What is Piriformis Syndrome?
Pain in the lower portion of the back that moves into the buttock and then radiates down the back of the thigh and into the leg is known as Sciatica and it is sometimes caused by Piriformis Syndrome.
This is one of the most common causes of Sciatica and it is due to irritation of the spinal nerves in or close to the lumbar spine. Sometimes nerve irritation can occur further down the leg. Piriformis Syndrome can be a very painful condition, but it is not life-threatening and it rarely requires surgery. Most people who develop Piriformis Syndrome can manage their symptoms successfully with simple, conservative treatments.
Piriformis Syndrome is an unprecedented neuromuscular issue that is caused when the piriformis muscle compresses against the sciatic nerve. The piriformis muscle is a large, band-like muscle situated on the bottom of the lower back and buttocks close to the highest point of the hip joint. This muscle is critical in providing movement and flexibility since it balances the hip joint and provides mobility for the leg.
The sciatic nerve is a thick and long nerve in the body. It is adjacent to the piriformis muscle, going down the back of the leg into the feet. Nerve pressure can be caused by spasms of the piriformis muscle.
In the United States, women are much more likely to develop Piriformis Syndrome, in fact, the incidence ratio of women to men for the disorder is 6:1. Some authors estimate the incidence of Piriformis Syndrome to be around 6% in patients who have Sciatica.
The condition is most often seen in women who are between the ages of 30 to 40 years old, due to hormonal changes women experience throughout life. This hormonal influence is especially significant during pregnancy when the pelvic muscles change to prepare the area for childbirth. Piriformis Syndrome is not seen in children and rarely occurs in people younger than 20 years old. Piriformis Syndrome affects people of all lifestyles.
Reasons for Piriformis Syndrome
Sciatica is caused by inflammation of the sciatic nerve. It is not known what initially causes Piriformis Syndrome and starts this irritation. Some doctors believe the condition starts when the muscles spasm and squeeze the sciatic nerve up against the pelvic bone.
Piriformis Syndrome sometimes begins with an injury such as falling. A hematoma is formed when bleeding occurs around and in the piriformis muscle and pools in the area. The muscle swells and puts pressure on the sciatic nerve. Piriformis Syndrome is the result, with muscle spasms occurring, even though the hematoma dissolves.
The muscle tissues eventually heal, but some of these fibers are replaced by scar tissue. This scar tissue isn't as flexible as healthy muscle tissue and when the piriformis muscle tenses, it puts pressure on the nerve, causing Piriformis Syndrome.
A full explanation or reasons for Piriformis Syndrome are obscure. Suspected causes include:
- Impairment of the piriformis muscle, either due to aggravation in the piriformis muscle itself, or bothering of an adjacent structure, for example, the sacroiliac joint or hip
- Swelling of the piriformis muscle, because of damage or impairment
- Bleeding in the region of the piriformis muscle.
Anyone or a mix of the above issues can influence the piriformis muscle (causing buttocks pain) and may influence the adjoining sciatic nerve (causing pain, tingling, or numbness in the back of the thigh, calf, or foot).
There are different risk factors that may make people more inclined to create piriformis disorder.
- A few investigations recommend that piriformis disorder is more typical in females by a 6:1 proportion, thought to be because of anatomical contrasts.
- Anatomical variety in the situating of the sciatic nerve in relation to the piriformis muscle may prompt piriformis disorder. In a few people, the sciatic nerve navigates through the piriformis muscle, for instance, maybe improving the probability of sciatic nerve pressure.
- Direct injury or damage to the buttock can prompt swelling, hematoma development, or scarring, which may prompt pressure or entanglement of the sciatic nerve.
- Incorrect position when sitting may prompt direct pressure against the sciatic nerve. Piriformis disorder has, hence, some of the time been alluded to as "fat wallet disorder" or "wallet sciatica," as it has been found to happen in individuals ceaselessly sitting against their wallet on a hard surface.
- Abuse or monotonous developments, for example, happen with extended walks, running, cycling, or paddling can prompt aggravation, fit, and hypertrophy (amplification) of the piriformis muscle. This can improve the probability of sciatic nerve disturbance.
Piriformis Syndrome: Symptoms
Piriformis Syndrome can cause Sciatica, resulting in pain that shoots down the back of the thigh and into the leg.
