u/Resident-Hunt-245

Hello Steve!

I really need an advice because I'm kinda stuck with my issue for about of 9 months already.

Pain map.

Background:

38F, road cyclist, fit. September 2025 started to feel weirdness with my right leg which presented as lower wattages, shin during the ride and a foot stiffness and light pain in the morning. Rest didn't help. After one long ride (zone 2, nothing difficult) where I spent a lot of time in the aero position because of the wind, the next day I woke up with the terrible glute pain in the middle of the butt cheek.

Fast forward to November, after several sessions of shock wave and dry needling the pain was still there.

I did 2 MRIs:

Lower Back MRI:

Initially came totally clear. Asked to have another look. Radiologist updated with minimal annular L5/S1 disk tear. So minimal, that they didn't even notice it. But ok. I did transformational targeted S1 nerve block to rule out the disk (lidocaine + steroid). The block did nothing with my pain even for 1h. I also never ever had a back pain.

Hip MRI:

No issues except labral tear. No tendon problems, inflammation, nothing. By that time I developed light pain in the groin too. I did cortisone injection which gave me mixed results. I could move a bit better, sit better but no dramatic change.

Fast forward to March

The groin pain progressed, the pain in glute remained despite I tried to strengthen glutes, did another round of shockwave. Was redirected to hip preservation specialist who found CAM impingment. This time we did only lidocaine injection to the joint. It helped with pain in the glute but not 100%. But there was a clear improvement in movements.

So, given that there were no other issues discovered, I did hip arthroscopy. Initially first 6 weeks after the surgery the glute pain was 10 times worse. It was just terrible. I had to take a lot of medication.

Today, I'm 13 weeks post op

My ROM is perfect and the surgeon tells that the joint is fine. I don't have pain in the groin anymore which is a success. But the glute pain is still with me. I should say it's better than right after the surgery though. I'm doing again strengthening and I'm progressing however very slow. Focusing on gluteus medius because it's noticeably weaker than on the other side.

Stretching never worked for me, dry needling, electric accupuncture and muscle relaxers give temporary relief, lacrosse ball aggravates it as well as deep muscle release massage. Osteopath didn't help either.

At this point I think I've tried everything and fixed mechanical issues I had but the stubborn pain is still with me. The only thing I haven't tried is Piriformis steroid injections but I'm hesitant because I've read that it can harm tendons. And I'm actually not 100% sure my tendons are good even there were no signs on MRI. Also I've heard about Botox into Piriformis but I'm scary to do it too. What if it will create more problems.

I attended 3 physical therapists and 2 of them think there is a tendon involved but the area where I have pain is very crowded. It's basically the junction of gluteal tendons, sit bone, sciatic nerve, muscles. Different tests were negative including low back tests. Except maybe those which provoke Piriformis pain like figure 4, bending or bringing knee to chest.

Please advice me if anything else I can do besides exercises. Should I just give it a time?

Thank you.

My PT recommends 2 days of rest and 5 days of doing exercises. Sometimes I feel I need more time to recover. Wonder how was it by you at 12 weeks post op? Also, how many steps did you do around this time? Trying to understand if I do too much...

Tried indoor road bike on my Tacx trainer, almost no resistance and had a tight, pulling ache in the groin afterwards. I think the cause is my low stack since it's a road bike. When was it fine to ride again in the aggressive position?

Basically the title. Almost no groin pain, good ROM. My glute medius, piriformis, hamstrings aches non-stop. I have a lot muscle compensations according to my PT. We started to work on balancing on one leg and my knee is rotated inward because of weak glute med. Dry needling helps a bit as well as muscle relaxants however my main pre-op symptom which was glute pain still remains.

I'm starting to think it's irrelevant to the joint and it's something else however lower back and other potential causes were ruled out before the surgery. My surgeon also thinks it's muscles not something neurological.

Does anyone relate? It drives me nuts.

Had a 12 weeks appointment. During the examination I had no pain when they checked my ROM. But after 1h I started to feel dull ache. Is it normal?

Basically the title. I'm 10 weeks post op. When I step on the operated leg, my weight distributed not evenly on the foot. I tend to put more weight to the outside. Did someone have a similar problem?

I know it's a popular topic here and I think many people tell that Piriformis is extremely rare but hear me out and possible give me some advice. Because I'm kind of lost at the point.

TL;DR; 8 months of gluteal pain without improvement + irritation in hamstrings, no numbness or severe pain in the back.

I did 2 MRIs:

- lumbar. Findings: 3mm protrusion without a nerve contact in L5/S1. This was even missed at first look and only discovered when I asked to have another look. Also asked a 2nd opinion and another radiologist thinks there is a minor contact with nerve.

- Hips: impingement + labral tear.

I did a CT-guided injection of lidocaine + cortisone into L5/S1 which did absolutely nothing.

Then I did lidocaine injection into the joint which partially improved the pain but not fully. After 6 months of struggling I did hip arthroscopy and now 10-weeks post op doing my rehab. Groin pain is gone, joint is fine now but glute pain is still there with no improvement.

My PT thinks (and I agree it's sounds probable to me) the pain in the glute is mostly deep gluteal syndrome (aka piriformis) where deep muscles overwhelmed by stabilising joint caused by weak gluteus medius and anterior pelvic tilt so I'm working on improving strengths.

Struggling with PT because it's super tricky to not aggravate symptoms and strengthen at the same time. Also doing dry needling which helps very little.

But. I still kind of think it could be my protrusion? Though I don't have a back pain. Only buttocks + hamstrings, inability to sit. Stretching aggravates it, clamshells aggravates it. If it's a disk what could be my next steps to proof it? Are there any tests?

Could it be that epidural failed but the cause is still disk?

Hi everyone!

I need something encouraging because I'm about to blow up and very depressed. I know some people tell 6 weeks is too early but...

I felt some progress around weeks 2 and 3 and than my improvement stuck. While in the groin it's more or less no pain (however I do have random aches), on the back side of the hip it's awful. I have a lot of pain in the glutes — SI joint, pirformis and also in hamstrings.

Even if I ice and rest it doesn't help. If I walk even a little I have burning in the hamstrings and glutes.

I can't sit and constantly alternate positions but it also doesn't help. My number of steps is not growing. Every step hurts.

My post op protocol included 6 weeks on crutches full weight bearing as tolerated. I used to put 50% or more depending on my pain. Also bike 3x15min/day. I tried to do everything I was prescribed but still in pain.

My levels of activity were incredibly low all this time. I barely walked more than 1000 steps a day, mostly lay and almost no sit.

Staring physio this week and have 6 weelk checkup tomorrow. Physio is my big hope but honestly things are not looking good so far in comparison to what I see from other people on this sub.

I wonder if I messed up the repair somehow. However I hadn't have any sharp pains or popping or even clicking.

I had it before surgery to some extent but now it's another level. It burns, aches, shoots to the calf and hamstrings.

Anyone had it? The point of pain is exactly where Piriformis is and weird shootings come down from this point down the leg.