome?

Some experts debate whether it truly exists, but essentially, it involves the piriformis, a small pear shaped muscle in that helps externally rotate (turn out) the hip and the sciatic nerve which runs down the entire back of the leg and is responsible for sensation and motor movement patterns of many of the muscles in the lower leg.

It is suggested that in this syndrome the sciatic nerve essentially becomes compressed or irritated by a tight piriformis muscle.  The sciatic nerve travels above, below or even through the piriformis muscle itself based on anatomical studies.

Some have even suggested that prolonged sitting with the hips turned out or sitting on a wallet can contribute to this problem.  I even remember being told in PT school that it is more common in truck drivers.  With that said, I think I can count on one, if not both hands the number of patients I have seen in 15 years that I truly believe had piriformis syndrome.

Now back to my runner.  He began having pain in his left buttock and hamstring in late December after seeing a trigger point specialist who suggested he had a tight piriformis and did some deep tissue work on it.  A short time afterward, he began having symptoms.  He saw a physical therapist for 2-3 sessions and was given some stretches to do.  Meanwhile, he began getting deep tissue massage focused on the area in January and February.

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So, for Labor Day 2010, I decided to take my family to Kings Island.  I have always been a fan of thrill rides and it has been well over a decade since I had been to Kings Island.  It was also before I have experienced more than one bout of sciatica.

My nieces live nearby and they agrred to watch my sons for a brief time while my wife and I headed off to ride some of the bigger rides.  I insisted we ride the Beast – a coaster classic by any standards.  It is the world’s longest wood coaster and lots of fun.

What I failed to remember was just how much jarring and abuse the good ol’ Beast could inflict on one’s body in those tiny little cars.  After 4 minutes of fun, it all came back to me.  For those who don’t know, I have been training for a marathon and admittedly after most 19 plus mile runs (I did one on Sunday) my back is stiff for a day or two.

Perhaps riding the Beast (and the Racers too at my wife’s insistence) the day after a long run was not such a wise move.  🙂  I woke up this morning with what I term “old man back.”  Now while that may sound funny, to anyone who has experienced it, you know how unpleasant it is. 

I crawled out of bed and managed to teach a boot camp class at 5:30 AM without incident.  Beyond the stiffness, my day has been marked by difficulty bending forward and lots of ice.  I am not complaining as much as I am telling you that as we get older (unfortunately I mean older than age 30) our shock absorption qualities in the spine begin to decline.

You see, our discs between the vertebrae act as a cushion and help prevent injury.  But, as we age, they naturally begin to degenerate in our thirties (degenerative disc disease – bummer).   This ultimately means we are more vulnerable to harmful forces and stress on the spine.  Ever wonder why those signs warn you not to ride if you have neck or back pain? 

It is likely the sudden torque, twists, turns and bumps that may leave you feeling rough then next day.  Am I saying not to ride?  NO!!  I love coasters.  I will be back at it again in the near future.  What I am saying is know your own personal situation and if you have some past back issues like me, be prepared to endure “old man back” for a few days as you hit the theme parks.

I will be over it in a day or so.  As a matter fo fact I ran 4 miles today with no pain.  Some keys to spinal fitness are:

1. Practice good body mechanics with bending, lifting, sitting, etc.
2. Don’t sit too much without standing up.  Our bodies need balance, and too much sitting (flexion) is bad for the discs in the back.  Be sure to stand up no less than once per hour as your back craves to be in extension an equal amount of time.  Standing back bends (sets of 5-10) is a great way to improve spinal fitness if you have a desk job.
3. Stretch and strengthen the abdominals, but avoid full sit-ups.
4. Strengthen the low back muscles and hips.
5. Avoid flexion and rotation moments.

In the end, if you have a flare-up, then use ice and let pain guide your movements.  One last tip: stick to the steel coasters for a smoother ride!