I’ve suffered from this for decades. Of late, I have found stretching exercises of immense value. Before pain strikes (ie when you know you’re about to do something that might cause the onset of pain) or afterwards as a means of getting rid of pain.
It won’t fix a major problem, but I’m convinced it actually shortens recovery time…
Mike
For me, this article also raises another issue besides the “bigger picture” one I commented on earlier. I think of all of the people looking for remote hidey-holes to weather out the coming storm. By a chain of circumstances, I have ended up in N Miss. One thing I really miss about N Cal. is the large number of good professional alternative treatment modalities I could find there. I don’t know how I would have ended up if it hadn’t been for the excellent chiropracter I had in the 80s in the Bay Area or the other excellent one I found later in the Central Valley. Most medical resources in this part of the country are far from ideal, and alternatives are almost nonexistant. Something to think about in making preps.
I’m siding with the exercise and stretching strategy to manage lower back pain. I’ve been working on stretching the piriformis muscle that joins the head of the femur to the sacrum. Many people who bicycle intensively have a problem with this muscle and the nerve routed around it. Usually the nerve goes underneath it, sometimes over it, and sometimes even through it. When the pirifomis spasms, ouch! Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra. Neither performed any tests or exam. It has been shown that a bulging disc alone is often not sufficient to cause back pain. Whether it’s a bulging disc or piriformis spasm, I don’t know. What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery. The more I use it, the better I feel.
I refuse to give up cycling and still train fairly regularly. What I do is after every ride I stretch the piraformis by first lying on my back with knees raised. Then cross one leg over the other and gently but firmly tug on the knee or on the top portion of the tibia. Make sure the pelvis sits flat. Hold for twenty seconds per side. There are several variations on this. Google “piriformis stretch”. I also stretch by touching toes with my knees locked and unlocked. Simple sit-ups with the knees bent helps to maintain alignment of the pelvis and strengthen the abdomen. Improves posture. Start a program of sit-ups beginning with an easy number of reps at first and then increasing the number by a few weekly. I’m up to 30 this week. Another help is rotations. There are two versions of this. While on the bike if I’m having discomfort, I straddle the top tube and face 90 degrees from the direction of motion. With both feet on the ground and grasping the saddle, I rotate clockwise when facing right until my back pops and then reverse. This takes some practice in relaxing the abdomen and diaphragm. Repeat facing left. It’s about 90% effective in relieving lower back pain during a ride. As part of my after ride stretching, I sit upright on the mat, bend one knee and cross it over the other leg. Grasp the ankle with the hand from the same side and place the opposite hand on the floor behind me. Then rotate gently including looking behind me and hold for twenty seconds. Sometimes I can get my spine to pop on this one. Of course, reverse it and hold for twenty. Another big help is moving my car seat up until my left foot is against the firewall. No need to cramp or apply pressure. The foot against the firewall is a queue to keep my pelvis firmly against the seat back and prevent slouching. Before I figured that one out, driving could be torture. Brisk walking on level ground is another good treatment. Keep your chin up, swing your arms, and walk far and fast enough to get your body temperature up.
One thing to keep in mind is obesity is no friend to your back. By significantly reducing the sugars in my diet, I’ve dropped about 8 pounds over the last month. My goal is a BMI of 22 or so. Not there yet and I expect it will take the better part of a year. Some people claim that BMI is too strict. Mule fritters. What’s normal in America is not healthy. We exercise too little and eat way to much crap. We snack on confections instead of restricting our intake to wholesome foods taken only at meal times. How many of us in our 50’s remember when we were children being told not to snack between meals? Now snacking is taken as a norm. What are snack foods made of? They’re mainly concocted from some combination of the three big, heavily subsidized commodity crops: wheat, corn, and soy. High in calories, low in nutrients, and very profitable. Read Michael Pollan. The quantity and quality of food that goes into your mouth affects your back.
And now the Peak Oil angle. Rising oil prices will drive up the cost of medical care, or, more properly called, disease intervention. All of my treatments have a low carbon footprint. They cost nothing. I can do them anytime and anywhere. Eating food with less processing uses less oil.
They say a person who has himself as a patient has a fool for a doctor. This fool had been getting good results. Is it foolish to believe a consistent routine of good maintenance practices can keep you from needing expensive repairs?
