Piriformis Syndrome
Piriformis Syndrome will vary in severity.
For this reason, please take the time to read about the following information
about this condition before you
decide what approach to take for helping with treatment and prevention of piriformis
syndrome:
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are not intended to be a
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the advice of your physician or other qualified health provider with any
questions you may have regarding a medical condition. Never disregard
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Piriformis Syndrome is a term for a condition in which the sciatic nerve
becomes pinched in the region of the buttocks. This pinching can cause
symptoms which include numbness, tingling, burning and achy soreness along the
sciatic nerve path, a nerve which extends from the buttock area down the back of
the leg to the foot. The sciatic nerve runs through a muscle in the
buttocks region called the Piriformis. When the muscle shortens or spasms
due to trauma, it can compress the sciatic nerve. This cause of sciatica
symptoms is known as Piriformis Syndrome. The Piriformis muscle can be
shortened and irritated from overuse of the muscle with repetitive movements
like aerobics and dancing. The approach to treating Piriformis Syndrome is
to reduce the compressive forces that are causing the pressure on the nerve.
This can be accomplished through manual muscle stretching, massage,
mobilization and pelvic adjustive techniques to take pressure of the Sacroiliac
joints, and stretches to increase the length and loosen
up the Piriformis muscle. At the onset of the irritation goals will be to
lessen the pain and help to minimize any inflammation. The
listed Therapies, Products and Activities section will give more information on
how to help your condition, however, as each Piriformis Syndrome condition is
different, always consult your doctor to determine what treatment is right for
your particular situation.
A good mattress will protect the back for the many hours that you are in bed.
A mattress that properly supports the body will also be a very important element in helping relieve
stress on the muscles and joints of the back. The most important information needed for finding a
correct mattress to support the back involves knowing what position you sleep in.
The menu below will help you to search for a mattress that is right for you.
Choose a sleeping position:
Whether you sit for minutes or hours, you can't underestimate the value of
proper posture while sitting. It has been demonstrated that at times there
can be as much as six times the amount of stress on your back when you sit than
while lying down. Fortunately you can lower the amount of stress placed
on the spine with proper back support. To accomplish this, first you must
decide whether the chair you use presently is adequate for your needs. A
good chair will be able to provide your lower back with proper lumbar pressure.
This pressure will keep the curve of the spine in this area supported in the
normal position. When a proper lumbar support is not provided with your
chair, an insert lumbar cushion can accomplish this. The size of the
cushion is very important, as too much lumbar support can compress and irritate
the spine. A good working ergonomic type of chair can be adjusted to allow
tilting and height control of the seat and chair back. Here are some tips
for adjusting your chair properly: Adjust the height of the chair to allow
your feet to rest comfortably on the floor. Adjusting the tilt angle of
the seat will change the position of your pelvis, thereby shifting the back
towards or away from the seat back. Tilting the front of the seat downward
will bring your lower back into extension and thus increase the lower lumbar
curve. Tilting the front of the seat upward will bring your lower back
into flexion and thus decrease your lumbar curve. Combine the seat angle
tilt with the seat back tilt for optimal support of the back. If the seat
back height can be adjusted, make sure the small of your back fits with the part
of the seat back which curves outward to support the lower back. If these
adjustments still do not support the spine properly, you will definitely need a
lumbar insert cushion or more ergonomically correct chair. Insert cushions
will need to have height adjustability to fit correctly. This is usually
achieved with a strap that allows you to set the height of the cushion to the
thickest part against the small of your back. Each person's spine curves
differently, so another important feature that some back support cushions
provide is the ability to adjust the size of the lumbar thickness to customize
the fit. We found two different types of backrest cushions that meet the
strict criteria of what we look for when helping patients to properly support
their posture while sitting (see link below).
Click Here to to purchase the
recommended backrest for your spine with
the adjustable air cushion found at Relief-Mart
.
Trochanteric braces can at times be useful as the Piriformis muscle can be
supported with one of these, as it will protect the muscle and pelvis from further injury.
It is placed over the outside hip area, at what is called the trochanter. While soft back braces can be useful for support of fatigued muscles and allow temporary relief
to the irritated tissue in the initial stage of injury, wearing any brace for
prolonged periods can also weaken the musculature, as the muscles will rely
on the brace to keep good posture. While too much movement of the back may
cause exacerbation of the Piriformis Syndrome, preventing movement of the area has been shown to
hinder the healing process. It can be noted that the use of a brace while
sleeping should not cause any of these problems, but many patients find that overusing the
brace can become irritating to the area.
