Piriformis Syndrome Causes Sciatic Pain

Piriformis Syndrome is one of the 4 conditions that can cause sciatica pain felt all the way down the leg. Research suggests that approximately 80% percent of Americans suffer from low back pain at some point in time. 70% to 80% of low back pain is muscle related. Of those with chronic sciatic pain 1 in 7 are susceptible to Piriformis Syndrome. The sciatic nerve passes through the piriformis muscle, rather than underneath it, in 15 to 30 percent of the population, which leads to a greater incidence of nerve entrapment, compression and sciatic nerve irritation leading to Piriformis Syndrome.

An accurate diagnosis for sciatic pain is essential to identify serious spine issues, or to establish that the problem lies in the soft tissue. Soft tissue conditions can be treated with less invasive treatments like chiropractic, massage, exercise, stress management techniques, or Prolotherapy. Regular stretching is the best method for improving flexibility and reducing pain.

Eliminating low back and sciatic pain is a multi-step process. The successful treatment and complete healing is seldom found on the first attempt. Low back, or sciatic, pain has roots in Mind/Body/Spirit and Life-style. A hopeful, step by step, attitude is absolutely essential! Don’t give up—Become knowledgeable!

Previously, my lumbar/sciatic pain was agony—I had reached the point where pain was constant. I started by consulting allopathic medicine, an orthopedic specialist who reviewed my MRI and stated my spine issues were mild to moderate and not remedial by surgery. It was unbelievable that such intense pain had no visible cause on the MRI. And it was mentally frustrating that my quality of life was deteriorating because of inflammation. The surgeon recommended Pain Management for inflammation. I tried various Pain Management approaches but was unwilling to take medications that damage the liver and kidney functions. I was also unwilling to have a Lumbar Facet Rhizotomy, which entails a heated needle destroying selected nerves in your back. 

The word inflammation kept coming back to me. Allopathic medicine views inflammation (localized protective reaction of tissue to irritation, injury, or infection, characterized by pain, redness, swelling, and sometimes loss of function) as a reaction to be stopped at any cost. Alternative healing modalities view inflammation as a symptom, or as an essential part of the healing process, which helps us to the identifying the initiating cause of disease.

I thought, what causes inflammation? Irritation and injury. I was well aware of the falls and injuries that over stretched and twisted my knees and low back. I also have genetic ligament and tendon laxity. My personal history led me to try Prolotherapy treatments to strengthen my lumbar back, sacrum, and knees--- Prolotherapy therapy works! So why do I still have sciatic pain? I know I am a work in progress. What remains to do—is to get the piriformis muscle to relax. The piriformis went into spasm years ago as part of an original fall. 

Piriformis Syndrome, which creates sciatic pain is a condition caused by a taut or shortened piriformis muscle, or when a piriformis goes into spasm. The piriformis muscle is located at the right and left top of the buttocks next to each hipbone. The piriformis muscle is a lateral rotator buried deep in the gluteus muscles and helps the foot and leg turn outward. A hip out of alignment can impinge upon, or compress the sciatic nerve causing chronic pain.

Piriformis syndrome and sciatica have many of the same symptoms. It is difficult to distinguish Piriformis syndrome from sciatica, therefore it is important to be knowledgeable.

To identify Performs Syndrome:

·      Notice when the pain initiates. If the pain usually starts after climbing stairs or some sort of lower-body exercise, this could be Piriformis Syndrome. 


·      Difficulty sitting for long stretches of time? Do you need to take frequent breaks from your desk job because of numbness down through part of the leg, tingling or pain?

·      Apply pressure to the piriformis muscle (located in the upper part of your buttocks, right next to your hip bone). If this induces pain and the problems you get from sitting too long or walking up stairs, this could be piriformis syndrome. 


·      Visit the doctor and discuss all of your symptoms. The doctor will order tests to rule out sciatica from disc degeneration or herniation. Remember, piriformis syndrome may exist along with sciatica and complicate making a complete diagnosis.

·      Piriformis Syndrome can develop and cause sciatic nerve pain on one or both sides. Sitting may be difficult and there may be a feeling of a large painful knot in the buttocks.

Life Style causes of Piriformis Syndrome

·      Muscle imbalance and weakness from sitting all day.

·      Strenuous, overuse injury results from activities of the legs: Rowing, Sculling, Bicycling, and Running.