[quote=JAG][quote=ao]
Also, a key thing to remember is that virtually all pain (except that of psychogenic origin) is secondary to one of only two factors, chemical irritation or mechanical deformation. Pain of chemical origin is best treated chemically and pain of mechanical origin is best treated mechanically.
[/quote]
ao,
I’m afraid you lost me on this statement. The mechanism by which trigger points create referred pain is distinctly a chemical process, yet their treatment is best achieved by mechanical means. In fact, there is no drug or nutraceutical that has shown any effectiveness in the resolution of trigger points (at least not in a double-blind, placebo controlled study). Even the injection of trigger points with a local anesthesia must be classified as a mechanical treatment method, because trigger point injection with a saline solution works equally as well.
Perhaps by “mechanical pain” you were implying nerve compression, in which case removing the mechanical compression would be warranted, and probably best done by mechanical means. But I know of one case of nerve compression that was effectively addressed by chemical means. My father came to me with a complaint of sciatica-type pain. I knew from X-rays that I had taken of my father when I was in Chiropractic College in the late 80’s, that he had a spondylolisthesis, so I suspected that his symptoms were secondary to nerve trunk compression in his lumbar spine. I told him surgery would probably be needed at some point. My father, who was at the time being treated for lymphoma at M.D. Anderson Cancer Institute, mentioned his sciatica symptoms to one of his doctors there, who then referred him to another doctor in the M.D. Anderson ecosystem. This doctor suggested that my father try a treatment protocol involving the drug Neurontin, before committing to a surgical option. To my amazement, the neurotin actually worked for my father. It took about 6 weeks for all his symptoms to subside, but he has been off the drug for several years now and is still pain-free.
I realize that discussing alternative healthcare topics is a bit like discussing politics or economics, as many professionals in the field hold deep-seated beliefs about the efficacy of their particular approach, myself included. I think it’s important to remain open to other approaches, but to always have a foundation of good medical research to base your work on. To this end, no alternative treatment to pain has more medical research supporting it than Trigger Point Therapy, which is why I felt comfortable recommending it here.
Thanks to everyone for their comments on this thread…Jeff
[/quote]
Jeff,
Good points. That statement about chemical and mechanical pain comes from Barry Wyke, the eminent British neurologist. Sorry for my omission and not clarifying that certain problems can have pain of mixed origin (i.e. both chemical and mechanical) while with other problems, one form or the other dominates. Also, I excluded pain of psychogenic origin since I didn’t want to go there.
Let’s look at trigger points as defined by Travell. In general, some type of mechanical deformation will generate them (even though sometimes the mechanism could be neurological). Mechanical deformation is inclusive of but goes far beyond just nerve compression (if by nerve compression, you mean nerve root compression). It can involve any type of compressive, tensile, shear, or other force to virtually any tissue in the body.
Getting back to the chemical pain, if you recall from Travell’s Vol. 1 Chapter 4 on Perpetuating Factors, there are a whole range of nutritional deficiencies (i.e. a chemical problem), for example, which can act to perpetuate trigger points. You can spray and stretch or inject until the cows come home and the problems will tend to come back because the underlying nutritional deficiency has not been addressed. Mechanical deformation will obviously create some level of chemical irritation (the extent depending upon the extent and rate of mechanical deformation, among other factors) since pain is ultimately dependent upon nerve signalling which is an electrochemical process.
Neurontin can definitely be effective since it deals with a chemical component of pain. If there is nerve root compression, there is a mechanical problem to begin with but as the nerve root becomes inflamed and swollen and the patient becomes increasingly symptomatic, the symptoms will become increasingly of chemical origin. It’d be better to correct the spondylolisthesis (which can often be performed with ventral technique) or train in postural and movement strategies to minimize or alleviate spondylo sourced deformation AND also treat the chemical component of pain, but if the nerve root swelling subsides, the pain will generally subside and allow the patient to recover.
The point I was making was that if a patient has a mechanical problem like a derangement syndrome (let’s say a bulging disc or a meniscal displacement), the best approach is a mechanical approach to reduce the derangement rather than a chemical approach of prescribing NSAIDs, analgesics, or muscle relaxants to decrease inflammation, pain, or muscle spasm, respectively.
On the other hand, if a patient has a chemical problem such as an acute rheumatioid arthritic flare-up, the best approach is chemical such as medication and/or an appropriate diet to quiet down the inflammation.