Caution should be taken when applying traction to any newly injured area, and
is should not be performed in these cases unless specifically recommended by
your doctor. Lumbar (low back) traction can be accomplished through
various products which keep the pelvis stationary while using gravity to force
separation of the vertebrae and thereby open the spinal canals that the nerves
exit through. However, the multifidous muscle which attaches to the lumbar
vertebrae may not allow the separation of the vertebrae if the muscle is in too
much spasm. Some types of traction allow for better separation when the
multifidous muscle is in spasm. One such type of traction is performed by
doctors of chiropractic through applying pressure manually to the spine while a
flexing table tractions the spine in a downward motion. In the earlier
stages, light traction can provide an unloading of the spine, thereby releasing
the nerve pressure between each segment created from a decrease in circulation
and an increase of inflammation within the joint space. In later stages,
traction combined with body movement may also help to break up scar tissue build
up between the joints. When the muscles are in too much spasm to allow for
this type of traction, upright types of traction units can enable a person to
move their body during the therapy to avoid further muscle spasm, while
providing a relieving therapy to the spine. Home
traction units may be beneficial in treating Piriformis Syndrome, As the
spinal level above are often compressed from the tightening, but caution should
be taken not to apply too much traction too quickly to the back, as this may
initiate a spasm to the surrounding musculature.
For home use we
recommend a weight bearing traction therapy where a person is able to move the
body to help avoid any muscle spasm of the back while taking pressure off
the spine. However, there is a real advantage to being able to exercise while
decompressing the spine. Therefore, using an apparatus like the
Disc-Traction belt below will allow you to exercise and stretch the low back
without the added gravitational stress in a recumbent position as well
(see link below).
Click Here
- to purchase the recommended
support and traction unit that takes pressure
off the spine in any weight bearing or non-weight bearing position found at
Relief-Mart
Electric stimulation is an effective way to reduce pain. This is
accomplished though blocking the same pain receptors that cause the nerves to
irritate due to Piriformis Syndrome. Micro-current is a specific
type of electric stimulation which has been shown to stimulate healing to the
injured tissue. Some electric stimulation units can charge the muscles to
contract when the intensity is raised or it is placed over a motor point of the
muscle. At times, this contraction causes the muscles of the back to
loosen up by fatiguing them, while other times it may cause further irritation
to the tissue. Home electric stimulation devices may not always be as
effective as the more costly type usually found in a health practitioner's
office.
Ultrasound is an extremely effective way to stimulate proper tissue healing.
Sound waves are generated from a crystal vibrating inside the head of the
ultrasound wand and then transmitted through sound conducting gel to the tissue.
This allows the sound waves to break down unwanted scar tissue, increase
circulation to the area, and help relax the musculature. This can be
extremely beneficial in the case where the Piriformis Syndrome has caused
soft tissue irritation to the back. Ultrasound can only be used in the
presence of a licensed health practitioner.
Ice can be used in the initial 72 hours of an injury to reduce inflammation
and numb the pain associated with Piriformis Syndrome. One
potential problem with ice is that temporarily it will tighten the musculature
even more. Also it should be noted that ice should not be used for longer
than 20 minutes to an area, as it will cause a reversal reaction which will
allow the tissue to become more inflamed. For low back inflammation we
recommend using a combined brace and ice gel pad to put a more firm pressure
over the irritated area. This will also provide support over the injured
area while providing ice therapy. Patients we surveyed feel that the brace
and ice gel pad combination below works extremely well (see Soft
Back Brace section for more information on bracing).
Click
here to purchase the
recommended Ice gel pads which attach to
the adjustable air back brace found at Relief-Mart
Hot packs are useful for increasing circulation and thereby
loosening up the muscle tissue. Waiting to use heat therapy until three
days after the onset of when the initial irritation of the Piriformis Syndrome
occurred will give the swelling a chance to go down, as heat increases the
inflammation to the area. It is believed that moist heat is better than
dry, as there is less possibility for dehydration to the musculature. We
found a simple to use moist heat pack (depicted below) which contains beads that
activate upon being heated up in a microwave to give off moist steam without
adding water. This occurs from a natural process by which the beads retain
moisture from the air. The ease of use, combined with the comfort of this
product, make it a very popular therapy with the patients we surveyed.
Click here to purchase the
recommended Therabeads moist
heat packs found at Relief-Mart
As previously mentioned, moist heat therapy is useful for increasing
circulation and thereby loosening up the muscle tissue. In the case
of a heated whirlpool, the heat will completely surround the area. Add to
this the jet massaging action of a Jacuzzi and you have a great way to relax the
muscles of the back. Waiting to use heat therapy until three days after
the onset the Piriformis Syndrome first occurred will give the swelling a
chance to go down, as heat increases the inflammation to the muscles.
Many of the same benefits seen with regular massage can be accomplished with
mechanical massage devices that penetrate deeply through a tapping action called
percussion, and thereby disperse lactic acid in the soft tissue and increase
circulation, giving an overall relaxing effect to the musculature. This
can be very effective for the "knotted up" type of musculature.
