2 ACL surgeries, a long recovery, and now piriformis syndrome has put me in the ER — my timeline and a question about injections
Hey everyone. Long post, I know — but I want to give the full picture because I genuinely don't know how much of this is connected. Would really appreciate hearing from anyone who's been through something similar.
**Background & surgery history**
**2006** — First ACL injury (left knee). Played football semi-professionally — lower back issues were already a recurring problem back then. Required medication and taping just to get through matches.
**May 2024** — Phase 1 of a two-phase left knee reconstruction. Bone transplant to reduce the old graft hole, plus meniscus surgery. Had to wait at least 6 months for the bone graft to integrate before moving to phase 2.
**June 2025** — Phase 2 ACL reconstruction and another meniscus. Completed rehab. Knee is functional — flexion is reduced compared to the right side, but I can manage. Back to playing padel and doing yoga.
**October 2025** — Lower back pain flares up on both sides, right significantly worse. Familiar from my football days. Started strengthening work and physio.
**Dec 2025 – Jan 2026** — Lower back settles a bit... then the pain migrates to my right glute.
**February 2026** — Doctor diagnoses piriformis syndrome. Prescribed Tramadol 75mg and Enanplus 25mg because at that point I couldn't sit or lie down without significant pain. Kept up with padel and yoga when possible, continued physio.
**March 2026** — Gradual improvement with consistent therapy and exercises. Using meds as needed, going 1–2 weeks without then needing them again when it spikes. Muscle MRI (waist down) came back completely clear.
**April 2026** — Two weeks in Asia with long-haul flights both ways. I believe this pushed me over the edge. Extended sitting in a compressed position was brutal and I came back in significantly worse shape.
**Today (May 2026)** — Last night, i barely slept due to pain and pushe through avoiding medication. Ended up in the ER this morning. Couldn't get out of bed. Every movement sends shooting pain down my right leg, right lower back is now radiating as well. Tramadol no longer fully masks the pain. ER added Valium 5mg every 8 hours on top of the Enanplus.
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I'll be honest: I'm exhausted. I'm sick of living on tramadol. I hate the way it makes me feel and I hate that it doesn't even work properly anymore. The ER and most doctors I've seen here in Spain feel like they're managing symptoms rather than treating the actual problem. The MRI showing nothing is both a relief and deeply frustrating — it leaves me stuck with a diagnosis no one seems willing to treat aggressively. Although a new rehab clinic ive started to see mentioned a an MRI (Lumbar) would be good to have.
My question for the community:
I've been looking into image-guided corticosteroid injections combined with Botox injections directly into the piriformis muscle, alongside 1-on-1 physiotherapy twice a week. Has anyone gone this route? Did the injections provide meaningful relief, even if temporary? And did that window of reduced pain actually allow PT to be more effective?
From what I've read, the Botox specifically relaxes the piriformis over several months, which could give my body a real chance to respond to rehab rather than fighting a chronically spasming muscle. I'm willing to push my doctors for a pain management or physiatrist referral — I just want to hear from real people first.
If you've dealt with stubborn, long-running piriformis syndrome, what finally helped? Thanks in advance.
Below is the area where i have constant pain.
