Over the past couple of years, I’ve been learning a lot about how to cope with episodic physical pain. About 2 to 3 years ago, I experienced an injury that led to severe sciatic pain and great difficulty walking for a few weeks. I went to my physician, and he said it was piriformis syndrome. I had never heard of the piriformis muscle, let alone a syndrome having to do with it, but apparently, it’s a muscle we all have in our rear ends, and for some of us, it sort of wraps around the sciatic nerve. As a result, when the piriformis has problems, it irritates the sciatic nerve, causing extreme pain and difficulty walking, moving around, sleeping, and so forth. I went to physiotherapy and rested a fair bit, and after about 3-4 weeks, it went away. The physiotherapist, although extremely helpful, left me on an ominous note, suggesting that it might come back at some point. I wasn’t too thrilled with that prospect, as this was probably some of the most severe physical pain I’ve ever experienced (and I’ve experienced a lot of physical pain at various times throughout my life). Nevertheless, I merrily went along my way, gradually forgetting the trauma of the flareup of piriformis syndrome, until it did, indeed, come back! I had been spending a lot of time sitting around on flights, and when I got home, it started to flare up again. I was rather resentful having to deal with this yet again, particularly as it severely curtailed my everyday activities, and I am one of those people who really enjoys staying fit and active. I didn’t have patience for the process of pain and recovery, and I sure didn’t want to sit around and let my body go to pot.
To cope with this situation, I had to re-learn what we teach a lot of our clients about the importance of both accepting physical or emotional pain and if possible, working to change it. I practised radical acceptance that the pain was present, tried mindfulness practices involving observing and noticing the pain as well as other areas of my body that were not experiencing pain (this is commonly referred to as the body scan technique and is one of a package of mindfulness practices that have a lot of evidence for the treatment of pain). On the change or problem-solving end of the spectrum, in the case of piriformis syndrome, a variety of stretches and exercises can provide short term relief and expedite recovery. They can also be quite painful, so I had to use other skills to get myself to do them, such as thinking about the pros and cons of doing versus not doing the exercises. This is also a skill that we teach our clients: reviewing the pros and cons of practising skills versus the pros and cons of engaging in some kind of ineffective behaviour. In the longer-term, I realized I had to accept that I’ll probably have to be careful and curtain certain physical activities that tend to exacerbate or bring on the sciatica, as well as continue to make time for preventative stretching exercises on a regular basis.
I think this general set of skills (radical acceptance, mindfulness, pros and cons, and problem solving) is probably quite applicable to a lot of physical or emotional problems that come and go in an episodic fashion. Depression, for example, tends to come and go, and much like my severe sciatic pain, can be debilitating, miserable, and demoralizing. When you feel depressed, you often can’t really imagine not feeling depressed. I sometimes feel the same with the sciatic pain: When it’s happening, it’s hard to remember what it’s like to be without it. It’s also hard to accept something like depression. It can be easy to become resentful or ruminate about why you have to go through such misery, and yet, resentment and rumination just make things worse. Balancing acceptance of exactly what you are feeling with small steps toward change can be a good place to start in becoming free from this miserable cycle. When you’re depressed, it can be difficult to take those small steps toward change. Getting up in the morning, showering, getting dressed, eating, seeing people, and so forth, can be painfully difficult, just like my stretching exercises. At these times, I think it’s helpful to practice thinking about the pros of getting up and doing something and the cons of staying in bed.
There’s also another vicious cycle that I’ve observed among some of the folks we’ve worked with who struggle with depression: In the in-between periods, when they’re not depressed, they struggle with worry that they will become depressed again and start to think that it’s pointless to bother building their life back up, as it will all come crashing down later anyway. It can be easy to fall into this trap with physical pain as well. I could decide that, because it’s probably going to come back anyway, I shouldn’t bother doing my preventative stretching or getting back to my regular exercise routine, etc. I’ve found the skill of mindfulness of pleasant events to be helpful in these instances. I focus on the fact that I’m feeling strong and doing well, actively try to appreciate it and not take it for granted, and try to be unmindful of worries that the pain will return. I also use pros and cons to get myself to do my preventative yoga and stretching exercises, and to get myself to avoid sitting for too long or doing other things known to exacerbate the condition. If you struggle with depression, you might consider focusing on mindfulness and appreciation of the periods between the pain. Really jump back into your life, but don’t be naive to the possibility that the depression will return. Take preventative steps to reduce the likelihood or intensity of future episodes.
Finally, if anyone reading this has actually suffered from piriformis syndrome, I thought I’d briefly share the 25-minute yoga routine that I’ve found even more helpful than the various stretches you can find online: Sun salutation x 2, revolved chair pose, downward dog to pigeon pose, sun salutation x 2, revolved triangle pose, wide leg forward bend, child’s pose, seated half spinal twist, and of course, corpse pose. One important caveat here is that I’m not a physiotherapist or a yoga instructor. I have, however, found this routine particularly helpful during flareups (especially shortly before bed, I’ve found it helps reduce pain and stiffness at night) and am hoping it will be preventative as well. I’ve got it on my schedule for tomorrow morning. ~ Alexander L. Chapman, Ph.D., R.Psych