More superficial massage devices that just vibrate may serve to increase
circulation to the tissue, but lack the other aforementioned benefits. It
should be noted that the stretching of the muscular fibers will not occur like
it does in manual massage. Percussive massagers should be used on slower
speeds when the soft tissue is very inflamed, as it is less irritating to the
area. We found an extremely effective, yet affordable variable speed
percussive massager that can be used on the neck and back (pictured below) and
feel that it meets every criteria we look for in a home massager.
click here to
purchase the
recommended percussive variable
speed massager found at Relief-Mart
Over-the-counter sprays, sports creams and ointments that have analgesic
properties can be useful for pain control of the Piriformis Syndrome,
without any intestinal side-effects. Menthol is the active ingredient which
works to block pain receptors and help relieve pain in the soft tissue and
joints. The higher the menthol percentage, the stronger the formula.
Some companies use as much as 16 percent menthol, but that much is not necessary
to achieve results and can cause burning side effects. Menthol can be
derived naturally from peppermint or be synthetically produced. Natural
menthol penetrates the skin more effectively. Other
ingredients such as capsaicin, peppermint and eucalyptus can also help to block
pain. Keep in mind that capsaicin or capsicum are responsible for the
burning/tingling sensation that occurs in the same pepper spray that police use
to stop attackers. Use of these Cayenne pepper derivatives can leave
residual numbness and tingling in an area for days after each use. Some companies are also using other herbs believed to have natural
healing, relaxing and mild anti-inflammatory properties such as MSM
(methylsulfonylmethane) and Glucosamine, but most only add trivial amounts.
Glucosamine and MSM are usually taken in oral pill form. Dosages usually
range between 1,000-1,500 mg a day. Glucosamine is currently undergoing many trials to
determine effectiveness for helping cartilage repair. Studies have
demonstrated that patients with deterioration of joint cartilage halt and even
regenerate the tissue after taking Glucosamine for at least six weeks.
For a topical pain reliever to
work effectively it needs to have a good transport mechanism (ability to let
ingredients be able to pass through the first layer of skin down to the deeper tissues
below). In theory, supplements such as Glucosamine Sulfate and
MSM have small enough molecules to pass through the skin barrier and not
just affect the top of the skin, but rather penetrate deeper down. Because
Glucosamine and MSM absorb so well, they also make great skin conditioners.
Where as taking Glucosamine and MSM will affect your whole body, placing it over an
area can add 28 times more than a pill would provide over a specific area.
Topical pain relievers with
oils and waxy substances like glycerin, strearic acid and cetyl alcohol would
make a poor transport mechanism for ingredients like Glucosamine and MSM, yet
some companies continue to use this ingredient. While methyl and propyl
paraben are preservatives that offer an indefinite shelf life, they also lessen
the penetration of a topical pain reliever.
Therefore, the best type of topical analgesic is one that combines good
powerful natural ingredients, with a good transport mechanism that has no
preservatives, but also no oils to block penetration or eventually turn the
formula rancid. Therapain Plus (shown below) meets the above criteria and
has proven successful with the patients we surveyed.
click
Here to purchase the
recommended natural topical pain
relieving formula with 14,000 mg of MSM and
Glucosamine found at Relief-mart
Certain vitamins and herbs can be used as supplementation for the body's
natural healing and defense system. The RDA recently increased some of its
recommended daily values for certain vitamins, and has listed tolerability
ranges (See RDA's website for further information). It has been a long
standing debate as to how much extra supplementation can be utilized by the
body, and many contributing factors may play a part in this process. These
factors may include weight, smoking, exercise, stress, pregnancy, and
quality/type of the supplementation. While the FDA does not approve
any of the following vitamins and herbs for use of pain or inflammation, many
doctors surveyed are currently using some or all of the following in their
practice to target muscle and connective tissue:
Vitamin E, Vitamin C, Zinc , Calcium, Copper, Boswellin, Bromelain, Curcumin,
Hops, Valerian Root, Kava Kava, MSM and Glucosamine Sulfate.
*Glucosamine and MSM have the most consistent scientific evidence that
support its use for many conditions. For more information on Glucosamine and MSM,
click here.
While nutritional changes will not usually produce immediate results, there
can be no better way to make long term changes in the body than eating right.
Some foods have properties which have been shown to change inflammatory levels.
Acidic fruits can mildly block the body's inflammation process, whereas red meat
and shellfish increase arachidonic acid, which is known to increase inflammation
levels. As new nutritional studies are constantly being performed, more
information will be continually added to this site on this topic and addressed
in our free monthly newsletter.
