Piriformis and Groin Strain - maybe?

[Saddlepal3]

Looking for advice: I am one year out from a Total Hip Replacement on the left side; 6 months out from a revision of a Resurfacing on the right side. All seemed to be going well until about 6-8 weeks ago. On the left side, I have significant thigh pain that starts up after I’ve been sitting for awhile. I think it’s originating in my butt, but the pain is centered in the thigh. On my right side, I have a sharp pain that originates at the groin and radiates down the inside of my thigh. Neither pain is all the time, but they both completely stop me in my tracks when either or both hit. My research leads me to believe that the left thigh may be Piriformis Syndrome, which could be a result of the surgery a year ago; the right is likely a groin strain, but I have no clue what caused it. Am wondering if anyone out there experienced these and if there is effective treatment. I really hate to go back to my cane!

[jimbone]

Hello Saddlepal-

Sorry to hear about this.  Not sure my experience is comparable but it might suggest some ideas.  You mention Piriformis Syndrome as a possibility in your left leg.  I am somewhat familiar having dealt with similar symptoms both prior to and after surgery.  My understanding is that this manifests when the piriformis muscle is clamped down or spasmed over the sciatic nerve which usually runs right along next to the muscle although sometimes actually runs through it [anatomically rare].  The sciatic nerve path generally then runs down either the outside of the leg or toward the back so either the IT Band area or the hamstrings [all this surgery for me this year has brought out my anatomy nerd so I get to look up what's bugging me].  One thing I've encountered is that while most of us are very similar physically there are some subtle and minor differences- as in the sciatic nerve pathway.  When you mention thigh pain I automatically think of the front of the thigh in the quads.  The sciatic nerve doesn't travel there so if that's the painful area it's maybe something else.  You said it seems to start in the buttock which does indicate a possible sciatic issue and if it's on the outside or back of the leg you might be dealing with that.  It was a significant issue for me before surgery and a concern I discussed with Dr, Pritchett prior to as I wanted an MRI of the tissues to see if I was in the "through the piriformis muscle anatomy group" thinking it might effect how the surgery was done.  Didn't happen.  They relieve [cut] the piriformis during most THR [not the anterior approach though] and HR and then re attach.  I've found this can cause difficulties.  My 1st hip, on the right this resolved fairly quickly [although the muscle is still not as flexible as before but there is no pain].  The second hip on the right has remained stubbornly difficult and still causes me a specific sharp pain right at the location of the piriformis re attachment when I challenge it too much [which is not much].  It has improved considerably in the 5 1/2 months since surgery but is far from all the way repaired.  The things I find most helpful are stretching, elliptical and foam roller [or a tennis ball].  I can't come close to the piriformis stretch recommended [ankle over the knee or knee pulled across chest] although I continue to try.  What helps for me is to sit on my knee and ankles with my torso stretched toward the floor and my hands/arms stretched out in front.  This is really more of a gluteus medius stretch but those two muscle are right next to each other and it seems to help.  For inside thigh/groin pain I use the foam roller on the adductors as well as massaging the really tight muscles with what the massage therapist call a cross fiber technique- basically using your thumb to stroke across the taut tissues like a banjo string.  It's taken several months but I am finding relief.  I've gone on too long as usual.  Hopefully someone else will respond with some ideas that might work better for you.  Lastly, the elliptical seems to help keep the joint and legs more fluid but 20-25 minutes medium fast paced with a few sprints seems to be the limit [I get bored] and sometimes after the weight circuit just a short easy 10 minutes to loosen up seems to help.  I find resting it or taking it easy on it is sometimes just as important as exercising it.  Very lastly- do you have a good deep tissue massage therapist?  They can really help too.  Ok- be well and best wishes.