Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

IN PAIN FROM PF

Posted by Suzie F on 7/18/01 at hrmin (053648)

I am new to this board as I have recently found this website. I first want to express my thanks for all the wonderful information I have found here. It has all been so useful to me when both speaking with and making decisions with my podiatrist and now the orthopedist. I have only been experiencing PF since the first part of this year. As symptoms worsened I finally decided to see a podiatrist and then an orthopedist. Both diagnosed PF. It is so incredibly painful that at times it is debilitating. I had my first physical therapy session today and came home with a group of exercises I must do. I was rather concerned when the therapist expressed that I probably will have to live with this the rest of my life no matter what I do. There will be good days and there will be bad days. (Sort of like having arthritis - in my mind anyway). So---does this ever go away or am I destined to the 'learning to live with this horrible pain institute?' If anyone has done PT plus topicals plus ice, etc.- how long until you felt better? Do you ever heal to where you feel normal again? Thanks for your help.

Re: IN PAIN FROM PF

Julie on 7/19/01 at 03:38 (053680)

Susie, let's hope your therapist is being unduly pessimistic. Most cases of PF do get better in time and with appopriate treatment. In my own case, it took about six months to improve to the point where I could resume more or less normal activities, and now, after 11 months, it is fully under control. However, I believe that 'once a PF sufferer, always a PF sufferer' (yes, rather like an alcoholic!) in the sense that it's vital to avoid a recurrence of the problem in what is clearly a 'weak spot'. Maybe that's what your PT meant - ask her.

So I keep wearing my good supportive trainers with my custom orthotics outdoors, and my Birkenstocks indoors. I never let my bare feet touch the ground if I can help it, and if I'm going to be on my feet all day I still occasionally apply tape to give the arch more support, or wear my elastic ankle support (which also supports the arch).

What other treatments have your podiatrist and orthopaedist suggested? As Dr Davis explained so clearly yesterday, no single treatment works on its own.

Do read the heel pain book (if you haven't already) so that you can involve yourself actively in your healing. I think the main thing to understand is that PF is an injury, and like any injury, it needs rest in order to heal.

Be prepared for healing to take time. You've had PF since the beginning of the year, but have only recently consulted doctors. So it may take longer than if you'd started dealing with it right away. Patience, and commitment to your healing will, hopefully, have results, so that you eventually 'feel normal' again.

If conservative treatments don't work, there is ESWT to consider. There is plenty of information about this non-invasive treatment here. Keep reading, and keep posting. There are lots of knowledgeable people here who have been through it, and can help you.

Good luck!

Re: You sound like me

Carmen H on 7/19/01 at 09:04 (053698)

Hi Suzie! Your post sounded like my thoughts when I got this terrible injury. I cried alot and felt hopeless. I also sufferfrom Priformus Syndrome (which I had surgery for and didn't get fixed) so I know the hopelessness you feel. Rest has been the best treatment so far and with icing I am able to minimize the suffering . But I have found that I have to put this foremost in my mind. In other words I live my life around what I need to do for my feet that day. I always keep in mind when I need to stretch, when I walk I think about icing when I get done, I never ever walk or stand without shoes, it's always in my mind what I can do to make sure I am not reinjuring my feet. Not getting out of bed without stretching. Not even to usethe bathroom. When I am sitting at my desk or even cooking dinner I am doing a stretch or exercise of some sort to strengthen that muscle around the Fascia. It's NO fun but I finally accepted it is part of my life and I need to take control before it controls me. I gave away shoes I know I can't ever wear again. I understand it will take a long period of time to recover and I have to accept that or I will go nuts....this board has helped in MANY ways. Most of all it is a comfort to know other people feel the EXACT same way. We are not alone......Stay on here and keep reading.
Keep your chin up. Don't forget you are a patient...it's your right to ask your doctor questions.

Re: You sound like me

Julie on 7/20/01 at 02:22 (053791)

Carmen, what is Piriformus syndrome? Can you explain about it, please?

Re: I'll do my best

Carmen H on 7/20/01 at 08:50 (053807)