A problem such as an adhesive capsulitis (i.e. frozen shoulder) will have mixed origins. The capsular restriction is definitely mechanical and requires mobilization (i.e. mechanical treatment). But the inflammation of the anterior inferior capsule is chemical and will benefit from anti-flammatory medication and normalizing estradiol levels (i.e. chemical treatment). That’s a gross oversimplification but you get the point.
Hope that makes it clearer.
FWIW, I consider trigger point therapy more of a mainstream than an alternative approach. I don’t know if you ever met Janet Travell but she was a very smart lady and knew the science behind what she did very well. Being an MD, her work progressively gained credibility with the mainstream (possibly faster than if one were a non-MD) and is pretty well accepted in most medical circles. Feldenkrais, on the other hand, is definitely an alternative therapy but again, Feldenkrais was an absolute genius who understood the physics, neurophysiology, etc. behind human movement better than most licensed healthcare professionals.
Also, with regards to the perusal of the library comment, if there are any old or out of print books you’re interested in and can’t find, drop me a line. I just did an inventory of my library and in checking the prices of some of the reference books I have that I haven’t used in a while, I found that many of them are rare and worth $200, $300, $400, or more online. I’m probably going to be selling off those I rarely use in anticipation of getting a better price for them now than I will post Crash when I retire. I’m sure if we met in person, we could have some great discussions. I’ve always valued and learned from your input here.
DurangoKid-Like you, I struggled with a tight piriformis and associated sciatica for many years. Mine was caused by a mild case of cerebral palsy. About a year ago, I attended a seminar series entitled “Pain Free Living” by Henry Ford Hospital in the Detroit area. There was a physical side and a mental side to their philosophy. The physical side started with the assumption that much pain is caused by overly tight muscles: When a muscle is always contracted, the brain learns that contracting it more doesn’t result in much motion, so the brain recruits other muscles to perform the desired movement and “forgets” how to relax and contract that muscle. The seminars taught us somatic muscle education to re-engage the brain to control contracted muscles. The link below shows a version of exercises for the low back. You can also google “somatic education” to learn more exercises. I can honestly say that, at age 49, these simple exercises changed my life!! For me, they were much more effective than stretching, and the results have been consistent for nearly a year. If you are interested, try these once in the morning, and again just before bedtime. I also do them after activity which contracts my piriformis.
Another thing that I learned from those seminars is that using a strap (preferably with slight stretch) to hold your thighs together while seated greatly reduces low back stress. Driving is much easier when I use the strap. In a pinch, I have wrappec a jacket around my legs and tied the sleeves together.
Julie
http://www.somatics.com/sciaticasymptoms-piriformissyndrome.htm
[quote=DurangoKid]I’m siding with the exercise and stretching strategy to manage lower back pain. I’ve been working on stretching the piriformis muscle that joins the head of the femur to the sacrum. Many people who bicycle intensively have a problem with this muscle and the nerve routed around it. Usually the nerve goes underneath it, sometimes over it, and sometimes even through it. When the pirifomis spasms, ouch! Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra. Neither performed any tests or exam. It has been shown that a bulging disc alone is often not sufficient to cause back pain. Whether it’s a bulging disc or piriformis spasm, I don’t know. What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery. The more I use it, the better I feel.
I refuse to give up cycling and still train fairly regularly. What I do is after every ride I stretch the piraformis by first lying on my back with knees raised. Then cross one leg over the other and gently but firmly tug on the knee or on the top portion of the tibia. Make sure the pelvis sits flat. Hold for twenty seconds per side. There are several variations on this. Google “piriformis stretch”. I also stretch by touching toes with my knees locked and unlocked. Simple sit-ups with the knees bent helps to maintain alignment of the pelvis and strengthen the abdomen. Improves posture. Start a program of sit-ups beginning with an easy number of reps at first and then increasing the number by a few weekly. I’m up to 30 this week. Another help is rotations. There are two versions of this. While on the bike if I’m having discomfort, I straddle the top tube and face 90 degrees from the direction of motion. With both feet on the ground and grasping the saddle, I rotate clockwise when facing right until my back pops and then reverse. This takes some practice in relaxing the abdomen and diaphragm. Repeat facing left. It’s about 90% effective in relieving lower back pain during a ride. As part of my after ride stretching, I sit upright on the mat, bend one knee and cross it over the other leg. Grasp the ankle with the hand from the same side and place the opposite hand on the floor behind me. Then rotate gently including looking behind me and hold for twenty seconds. Sometimes I can get my spine to pop on this one. Of course, reverse it and hold for twenty. Another big help is moving my car seat up until my left foot is against the firewall. No need to cramp or apply pressure. The foot against the firewall is a queue to keep my pelvis firmly against the seat back and prevent slouching. Before I figured that one out, driving could be torture. Brisk walking on level ground is another good treatment. Keep your chin up, swing your arms, and walk far and fast enough to get your body temperature up.
