Piriformis syndrome is a painful condition that occurs when the largest muscle that helps rotate the hip (the piriformis in fact) compresses the sciatic nerve that extends from the spinal cord to the lower legs through the lumbar spine. This compression causes pain in the lower back, hips and buttocks. This pathology is still a subject of debate in the medical world: some believe that the problem is diagnosed too often, while others think exactly the opposite. In reality, only an experienced doctor can diagnose piriformis syndrome. However, you can learn to recognize the symptoms and know what to expect when you go to the doctor for a visit. Read on to learn more.
Steps
Part 1 of 4: Knowing the Risk Factors
Step 1. Assess gender and age
Some research has found that women are 6 times more likely to suffer from this disorder than men. It also occurs more often in people between the ages of 30 and 50.
- The high incidence among women can be explained by the different biomechanics of the pelvic area compared to men.
- Women can develop the syndrome during pregnancy. As the pelvis widens during this time, it can induce contraction of adjacent muscles. Pregnant women often develop a pelvic tilt to support the baby's weight; also in this case the adjacent muscles can become tense.
Step 2. Consider your health
If you have other conditions, such as lower back pain, you may be at increased risk of suffering from piriformis syndrome.
About 15% of cases are due to structural or congenital anomalies concerning the link between the piriformis muscle and the sciatic nerve
Step 3. Review your activity level
The syndrome is almost always diagnosed after what doctors refer to as "macrotrauma" or "microtrauma".
- Macrotrauma is due to a particularly serious event, such as a fall or a car accident. The most common cause of piriformis syndrome is a macrotrauma to the buttocks, which involves inflammation of the soft tissues, muscle spasms and nerve compression.
- Microtrauma consists of a series of continuous minor injuries in the area. For example, cross-country skiers constantly expose their legs to microtrauma, which can potentially cause inflammation and muscle spasms. Running, walking, climbing stairs, or even sitting for a long time can compress the piriformis and block the sciatic nerve, causing pain.
- Another form of microtrauma that can cause this disorder is "wallet neuritis". This situation occurs when a person keeps their wallet (or cell phone) in the back pocket of their pants, putting pressure on the sciatic nerve and consequently causing irritation.
Part 2 of 4: Recognizing the Symptoms
Step 1. Monitor the origin, type and intensity of the pain
One of the most common symptoms of this syndrome is pain in the buttock area, right where the piriformis is located. If you experience constant stinging pain in one or both of your buttocks, you may be suffering from this ailment. Other types of pain that you need to look out for that could indicate the syndrome are:
- Pain when you sit, stand or lie down for more than 15-20 minutes
- Pain that radiates to the front of the thigh
- Pain that gets better when you move, worsens when you sit
- Pain that is not completely reduced even by changing position;
- Pelvic and groin pain. This can be at the labia, for women, and at the scrotum for men;
- Dyspareunia (pain during sexual intercourse) in women;
- Pain during evacuation.
Step 2. Evaluate the pace
Compression of the sciatic nerve due to piriformis syndrome can make walking difficult; you may also feel weak in your legs. The two main aspects to observe when you find yourself walking with difficulty are:
- Antalgic gait, it is a type of walking that is developed to avoid pain. This usually leads to limping or taking shorter steps so as not to feel pain.
- Foot drop: The forefoot tends to hang out of control due to pain in the lower leg. You may also not be able to lift your toe straight up.
Step 3. Pay attention to tingling or numbness
When the sciatic nerve begins to compress due to the syndrome, you may experience a tingling or numb sensation in your feet or legs.
This sensation, known in the medical field as "paresthesia", presents itself as a tingling, prickling or "stinging" sensation
Part 3 of 4: Getting a Medical Diagnosis
Step 1. Consider seeing a specialist
It is difficult to diagnose piriformis syndrome because symptoms are usually similar to the more common lumbar radiculopathy (numbness in the leg due to back pain). Both of these disorders are caused by compression of the sciatic nerve; the only difference is the "point" where the nerve is compressed. Piriformis syndrome is much rarer than lower back pain, and most primary care physicians don't have a deep understanding of this condition. Therefore, consider seeing an orthopedist, physiotherapy specialist, or osteopath.