The Piriformis Syndrome symptoms can occur in only one leg, or sometimes they are experienced in both legs. Piriformis Syndrome can cause pain that travels down the leg and into the foot, making it sometimes mistaken for a herniated lumbar disc. Piriformis Syndrome rarely causes Piriformis Syndrome symptoms of weakness, but sometimes it causes sensations of tingling in the legs.
People who have Piriformis Syndrome may have trouble sitting. Since sitting on the affected side causes pain, people with the condition will sit with their sore buttock tilted upward instead of sitting flat down in a chair.
Piriformis Syndrome, for the most part, begins with pain, tingling, or numbness in the buttocks. Pain can be serious and reach out down the length of the sciatic nerve (called sciatica). The pain is expected in the piriformis muscle compacting the sciatic nerve, for example, while sitting on an auto seat or running. Pain may likewise be activated while climbing stairs, applying firm weight straightforwardly against the piriformis muscle, or sitting for extended periods of time. Most instances of Sciatica, in any case, are not due to piriformis disorder.
People with Piriformis Syndrome may encounter an assortment of Piriformis Syndrome symptoms, which may happen irregularly or they might be available incessantly. The side effects of Piriformis Syndrome are regularly exacerbated by drawn-out sitting, delayed standing, crouching, and climbing stairs.
- Pain in the buttocks or hip area is the most widely recognized Piriformis Syndrome symptoms.
- Pain may emanate from the buttock area down into the lower leg along the way of the sciatic nerve. A few patients may experience lower back pain.
- There might be numbness and tingling in the buttock area, which can now and then transmits down to the lower leg.
- Women may experience pain during intercourse.
Diagnosis of Piriformis Syndrome symptoms usually starts with your physician taking a complete history and performing a physical examination. You will be asked questions about how your pain affects your daily activity and about your other symptoms. Your doctor will ask if there are any activities that help your pain or if any positions relieve your symptoms of piriformis syndrome. You will also be asked if you have had any recent accidents or past injuries. Your family history is also important in diagnosing piriformis syndrome.
Your doctor will check your posture, watch how Piriformis Syndrome symptoms might be affecting your gait, and check for the location of your pain. Your physician will want to see which movements make your pain worse.
Your muscle strength, your reflexes and skin sensation will also be tested because it is sometimes difficult to distinguish Piriformis Syndrome, which comes from the sacroiliac area, from a pain that comes from other spinal disorders.
Lab tests might be ordered to rule out an infection or Arthritis. Your blood might be drawn and your urine may also need to be tested due to Piriformis Syndrome symptoms
Other tests your physician may recommend to diagnose Piriformis Syndrome include:
- X-rays: To help diagnose piriformis syndrome, X-rays of the pelvis and lower back are typically taken. These tell your doctor how much degenerative damage has occurred in the sacroiliac joint. X-rays of the hips and lumbar spine may also be used to rule out conditions that cause symptoms similar to Piriformis Syndrome.
- Magnetic Resonance Imaging (MRI): An MRI may be recommended to give the physician detailed pictures of the soft tissues, to rule out conditions other than Piriformis Syndrome. An MRI uses magnets and radio waves to produce images of your pelvis and lumbar spine.
- Neurography: This is a special MRI test that is used to examine the nerves. It uses an MRI scanning machine, but the settings are calibrated to locate irritation along the nerves. Neurography may be changing the way physicians diagnosis conditions like Piriformis Syndrome, Carpal Syndrome, and Thoracic Outlet Syndrome.
The most accurate method doctors use to diagnose Piriformis Syndrome involves injecting an anesthetic into the muscle. The piriformis is located deep within the buttock, so this procedure requires guidance with use of a CT scanner, an open MRI or a fluoroscope. If the pain resolves following the injection, your physician can be reasonably certain your symptoms were caused by Piriformis Syndrome.
Piriformis Syndrome Treatment
Piriformis Syndrome treatment often begins with nonsurgical treatment. In cases which are not severe, a physician may simply monitor the patient's symptoms to see if they improve. Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen are often used to decrease the inflammation and pain which are caused by nerve irritation. Acetaminophen will help to relieve pain in many cases of Piriformis Syndrome, but it will not treat the inflammation.