One thing to keep in mind is obesity is no friend to your back. By significantly reducing the sugars in my diet, I’ve dropped about 8 pounds over the last month. My goal is a BMI of 22 or so. Not there yet and I expect it will take the better part of a year. Some people claim that BMI is too strict. Mule fritters. What’s normal in America is not healthy. We exercise too little and eat way to much crap. We snack on confections instead of restricting our intake to wholesome foods taken only at meal times. How many of us in our 50’s remember when we were children being told not to snack between meals? Now snacking is taken as a norm. What are snack foods made of? They’re mainly concocted from some combination of the three big, heavily subsidized commodity crops: wheat, corn, and soy. High in calories, low in nutrients, and very profitable. Read Michael Pollan. The quantity and quality of food that goes into your mouth affects your back.
And now the Peak Oil angle. Rising oil prices will drive up the cost of medical care, or, more properly called, disease intervention. All of my treatments have a low carbon footprint. They cost nothing. I can do them anytime and anywhere. Eating food with less processing uses less oil.
They say a person who has himself as a patient has a fool for a doctor. This fool had been getting good results. Is it foolish to believe a consistent routine of good maintenance practices can keep you from needing expensive repairs?
[/quote]
DurangoKid,
Is one or both piriformis muscle(s) affected?
[quote=grandefille]DurangoKid-
Like you, I struggled with a tight piriformis and associated sciatica for many years. Mine was caused by a mild case of cerebral palsy. About a year ago, I attended a seminar series entitled “Pain Free Living” by Henry Ford Hospital in the Detroit area. There was a physical side and a mental side to their philosophy. The physical side started with the assumption that much pain is caused by overly tight muscles: When a muscle is always contracted, the brain learns that contracting it more doesn’t result in much motion, so the brain recruits other muscles to perform the desired movement and “forgets” how to relax and contract that muscle. The seminars taught us somatic muscle education to re-engage the brain to control contracted muscles. The link below shows a version of exercises for the low back. You can also google “somatic education” to learn more exercises. I can honestly say that, at age 49, these simple exercises changed my life!! For me, they were much more effective than stretching, and the results have been consistent for nearly a year. If you are interested, try these once in the morning, and again just before bedtime. I also do them after activity which contracts my piriformis.
Another thing that I learned from those seminars is that using a strap (preferably with slight stretch) to hold your thighs together while seated greatly reduces low back stress. Driving is much easier when I use the strap. In a pinch, I have wrappec a jacket around my legs and tied the sleeves together.
Julie
http://www.somatics.com/sciaticasymptoms-piriformissyndrome.htm
[/quote]
Julie,
Thanks for that reference. Thomas Hanna studied under Moshe Feldenkrais (who Jeff referred to) and added in some PNF (proprioceptive neuromuscular facilitation) work from Knott and Voss. The work is a bit of an oversimplification of complex problems but there is no doubt that many of the interventions can be very effective.
The key is picking the right “tool” for the job and knowing how and why to pick the right “tool”. The problem with so many practitioners is that when all you have is a hammer, everything looks like a nail.
Some people need stretching, some need strengthening, some need motor control, some need stabilization, some need mobilization, some need postural training, some need body mechanics training, some need improved somatic awareness, some need changes in their mental conceptualizations, etc., etc. A hammer is a great tool for pounding a nail but lousy for cutting wood. A saw is great for cutting wood but lousy for pounding a nail. For some folks, the strap to hold the thighs together works great, for others is will raise holy havoc. The key is understanding WHY.
[quote=DurangoKid]I’m siding with the exercise and stretching strategy to manage lower back pain. I’ve been working on stretching the piriformis muscle that joins the head of the femur to the sacrum. Many people who bicycle intensively have a problem with this muscle and the nerve routed around it. Usually the nerve goes underneath it, sometimes over it, and sometimes even through it. When the pirifomis spasms, ouch! Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra. Neither performed any tests or exam. It has been shown that a bulging disc alone is often not sufficient to cause back pain. Whether it’s a bulging disc or piriformis spasm, I don’t know. What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery. The more I use it, the better I feel.