I'll do my best. Of course the doctor that explained the medical terms to me explained it in 'medical terms'. All I know is that I feel pain all the time.....more about that in a minute.
The Piriformus is a band of muscle that is located near the lateral rotators and the top of the femur....running along the sciatic nerve and somtimes (in my case) getting entangled in the nerve. When the muscle is in Spasm it feels like someone is hammering a nail into my butt bone. It is also referred to as the 'Pain in the butt syndrome.'
About two years ago I was taking Spin, Kickboxing, weight lifting and cardio and I sat down on a stool in my office (a hard wooden stool) and I felt like my butt bone cracked in half. I stood up and thought I had injured it doing dead lifts the day before. So I laid off the lower extremities a few days and I have only had ONE pain free day since that day.
I saw 9 doctors, Chiros, massage therapists, GP's, PT's, Orthos, Even a Gyno (they thought it was related to my endometriosis), and finally I started doing more research on the internet and I diagnosed my self and called a Sports Medicine Ortho he was the ONLY one familar with Piriformus Syndrome. I got a shot (my ONE day of relief) and ended up in surgery. I was told the chances of it working would be 50/50. He said when he got in there the sciatic nerve was wrapped around the muslce like a braid......the scar is 7' long, the healing process was painful, and it was rough! It has spread to the other side and I have it in both glutes now. Voixx helps but so does exercise.....so on and on and on it goes.
Does this shed any light at all? I have tried trigger point therapy but with my NEW EXPENSIVE problem of PF of the feet $25.00 for 30 minutes doesn't work for me. I use a golf ball to target that spot and release that muscle to get relief.....I sound like a mess huh?

Re: Piriformus

Julie on 7/20/01 at 10:56 (053816)

Thanks Carmen. I understand your explanation - I asked because I've just got interested in the piriformus muscle: I've got a tight one myself which has been causing me a bit of bother since a flare-up of an old sacro-iliac problem a couple of weeks ago. It's not a muscle I was terribly familiar with, but the osteopath who treated me the other day identified it and worked on it. It helped and I'm better. Now I know where it is, and a bit more about it from your post, so thanks!

Piriformus syndrome sounds very nasty. I'm sorry the surgery didn't work. Perhaps the enforced rest from all your training will relieve your pain a bit - I hope so.

Now I must do some research to find out HOW the sciatic nerve and the piriformus get tangled up. I like to know about things in case they happen to any of my students!

Re: You'll be able to help

Carmen on 7/20/01 at 11:20 (053823)

Julie I have faith that you'll be able to help people with this problem. Most people like myself couldn't identify it. That's why I had to diagnose myself. I am getting good at that. One way to REALLY hit that muscle is to put one finger on the side of your hip about halfway down and one finger at the crack of your bum in the middle and bring those finger together to meet in the middle of that 'cheek' so to speak......Press and you'll feel it. I do that stretch where you cross your right ankle over the left knee while lying on your back and pull the left knee towards you. Keeping your sacrum in contact with the floor. This will stretch the right piriformus....and then reverse to do the other side.
It feels so GOOD. Also an 'on all fours' stretch that is hard to explain....but if you are interested I will do my best.
Let me know if you have any more questions on the symptoms and what I have tried to help it. Unfortunately REST doesn't help.....it may even hurt.

Re: You'll be able to help

Julie on 7/20/01 at 11:54 (053825)

Yes, that's where it is: I can feel the osteopath's strong fingers digging in right now.

And yes, that's an excellent exercise: I do it too - directing the right knee away as I pull the left knee forward. Do you do that? It makes it very strong!

And yes, please describe the all fours exercise.

No - no rest the the wicked piriformus. It needs to be moved.

Re: Here we go....

Carmen H on 7/20/01 at 13:28 (053833)

Okay I'll try to explain. Get down on all fours. Keeping hands hip width apart. Take your right foot cross it over your left ankle keeping the leg straight and the toes flexed so the ball of your foot is in contact with the floor. Holding that position make sure the rest of your body stayed in it's original place. Gently and slowly slide the right foot OUT until your groin is almost sitting on your heel. You should feel the pull in the left hip area and in your rear. I hope this makes sense......it's kind of hard to explain unless you can see it done. At least it was for me....you should have an easy time with it being in yoga.
I love this one though....with the right breathing technique I can almost feel my hip 'melt' so to speak with relaxation.
Oh and I meant to tell you I did try the taping a couple of days ago and it felt pretty good. I do on occasion when I need more support. Most of the day I sit and work so I don't want to waste tape.

Re: Here we go....

Jeff on 7/20/01 at hrmin (053839)

Howdy Carmen, My understanding of Piriformis Syndrome is that the sciatic nerve passes beneath the piriformis muscle. Anything that put the piriformis into spasm will compress the sciatic nerve resulting in pain local to the compression and distal along the distribution of the sciatic nerve.
Think about a pinched nerve in the neck. It's a vicious circle; the greater the pain the more the muscle goes into spasm, and the nerve gets pinched all the more. They're very similar problems.
Jeff

Re: Thanks Carmen and Jeff

Julie on 7/21/01 at 01:05 (053882)

Thanks, Carmen, for the description, and Jeff for the explanation of the relation between the sciatic nerve and the piriformis.

Carmen, could you confirm: are we stretching the foot BACK to rest the groin - almost - on the heel?

By the way - my last post meant to say 'no rest _for_ the wicked piriformis'. Just in case you thought I was saying 'rest the wicked piriformis'. Not much point making a joke if you botch the crucial word.