You should first see your GP and ask him to refer you to a specialist
Step 2. Know that there is no precise test that can define piriformis syndrome with certainty
Your doctor will likely need to do extensive physical tests and undergo some tests to make a diagnosis.
Some tests, such as magnetic resonance imaging, computed tomography, or a nerve conduction study, may be done to rule out other conditions such as a herniated disc
Step 3. Let the doctor run diagnostic tests
To define the presence of the syndrome, the doctor will have to examine the range of movements you are able to do and will ask you to perform various exercises, including lifting the straight leg and rotating the lower limbs. There are other different tests that can indicate this condition, including:
- Lasègue's sign: Your doctor will ask you to lie on your back, flex your hip 90 ° and extend your knee straight out. If Lasègue's sign is positive when you are in this position, it means that the cause of your pain is pressure on the piriformis muscle.
- The Freiberg test: in this case the doctor rotates the leg inwards and lifts it while you are lying on your back. If you experience pain in the buttocks during this movement, it means that you suffer from the syndrome.
- The Pace and Nagle Test: For this exam you need to lie on the side of your healthy body. The doctor will flex the hip and knee, then rotate the hip while pressing down on the knee. If you are in pain, you have piriformis syndrome.
- The doctor may also "palpate" (examine with the fingers) the large ischial foramen, a hollow in one of the pelvic bones through which the piriformis muscle passes.
Step 4. Check for changes in sensitivity
The doctor will also want to check if the affected leg shows any signs of alteration or loss of tactile sensation. For example, he may lightly touch the limb using a tactile instrument. Probably the affected leg will perceive less intense tactile sensations than the healthy one.
Step 5. Get your muscles examined
The doctor may decide to check the strength and size of the musculature. The leg affected by the syndrome may be weaker and even shorter than the healthy one.
- The doctor could also palpate the buttocks (the large muscles of the buttocks) to define the state of the piriformis muscle; when it is very tight and contracted it could look like a sausage.
- He will also want to make sure of the pain you feel when pressing your buttocks. If you feel pain or achiness deep in your buttocks or hip area, the piriformis is contracted.
- He will also do a check to make sure that the buttock is not atrophied (tightening of the muscle). When the syndrome is chronic, the muscle begins to shrink and lose tone. It is also possible to notice an evident asymmetry between the two buttocks, as the affected one is smaller than the other.
Step 6. Ask for a computed tomography or MRI scan
Although the doctor can perform a physical examination to identify the symptoms of the syndrome, nowadays there are still no diagnostic tests that can detect the disease with certainty. For this reason, your doctor may recommend that you do computed tomography and / or MRI to determine if there are other factors that may be causing compression of the sciatic nerve.
- Computed tomography uses X-rays and a computer to process three-dimensional images of the inside of the body. This is possible thanks to transversal images of the spine. The examination allows to detect any anomalies in the area close to the piriformis and to monitor any changes of an arthritic nature.
- MRI uses radio waves and strong magnetic fields to create images of the inside of the body. This test helps to rule out other causes of lower back pain or sciatic nerve pain.
Step 7. Talk to your doctor about electromyography (EMG)
This test analyzes the reaction of the muscles when they are stimulated with electricity; it is often done when the doctor needs to understand whether the disorder is due to piriformis syndrome or a herniated disc. If you have the syndrome, the muscles around the piriformis react normally with electromyography, while the gluteus maximus and the piriformis itself show abnormal responses. If you have a herniated disc, all the muscles in the area will react in an unusual way. The electromyography test consists of two elements:
- The nerve conduction study uses electrodes attached to the skin to evaluate motor neurons.
- The needle electrode exam involves inserting a small needle into the muscles to assess their electrical activity.
Part 4 of 4: Treating Piriformis Syndrome
Step 1. Stop activities that cause pain
Your doctor may advise you to stop doing any physical activities that can cause you pain, such as running or cycling, for a while.