·      Runners who over-pronate,

·      Bicyclists and other athletes engaging in forward-moving activities are particularly susceptible to Piriformis Syndrome

·      Abnormal position of the pelvis resulting from repetitious movements: 1.) Getting in and out of a car, 2.) Standing and weight shifting on to one foot while waiting in line or holding a baby on your hips, 3.) Weak core muscles, and muscle imbalances that lead to postural dysfunctions.

An informal test to check for Piriformis Syndrome is to get on the floor and lie on your back and relax your legs to see which way your feet rotate, or look down at your feet as you sit. If toes rotate outward this means the Piriformis muscle is tight. If possible, you may start appropriate stretching exercises to help minimize or prevent Piriformis Syndrome.

Life Style Changes 

·      Try to avoid positions that trigger pain.

·      Rest, ice, and heat may help relieve symptoms.

·      When participating in sports or movement, such as running or lunging, prevention is often related to good form.

·      Avoid running or exersing on hills or uneven surfaces.

·      Warm up properly before activity and increase intensity gradually.

·      Use good posture while running, walking, or exercising.

·      If pain occurs, stop the activity and rest until pain subsides.

·      Try physical therapy, or massage therapy that addresses trigger points

·      Consider a chiropractor versed in the Sacro-Occipital Technique (SOT)

My SOT chiropractor gave me a great exercise for the piriformis muscle, which is called:

Step Out, Toe Out. 1.) Stand facing a wall---about 4 inches from the wall, 2.) be sure your feet are shoulder width apart and your weight is evenly balanced on your feet, 3.) you will work with one side then the other, 4.) Step your right foot one step to the right, 5.) Point right foot straight to the right. 6.) Place hands on wall shoulder high, 7.) Stay balanced, keep back straight and learn forward to wall—count to 15; 8.) Push yourself back upright; 9.) Repeat the process for the left side—one step left, point left toe left---straight back lean forward toward wall with hands shoulder high on wall---count to 15---push back to stand upright.

You may want to consult your medical professional befor trying this exercise. Start slow, respect your own needs, and build up repetitions over time. When I kept my back straight, I could feel my backbones realign.

A useful set of exercises are located at this website:

http://www.spine-health.com/wellness/exercise/stretches-and-exercise-sciatic-pain-piriformis-syndrome

http://www.webmd.com/pain-management/guide/piriformis-syndrome-causes-symptoms-treatments

http://www.sportsinjuryclinic.net/sport-injuries/hip-groin-pain/piriformis-syndrome

http://www.losethebackpain.com/conditions/piriformis-syndrome/

http://www.miraclestretch.com/Back-Buttock-Leg-Pain-Sciatica-Piriformis-Syndrome-s/13.htm#.U5SidygdU20

Prolotherapy for Chronic Back Pain

I am a chronic back pain sufferer. I have ligament laxity. Ligament laxity is a term that refers to ligaments in the body that can move more than usual. Doctors can also call these looser than normal ligaments hyper mobile; they do not generally refer to lax ligaments as a condition. Chiropractors tend to use the term to describe a potential cause of chronic joint pain or sprains.

For me exercise does not improve ligament or tendon laxity. When exercising here is a point of diminishing returns. I realized as muscle strength increased there was a corresponding tendency to tendonitis and ligament strain. Seemingly my muscle strength over powered my ligaments. Physical trainers and even physical therapists that have the “boot camp” mentality and harass one to work through pain often frustrate me. Pain is a symptom of something wrong, not something good.

Yes weight-bearing exercise is healthy, while running faster and longer builds muscle as well as a stronger heart and lungs. However this does me no good if I end up with sprained ankles and I can’t walk at all. Swimming is the best exercise foe me to keep up muscle strength, flexibility and cardiovascular health.

Hyper mobility is genetic. An estimated 5% to 12% of the adult population has some degree of generalized joint hyper mobility associated with ligament laxity. Marfan or Ehlers-Danlos are recognized syndromes, which are generally rare syndromes, and are characterized by ligament laxity and other determinants.  Hyper mobility syndrome appears to be familial with a clear-cut female predominance. Typically symptoms first appear in children or young adults. Although hyper mobile individuals have a potentially heightened aptitude for activities such as gymnastics, dancing, and playing musical instruments, they also have an increased susceptibility to dislocations, traumatic joint pain, tendonitis, and overuse injuries. These problems may present as a fibromyalgia-like syndrome triggered by exercise.