Re: CONFIRMATION on the stretch

Carmen h on 7/21/01 at 09:50 (053904)

Yes that's true. Your 'crotch' so to speak should be almost resting on your heel if you have done the stretch complete.....BUT of course you know...you should only stretch to feel the stretch. Not to 'pain'. So maybe some people's heel wouldn't quite reach the groin. Depending on how far they can stretch. It feels so good in my hips too.

Re: IN PAIN FROM PF

Julie on 7/19/01 at 03:38 (053680)

Susie, let's hope your therapist is being unduly pessimistic. Most cases of PF do get better in time and with appopriate treatment. In my own case, it took about six months to improve to the point where I could resume more or less normal activities, and now, after 11 months, it is fully under control. However, I believe that 'once a PF sufferer, always a PF sufferer' (yes, rather like an alcoholic!) in the sense that it's vital to avoid a recurrence of the problem in what is clearly a 'weak spot'. Maybe that's what your PT meant - ask her.

So I keep wearing my good supportive trainers with my custom orthotics outdoors, and my Birkenstocks indoors. I never let my bare feet touch the ground if I can help it, and if I'm going to be on my feet all day I still occasionally apply tape to give the arch more support, or wear my elastic ankle support (which also supports the arch).

What other treatments have your podiatrist and orthopaedist suggested? As Dr Davis explained so clearly yesterday, no single treatment works on its own.

Do read the heel pain book (if you haven't already) so that you can involve yourself actively in your healing. I think the main thing to understand is that PF is an injury, and like any injury, it needs rest in order to heal.

Be prepared for healing to take time. You've had PF since the beginning of the year, but have only recently consulted doctors. So it may take longer than if you'd started dealing with it right away. Patience, and commitment to your healing will, hopefully, have results, so that you eventually 'feel normal' again.

If conservative treatments don't work, there is ESWT to consider. There is plenty of information about this non-invasive treatment here. Keep reading, and keep posting. There are lots of knowledgeable people here who have been through it, and can help you.

Good luck!

Re: You sound like me

Carmen H on 7/19/01 at 09:04 (053698)

Hi Suzie! Your post sounded like my thoughts when I got this terrible injury. I cried alot and felt hopeless. I also sufferfrom Priformus Syndrome (which I had surgery for and didn't get fixed) so I know the hopelessness you feel. Rest has been the best treatment so far and with icing I am able to minimize the suffering . But I have found that I have to put this foremost in my mind. In other words I live my life around what I need to do for my feet that day. I always keep in mind when I need to stretch, when I walk I think about icing when I get done, I never ever walk or stand without shoes, it's always in my mind what I can do to make sure I am not reinjuring my feet. Not getting out of bed without stretching. Not even to usethe bathroom. When I am sitting at my desk or even cooking dinner I am doing a stretch or exercise of some sort to strengthen that muscle around the Fascia. It's NO fun but I finally accepted it is part of my life and I need to take control before it controls me. I gave away shoes I know I can't ever wear again. I understand it will take a long period of time to recover and I have to accept that or I will go nuts....this board has helped in MANY ways. Most of all it is a comfort to know other people feel the EXACT same way. We are not alone......Stay on here and keep reading.
Keep your chin up. Don't forget you are a patient...it's your right to ask your doctor questions.

Re: You sound like me

Julie on 7/20/01 at 02:22 (053791)

Carmen, what is Piriformus syndrome? Can you explain about it, please?

Re: I'll do my best

Carmen H on 7/20/01 at 08:50 (053807)

I'll do my best. Of course the doctor that explained the medical terms to me explained it in 'medical terms'. All I know is that I feel pain all the time.....more about that in a minute.
The Piriformus is a band of muscle that is located near the lateral rotators and the top of the femur....running along the sciatic nerve and somtimes (in my case) getting entangled in the nerve. When the muscle is in Spasm it feels like someone is hammering a nail into my butt bone. It is also referred to as the 'Pain in the butt syndrome.'
About two years ago I was taking Spin, Kickboxing, weight lifting and cardio and I sat down on a stool in my office (a hard wooden stool) and I felt like my butt bone cracked in half. I stood up and thought I had injured it doing dead lifts the day before. So I laid off the lower extremities a few days and I have only had ONE pain free day since that day.
I saw 9 doctors, Chiros, massage therapists, GP's, PT's, Orthos, Even a Gyno (they thought it was related to my endometriosis), and finally I started doing more research on the internet and I diagnosed my self and called a Sports Medicine Ortho he was the ONLY one familar with Piriformus Syndrome. I got a shot (my ONE day of relief) and ended up in surgery. I was told the chances of it working would be 50/50. He said when he got in there the sciatic nerve was wrapped around the muslce like a braid......the scar is 7' long, the healing process was painful, and it was rough! It has spread to the other side and I have it in both glutes now. Voixx helps but so does exercise.....so on and on and on it goes.
Does this shed any light at all? I have tried trigger point therapy but with my NEW EXPENSIVE problem of PF of the feet $25.00 for 30 minutes doesn't work for me. I use a golf ball to target that spot and release that muscle to get relief.....I sound like a mess huh?