[/quote]
Nice post DK,
I couldn’t have said it any better. We get a few patients every month in our practice that have symptoms related to Piriformis Syndrome. I would clarify one point however, stretching is a good method for maintaining a pain-free state, but generalized muscle stretching techniques applied to a muscle harboring trigger points, will do nothing but intensify any trigger point activity that is present. So the key here, as you described, is to be vigilant with your stretching routine and try to prevent the activation of trigger points in the particular muscle group.
Another point that you made, which I want to emphasize, is that is very common for people have spinal disc herniations and have no pain complaint associated with it. Likewise, many physicians attribute heel pain complaints to a heel spur found on X-ray, but if they were to X-ray the other foot they are more than likely to see a similar heel spur on it that is not producing a heel pain complaint.
Statistically speaking, the majority of musculoskeletal pain complaints are myofascial (muscular) in origin, so it serves one well to rule out trigger points as a cause of physical pain, before looking towards the traditionally recognized joint damage/dysfunction paradigm of modern medicine. As Dr. David Simons, the co-founder of modern Trigger Point Therapy wrote:
“Muscle is an orphan organ. No medical specialty claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points…”
Thanks again for the excellent post…Jeff
ao,Thanks for the clarification, and I completely agree with the points expressed. Regarding nutrient deficiencies and myofascial pain syndromes, you are correct that certain trace element, mineral, and vitamin deficiencies can perpetuate trigger points. Not long ago I read some research confirming this. Here is the abstract on PubMed. Take your zinc if you want to minimize pain and depression.
Best…Jeff
ao and JAG,
All PT’s (like any other profession) are not created equal.
Many thanks for input on this thread. About 10 yrs ago I learned to appreciate the value of an excellent manual physical therapist on spinal and associated issues from C1 to L5 and the iliosacral joints. That intensive experience has helped me for a decade, along with:
[quote=ao][quote=DurangoKid]
I’m siding with the exercise and stretching strategy to manage lower back pain. I’ve been working on stretching the piriformis muscle that joins the head of the femur to the sacrum. Many people who bicycle intensively have a problem with this muscle and the nerve routed around it. Usually the nerve goes underneath it, sometimes over it, and sometimes even through it. When the pirifomis spasms, ouch! Two doctors diagnosed me with a crushed disc in between my sacrum and lowest lumbar vertebra. Neither performed any tests or exam. It has been shown that a bulging disc alone is often not sufficient to cause back pain. Whether it’s a bulging disc or piriformis spasm, I don’t know. What I know for sure is that my exercise program helps me manage my lower back without drugs or surgery. The more I use it, the better I feel.
I refuse to give up cycling and still train fairly regularly. What I do is after every ride I stretch the piraformis by first lying on my back with knees raised. Then cross one leg over the other and gently but firmly tug on the knee or on the top portion of the tibia. Make sure the pelvis sits flat. Hold for twenty seconds per side. There are several variations on this. Google “piriformis stretch”. I also stretch by touching toes with my knees locked and unlocked. Simple sit-ups with the knees bent helps to maintain alignment of the pelvis and strengthen the abdomen. Improves posture. Start a program of sit-ups beginning with an easy number of reps at first and then increasing the number by a few weekly. I’m up to 30 this week. Another help is rotations. There are two versions of this. While on the bike if I’m having discomfort, I straddle the top tube and face 90 degrees from the direction of motion. With both feet on the ground and grasping the saddle, I rotate clockwise when facing right until my back pops and then reverse. This takes some practice in relaxing the abdomen and diaphragm. Repeat facing left. It’s about 90% effective in relieving lower back pain during a ride. As part of my after ride stretching, I sit upright on the mat, bend one knee and cross it over the other leg. Grasp the ankle with the hand from the same side and place the opposite hand on the floor behind me. Then rotate gently including looking behind me and hold for twenty seconds. Sometimes I can get my spine to pop on this one. Of course, reverse it and hold for twenty. Another big help is moving my car seat up until my left foot is against the firewall. No need to cramp or apply pressure. The foot against the firewall is a queue to keep my pelvis firmly against the seat back and prevent slouching. Before I figured that one out, driving could be torture. Brisk walking on level ground is another good treatment. Keep your chin up, swing your arms, and walk far and fast enough to get your body temperature up.