If the Piriformis Syndrome treatment is not effective in relieving the pain of Piriformis Syndrome, your doctor may recommend injections of a local anesthetic. Medication such as lidocaine help to relax the muscle and decrease the irritation of the sciatic nerve. Other medications such as cortisone are sometimes combined with an anesthetic to relieve the inflammation of Piriformis Syndrome.
Piriformis Syndrome treatment can also be done nonsurgically with botulism injection therapy. This is used to temporarily paralyze the muscle, relaxing it and taking pressure off the sciatic nerve. The effect of these injections on Piriformis Syndrome only lasts a few months. During that time, a program of stretching can be used which will provide a more permanent solution. By the time the effects of the injection have worn off, the muscles are no longer producing symptoms of Piriformis Syndrome.
Non-Surgical Piriformis Syndrome Treatment
Most doctors refer patients with Piriformis Syndrome to physical therapy. A skilled therapist will evaluate your condition, including the condition of your hip and sacroiliac joints and your low back. Typical physical therapy Piriformis Syndrome treatment for Piriformis Syndrome may include:
- Heat applications: Heat helps the muscles relax, which eases pain and spasms. Hot packs may be placed over the muscles of your buttocks, easing the pain of Piriformis Syndrome.
- Ultrasound: This therapy uses sound waves at a high frequency, directed through the skin to produce deep heating to the muscles. Deep heating prepares the muscles for stretching and relaxes muscles that are frequently tight and tense due to Piriformis Syndrome.
- Hands-on treatments: These may include deep tissue massage and soft-tissue mobilization. The therapist may help position your leg and hip in such a way that relaxes nerve signals and reduces Piriformis Syndrome pain.
- Stretching: Stretching for Piriformis Syndrome is usually attempted after the application of heat and hands-on treatment. You will be positioned in ways that provide a good amount of stretch to the piriformis muscle. Your therapist will also teach you ways to stretch at home. It's important to follow your program at home, being cautious and gentle as you stretch. Recovery from Piriformis Syndrome often depends on your compliance with your exercise program.
As your symptoms begin to improve, your therapist will likely increase your exercises to include training in posture, general conditioning exercises, and a muscle strengthening program to help prevent future episodes of Piriformis Syndrome and serve as Piriformis Syndrome treatment.
Surgery is usually considered only as a last resort for Piriformis Syndrome. Two procedures may be used. In the first, the piriformis muscle is cut where it connects to the hip bone. The other procedure involves cutting through the piriformis muscle to relieve pressure on the sciatic nerve in order to relieve symptoms of Piriformis Syndrome. These are both typically outpatient procedures and Piriformis Syndrome treatment and may be performed using spinal or general anesthesia.
Full recovery following surgery for Piriformis Syndrome can take several months. Your surgeon will probably recommend physical therapy as Piriformis Syndrome treatment for the first several weeks.
During physical therapy following surgery for Piriformis Syndrome, your therapist may start with treatments aimed at controlling muscle spasms and pain such as massage, ultrasound, electrical stimulation and applications of ice or heat. As you continue to heal from Piriformis Syndrome you will start learning how to regain your strength and mobility without injuring the area that is healing.
As you continue to heal after surgery for Piriformis Syndrome, your therapist will challenge you to more difficult exercises. The goal of therapy and Piriformis Syndrome treatment is to completely recover from Piriformis Syndrome, advancing in strength and functioning.
Eventually, you will be able to resume the activities you enjoy participating in. Your therapist will teach you how to safely participate in normal daily activities and provide guidance on what activities may be best to avoid to prevent recurrence of Piriformis Syndrome.
The spinal nerves in your lower back exit the spine and join together to form your sciatic nerves. This major nerve leaves the pelvis bones through the sciatic notch. Your piriformis muscles that are involved in Piriformis Syndrome connect at one end to the bones inside your pelvis and, on the other end, connect to the top side of the hipbones, one on each hip.
Your piriformis muscle helps to turn your leg and foot outward. Since the sciatic nerve is located under the piriformis muscle, problems in this muscle can cause irritation and inflammation of the sciatic nerve, which leads to the symptoms of Piriformis Syndrome.