Re: Piriformus

Julie on 7/20/01 at 10:56 (053816)

Thanks Carmen. I understand your explanation - I asked because I've just got interested in the piriformus muscle: I've got a tight one myself which has been causing me a bit of bother since a flare-up of an old sacro-iliac problem a couple of weeks ago. It's not a muscle I was terribly familiar with, but the osteopath who treated me the other day identified it and worked on it. It helped and I'm better. Now I know where it is, and a bit more about it from your post, so thanks!

Piriformus syndrome sounds very nasty. I'm sorry the surgery didn't work. Perhaps the enforced rest from all your training will relieve your pain a bit - I hope so.

Now I must do some research to find out HOW the sciatic nerve and the piriformus get tangled up. I like to know about things in case they happen to any of my students!

Re: You'll be able to help

Carmen on 7/20/01 at 11:20 (053823)

Julie I have faith that you'll be able to help people with this problem. Most people like myself couldn't identify it. That's why I had to diagnose myself. I am getting good at that. One way to REALLY hit that muscle is to put one finger on the side of your hip about halfway down and one finger at the crack of your bum in the middle and bring those finger together to meet in the middle of that 'cheek' so to speak......Press and you'll feel it. I do that stretch where you cross your right ankle over the left knee while lying on your back and pull the left knee towards you. Keeping your sacrum in contact with the floor. This will stretch the right piriformus....and then reverse to do the other side.
It feels so GOOD. Also an 'on all fours' stretch that is hard to explain....but if you are interested I will do my best.
Let me know if you have any more questions on the symptoms and what I have tried to help it. Unfortunately REST doesn't help.....it may even hurt.

Re: You'll be able to help

Julie on 7/20/01 at 11:54 (053825)

Yes, that's where it is: I can feel the osteopath's strong fingers digging in right now.

And yes, that's an excellent exercise: I do it too - directing the right knee away as I pull the left knee forward. Do you do that? It makes it very strong!

And yes, please describe the all fours exercise.

No - no rest the the wicked piriformus. It needs to be moved.

Re: Here we go....

Carmen H on 7/20/01 at 13:28 (053833)

Okay I'll try to explain. Get down on all fours. Keeping hands hip width apart. Take your right foot cross it over your left ankle keeping the leg straight and the toes flexed so the ball of your foot is in contact with the floor. Holding that position make sure the rest of your body stayed in it's original place. Gently and slowly slide the right foot OUT until your groin is almost sitting on your heel. You should feel the pull in the left hip area and in your rear. I hope this makes sense......it's kind of hard to explain unless you can see it done. At least it was for me....you should have an easy time with it being in yoga.
I love this one though....with the right breathing technique I can almost feel my hip 'melt' so to speak with relaxation.
Oh and I meant to tell you I did try the taping a couple of days ago and it felt pretty good. I do on occasion when I need more support. Most of the day I sit and work so I don't want to waste tape.

Re: Here we go....

Jeff on 7/20/01 at hrmin (053839)

Howdy Carmen, My understanding of Piriformis Syndrome is that the sciatic nerve passes beneath the piriformis muscle. Anything that put the piriformis into spasm will compress the sciatic nerve resulting in pain local to the compression and distal along the distribution of the sciatic nerve.
Think about a pinched nerve in the neck. It's a vicious circle; the greater the pain the more the muscle goes into spasm, and the nerve gets pinched all the more. They're very similar problems.
Jeff

Re: Thanks Carmen and Jeff

Julie on 7/21/01 at 01:05 (053882)

Thanks, Carmen, for the description, and Jeff for the explanation of the relation between the sciatic nerve and the piriformis.

Carmen, could you confirm: are we stretching the foot BACK to rest the groin - almost - on the heel?

By the way - my last post meant to say 'no rest _for_ the wicked piriformis'. Just in case you thought I was saying 'rest the wicked piriformis'. Not much point making a joke if you botch the crucial word.

Re: CONFIRMATION on the stretch

Carmen h on 7/21/01 at 09:50 (053904)

Yes that's true. Your 'crotch' so to speak should be almost resting on your heel if you have done the stretch complete.....BUT of course you know...you should only stretch to feel the stretch. Not to 'pain'. So maybe some people's heel wouldn't quite reach the groin. Depending on how far they can stretch. It feels so good in my hips too.