One thing to keep in mind is obesity is no friend to your back. By significantly reducing the sugars in my diet, I’ve dropped about 8 pounds over the last month. My goal is a BMI of 22 or so. Not there yet and I expect it will take the better part of a year. Some people claim that BMI is too strict. Mule fritters. What’s normal in America is not healthy. We exercise too little and eat way to much crap. We snack on confections instead of restricting our intake to wholesome foods taken only at meal times. How many of us in our 50’s remember when we were children being told not to snack between meals? Now snacking is taken as a norm. What are snack foods made of? They’re mainly concocted from some combination of the three big, heavily subsidized commodity crops: wheat, corn, and soy. High in calories, low in nutrients, and very profitable. Read Michael Pollan. The quantity and quality of food that goes into your mouth affects your back.
And now the Peak Oil angle. Rising oil prices will drive up the cost of medical care, or, more properly called, disease intervention. All of my treatments have a low carbon footprint. They cost nothing. I can do them anytime and anywhere. Eating food with less processing uses less oil.
They say a person who has himself as a patient has a fool for a doctor. This fool had been getting good results. Is it foolish to believe a consistent routine of good maintenance practices can keep you from needing expensive repairs?
[/quote]
DurangoKid,
Is one or both piriformis muscle(s) affected?
[/quote]
DurangoKid,
I didn’t get an answer on this so I’ll explain why I asked. If only one piriformis is affected, then the problem obviously isn’t just the pressure of a bike seat causing piriformis syndrome. Piriformis syndrome is very commonly misdiagnosed. It was unrecognized for years other than mention in some osteopathic journals. Then an article appeared in the Archives of Physical Medicine and Rehabilitation (which was not a very good article by the way) and every Tom, Dick, and Harry with pain in their buttock was being diagnosed as having piriformis syndrome. In my experience, piriformis related pain most commonly arises in one of three ways: (1) direct macro or micro trauma, (2) sacral dysfunction causing length/tension changes in the piriformis, and (3) disc derangement causing pain referred into the piriformis or piriformis up-regulations.
In your case, I would guess the most likely probability would be a flexed spine position when cycling contributes to a disc derangement which neurally sensitizes the piriformis. While stretching it is fine, it’s a bit of a bass ackwards approach. Some of what you recommended is good and some is not so good. Sit-ups are not the best approach. They strengthen the rectus abdominus but can neglect the transversus abdominis. The transversus abdominus is the key for postural support, not the rectus abdominus. Similarly, the toe touching may feel good initially but could be contributing to increased disc derangement that ultimately keeps contributing to your need to stretch. The rotational stretches with self manipulation are fine but could contribute to eventual development of hypermobility.
You didn’t mention any trunk extensor strengthening (or more specifically, multifidi strengthening) which should always complement trunk flexor strengthening (i.e. your abdominal exercises). You also didn’t mention any trunk extension mobility exercises which could help reduce any potential disc derangement and possibility eliminate your need to habitually stretch the piriformis. If you always have to stretch a structure, something is wrong, something is out of balance.
Your positive response to proper sitting posture in your vehicle and brisk walking also suggest disc derangement rather than a primary piriformis syndrome. If you have a sacral rotation, it could stress the disc and sensitize your piriformis. The sacral rotation could be corrected with appropriate manual therapy and if hypermobility has developed (which it may have from some of your activities), you could be trained in self correction of that dysfunction.
Also, HOW you use your body is at least as important as exercise. Most athletes don’t realize how subtle variations in body use and “body being” can create big differences in performance and comfort during that performance. In 32 years of working with an exercising population and patients including world class Olympic and professional athletes, I’ve never found one yet that didn’t have at least minor postural, movement, and awareness faults.
A good (and I emphasize good) evaluation by an appropriate professional could ascertain all this and allow your to target your problem with more specificity and enable you to more effectively prevent recurrences. You mentioned two doctors above (and I’m assuming you meant MDs) but unfortunately, very, very few know how to do a truly thorough structural and functional work-up of a patient with mechanical spinally based pain (including piriformis pain).