- If the pain is due to pressure when sitting for long periods, periodically take breaks to get up and stretch your muscles. Doctors recommend getting up, walking around for a while, and doing light stretching every 20 minutes. If you have to drive for a long time, stop often to get up and stretch a bit.
- Avoid sitting or standing in positions that are uncomfortable for you.
Step 2. Undergo physical therapy
This treatment usually helps a lot, especially if you start early. Your doctor can work with your physical therapist to develop a specific plan for your situation.
- Your physical therapist will likely guide you through a series of stretches, push-ups, adductions, and rotations.
- You can also undergo soft tissue massages in the buttocks and lumbosacral region to relieve irritation.
Step 3. Consider alternative medicine
Chiropractic, yoga, acupuncture, and massage are all great practices for treating piriformis syndrome.
Since alternative therapies have not been scientifically investigated as much as traditional medicine, it may be a good idea to discuss them with your doctor before starting any such treatments
Step 4. Consider Trigger Point Therapy
Sometimes the symptoms of piriformis syndrome can be caused by certain points known as muscle knots, usually found in the piriformis muscle or buttocks. Pressure on these nodes can produce local and continued pain. Often these points (also called Trigger Points, or "trigger points") can "simulate" a piriformis syndrome. This is one of the reasons why many tests are negative, and it may be the reason why doctors may not recognize this disorder.
Look for a health professional who has training in Trigger Point Therapy, such as a massage therapist, chiropractor, physical therapist, or even a doctor. If this is the cause, a combination of acupressure, stretching and strengthening exercises will often be the recommended therapy
Step 5. Ask your doctor about stretching exercises
Your doctor may also recommend stretching movements to do at home, as well as exercises that your physical therapist can recommend. Among the most popular exercises you can consider:
- Roll from side to side when lying down. Flex and extend your knees when you are flat on each side. Repeat for 5 minutes, alternating the side of the body.
- Stand with your arms relaxed at your sides. Rotate from side to side at hips for 1 minute. Repeat every two to three hours.
- Lie on your back. Lift your pelvis with your hands and make a movement in the air with your legs, as if you want to ride a bicycle.
- Do knee bends 6 times every two to three hours. You can use the kitchen counter or chair for support if needed.
Step 6. Follow the heat and cold therapy
Applying moist heat can loosen your muscles, while ice after exercise helps reduce pain and inflammation.
- To apply the heat, you can use a warmer or simply place a damp towel in the microwave for a few seconds and then lay it on the painful area. You can also take a warm bath, which relieves tension and irritation from piriformis syndrome. Let the body float in the water.
- For cold therapy, wrap ice in a towel or use a cold pack. Do not apply ice for more than 20 minutes.
Step 7. Take over-the-counter pain relievers
Non-steroidal anti-inflammatories, or NSAIDs, help relieve pain and inflammation. They are generally recommended to treat this type of pathology.
- Among the best known NSAIDs are aspirin, ibuprofen (Brufen) and naproxen (Momendol).
- Contact your doctor before taking these medications as they may interfere with other medications or conditions.
- If NSAIDs do not offer adequate pain relief, your doctor may prescribe muscle relaxants. Take them strictly following his directions.
Step 8. Ask your doctor about injections
If you continue to experience pain in the piriformis area, talk to your doctor about localized injections of anesthetics, steroids, or botulinum toxin.
- Anesthetics (lidocaine and bupivacaine among the most common) are injected directly into the trigger point, or "trigger point", and have a success rate of about 85% of cases that are simultaneously treated with physiotherapy.
- If the on-site anesthetic does not relieve pain, your doctor may prescribe injections of steroids or botulinum toxin type A (botox); both of these procedures have been shown to be effective in reducing muscle pain.
Step 9. Consult your doctor about surgical solutions
Surgery is considered a last resort to treat piriformis syndrome and is typically not evaluated until all other options have been tried. However, if none of the methods you have tried have solved the problem, you can discuss the possibility of having surgery with your doctor.