Chronic back pain can be a symptom of underlying structural problems, or it may be a symptom of an underlying condition. It is essential to have an appropriate physical exam to rule out kidney stones or kidney infection, prostatitis, chronic diverticulitis, cancer of the pelvis, endometriosis, ovarian cysts, fibroid tumors, shingles and circulatory deficiency from hardening of the arteries.

Your back supports your entire body, using a complex interconnecting network of nerves, joints, muscles, tendons and ligaments. All these components are capable of producing pain in the back, low back and surrounding areas. Because the back is connected to the rest of your body, back pain can be an early warning of underlying conditions elsewhere in your body.

Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities. The pain may be felt in the neck (or might radiate into the arm and hand), in the upper back, or in the low back (and radiate into the leg or foot). Other symptoms may include symptoms weakness, numbness or tingling.

If left untreated, most back problems only worsen as time and gravity take their toll on our bodies. After falling hard on my knee and twisting and torqueing my pelvis I had excruciating lumbar pain for nearly five years. I had sciatic pain shooting through my buttocks and down my leg into my foot. I could walk for about fifteen minutes at a moderate pace but could not tolerate standing after five minutes.

I started with physical therapy and back strengthening which created minor improvement but the PT became a treadmill sadist and I felt myself regress. I saw an orthopedic surgeon who requested I get an MRI. Although, I did have two slightly herniated discs, very slight spinal stenosis, and mild lateral arthritis, I did not meet his criteria for surgery because the pattern of symptoms did not indicate a diagnosis remediable by surgery.

My chiropractor told me about prolotherapy an injection technique that stimulates growth of cells and tissue that stabilize and strengthen weakened joints, cartilage, ligaments and tendons.

The injected solution intentionally causes controlled irritation in the tissue. This irritation is an inflammatory response, which increases the blood supply and thereby stimulates the tissue to heal and regrow new tissue. Typically prolotherapy involves the injection of natural substances such as dextrose into the tissue to initiate the healing process. Dextrose is the most studied substance worldwide and is extremely safe and effective. 

My initial prolotherapy, which occurred 1 ½ years ago, created a 20-30% improvement. (I have not lost any of this improvement.) I also worked with a Rolfer (Structural Integration therapy) and Sacral-Occipital Therapy Chiropractic. I would say I had another 30% improvement. Because I still have a tendency to extreme muscle tension in the lumbar, I felt that the pain had decreased significantly but not enough.

Recently, I attended a Dr. Norm Shealy workshop on wellness protocols. He described sacral shear as the cause of low back pain. This happens when the sacrum become hyper mobile and presses on the sciatic nerve. The sacrum is a small triangular bone located at the bottom of the spine and between the hips. I realized I had originally because I had only addressed half of the hyper mobility affecting my sciatic nerve. I am seeing a local osteopath for prolotherapy injections to strength the ligament laxity around the sacrum.

Prolotherapy was the innovation of Dr. Earl Gedney, an osteopathic physician and surgeon. In the early 1930s, Dr. Gedney caught his thumb in a door thereby stretching the joint and causing severe pain and instability. He was told that nothing could be done for his condition and that his surgical career was over. Gedney knew of a group of doctors that used irritating solutions to stimulate the repair of the distended connective tissue ring as treatment for hernias. He extrapolated this knowledge and utilized it to inject his injured thumb. He was able to fully rehabilitate the thumb. In 1937, Gedney published “The Hyper-mobile Joint,” the first known article about Prolotherapy. The 1937 article gave a preliminary protocol and discussed two case reports, one of a patient with knee pain and another with low back pain who were successfully treated with this method. Prolotherapy is practiced by physicians in the U.S. and worldwide. It is effective in treating many musculoskeletal conditions such as tendonopathies, ligament sprains, back and neck pain, tennis/golfers elbow, ankle pain, joint laxity and instability, plantar fasciitis, shoulder, knee, and other joint pain.  C. Everett Koop, the former US Surgeon General has endorsed prolotherapy, was helped by it, and practices it.

I view this odyssey as a life lesson; it took sixty years to get to this point I cannot expect to reverse the damage quickly. The alternative approaches I have chosen have been researched; they are not paid for by health insurance but they should be. Health insurance should pay for therapies that promote health, not pain killer medication addiction and steroids that cause physical deterioration.

http://www.medscape.com/viewarticle/413950

http://www.prolotherapy.com/Prolotherapy.php

http://www.getprolo.com/tag/sacroiliac-pain/#sthash.BYAO8X00.dpuf

http://www.getprolo.com/prolotherapy-after-back-surgery/