I would venture to guess (but I have no evidence) that if the study below focused on mechanical spinal pain rather than musculoskeletal problems in general, the orthopaedic manual therapy PT in private practice would come out on top. As I and also Southerner said, practitioners are not equal.
top.http://www.putmebacktogether.com/Home/PhysicalTherapyArticles/PhysicalTherapyArticle/tabid/134/itemId/98/Default.aspx
While I appreciate the physical/energy approach to managing pain, this article seems to have neglected natural low-tech herbal pain remedies. In the case of trauma, remedies (as opposed to therapies) can be very useful. If you hit your thumb with a hammer, you probably don’t want to lead off with stretching exercises. 
In particular, the cambium (inner bark) of willow trees is a potent pain reliever. In fact, this tree’s latin name (Salix), is the same root as the name of compounds in many artificial pain killers, such as aspirin (acetylsalicylic acid).
Willows are ubiquitous; you are probably no more than walking distance to one when you are in pain!
Another useful pain reliever is common ginger, which by weight, has been found to have the same pain relief as aspirin or ibuprofen.
…this subject addressed here. The more we can do to maintain/improve our health outside of the expensive and complex Western sick-care system, the more resilient we (and our communities) will be. Bravo, Capn’ Sheeple!
Jag,
Some of the ways of responding and terms you used in this article were reflected in a book I’ve been involved with for the last 6 months - The Presence Process by Michael Brown. Just curious if you had read the book as well.
Dan
Dan,
I’ve never heard of the book you mentioned, but the title appeals to me. Thanks for the recommendation, I’ll check it out.
Here is it’s listing at Amazon: The Presence Process: A Journey into Present Moment Awareness by Michael Brown
Jeff
I am also a graduate of a Feldenkrais training and sometime practitioner, and even though this author did not get it quite right, I am impressed that he has some awareness of this fantastic work, which remains not nearly as well-known as it should be. Less technically, the Feldenkrais Method is about the ease and efficiency of movement, and the organization of the nervous system and self-image, which of course has a relationship to pain. It can be very effective in relieving chronic pain, if the pain is related to poor organization of movement, and as you mentioned, mechanical in nature.
I have been living with sciatica pain for years. Stretching has been a life saver for me. I have seen so many doctors that only want to perscribe me an opiate or want to do back surgery. For them it is only about their bottom line. I hate that. So unconventional sciatica remedies including stretching and eating foods that full of natural anti-inflamatory qualities are the things that have helped me the best.
I was a little curious and amazed about your experience with Nutra Joint. It turns out that the main ingredient is Gelatine.Gelatine is extracted by boiling bones. I'd say most of the population doesn't cook from scratch and won't benefit from it unless they eat jello regularly. There's no gelatine in any of the store bought broths. It's been extracted to sell as a separate item as Knox Gelatine or to add to Jello.
So throw all the scrap left over chicken, beef etc bones in a kettle and add your favorite veggies and voila your natural medicine in a soup.
Sonya
Sonya,Knox has listened to their marketers and have a myriad of products with all sorts of additives and strengths. The original version - gelatine and 7 minerals/vitamins is still my favorite. About a year after I started taking it, I bought a couple of cans of the more expensive Nutra Joint with glucosamine and chondroitin. After 6 weeks, my knees started hurting again. Now, I stick with the cheap stuff. If I use it every day, my knees start "floating" and it feels like they may dislocate. Then, I stop taking it for a month or so until my knees feel raspy.
The local drugstores only carry the expensive versions with all the bells and whistles. I would prefer to buy local, but the stores won't even order me a case (6 cans which lasts about a year for me) so I buy it here: http://www.drugstore.com/osteo-bi-flex-knox-nutrajoint-with-gelatin-drink-mix-unflavored/qxp273297?catid=183281. About every 2-3 months they have various sales and you can get it as cheap as 2 for 1 … plus shipping.
Your solution of making soup is an excellent and tasty alternative. Do you crack the beef bones to get the goodness of the marrow out? If you don't have the time, inclination, or wherewithal to make a pot of soup regularly, this might work for you.
Grover
Groover,
Thanks for the extra info, but I'm just trying to understand what's happening here. I'm a little amazed with your results. I've been using glucosamine and chondroitin ( calcuim etc ) on a regular basis and it has helped significantly with one joint in particular (hand). I do make soups almost every week not always with bones . I find chicken, turkey and ham bones have a LOT of gelatine. The broth just makes this gel (jello) as it cools. Maybe the expensive version of Nutra Joint has way less gelatine? I have to look into this a little deeper. I'll experiement. It would make aging people more mobile .
Thx
Sonya