One of the most frequent questions our health experts encounter is whether
medication should be taken, and which one would be right for them. It is
important to remember that medications are aimed at temporarily reducing pain,
inflammation, and relaxing the body, but have not been proven to increase
healing to the area. Here are some of the most commonly mentioned
medications:
For over-the-counter medication, Ibuprofen has been indicated for temporary
pain relief. Studies have also shown that in higher amounts, Ibuprofen can
act as an anti-inflammatory, but a medical doctor's prescription is needed for
this dosage. Aspirin and acetaminophen are also indicated for muscle pain
relief, but do not show anti-inflammatory properties in prescription dosages.
Acetaminophen does not have warnings about adverse reactions for people with
aspirin allergies, as it is not an aspirin derivative. It has also been
demonstrated to be better tolerated by people with weak intestinal systems.
While Aspirin is known to be more abrasive on the intestinal system, it may have
other side benefits such as blood thinning that prevents the blood clots which
can lead to strokes and myocardial infarctions.
As these medications work to block pain and inflammation temporarily, it
stands to reason that the need for these medications can occur when a person can
no longer function due to the pain or when it hinders sleep and thereby
impedes the body's natural healing process. A person on pain medication
should consider that they may more easily overdo it during the temporary relief
period, which could cause further injury to the muscles.
*As side effects can occur, always consult your medical doctor to determine
if and what medication is appropriate for your situation.*
Muscular stretching can be a very important part of the healing
process for tightened muscles of the back. It is essential to lengthen any
shortened muscular tissue of the back to help prevent further pulling on the
already shortened fibers. Muscular strengthening exercises will be
important once the back irritation has subsided. Back strengthening
exercises help to build stability to weak tissue. It should be noted that
irritated muscles can become further damaged with strengthening exercises that
are premature to the healing of the area. The exercises below are general
exercises to increase flexibility and can help to stabilize the back.
However, it should be noted that for most of these exercises, you should not
feel the stretch in the back itself. For example, the back of the legs
have a group of muscles called the hamstrings. These muscles originate in
the lower pelvis and insert into the leg. When the hamstrings are
tight, the back itself can be tightened due to the pulling on the pelvis.
Therefore, stretching the hamstrings will not only loosen the leg muscles up but
they will take the strain off the back.
Each picture below depicts the exercise being performed
properly. The arrows are the direction the body will need to move towards
to get the correct angles. The red circles indicate the area of which you
should feel the stretch.
Warning:
*The following back exercises should never be performed if they
cause irritation to your back or any other condition while they are being
performed! As each Piriformis Syndrome condition is different,
always consult your doctor before performing any of these
exercises to determine what exercises, if any, are right for your particular
condition. If you have any discomfort after performing any of these
exercises, discontinue and immediately and consult a doctor to properly assess
your situation.*
Gluteus Stretch
Click picture to increase
size and quality
lying down on your back, bend your right knee, and place your
left leg over the right leg, resting the outside of the left ankle slightly
above the right knee. Place your right hand around the outside of your
right thigh and place the left hand around the inside of your right thigh.
Lock the two hands together. Now pull forward towards your chest to
achieve a stretch in the left gluteus portion of your buttocks. Do the
exact opposite to achieve a stretch of the right gluteus portion of the
buttocks. Hold each stretch for a minimum of 30 seconds, any less than 15
seconds and the muscle will not conform to the new increase in length. Do
3 reps, 3-6 times a day. Any pain you feel with this exercise should only
be a local stretching sensation to the back of your thigh and buttocks area,
without aggravating your condition.
Piriformis Stretch
Click picture to increase
size and quality
lying down on your back, bend your right leg and pull up your
right knee towards your opposite chest with your left hand. You
should feel the stretch in the Piriformis portion of the right buttocks.
Do the exact opposite to achieve a stretch of the left Piriformis portion of the
buttocks. Hold each stretch for a minimum of 30 seconds, any less than 15
seconds and the muscle will not conform to the new increase in length. Do
3 reps, 3-6 times a day. Any pain you feel with this exercise should only
be a local stretching sensation to the back of your thigh and buttocks area,
without aggravating your condition.
TFL Stretch
Click picture to
increase size
and quality
Start with stretching the TFL portion of the left hip and
outside thigh. While standing, hold your left hand securely on a solid surface
to support your body as you place your left leg past your right until you reach
a maximum stretch. Follow this with tilting your upper back to the right
side while simultaneously pushing the left side of the hip. Do the exact
opposite to achieve a stretch of the right TFL portion of the hip and outside
thigh. Hold each stretch for a minimum of 30 seconds, any less than 15
seconds and the muscle will not conform to the new increase in length. Do
3 reps, 3-6 times a day. Any pain you feel with this exercise should only
be a local stretching sensation to the TFL portion of the hip and outside thigh,
without aggravating your condition.
Calf Stretch
Click picture to
increase size
and quality
Start with stretching the right Gastrocnemius portion of the
right calf area. While standing, place your right leg in front of you and your
left foot directly behind you. Place the toes of your right forefoot up
against a door or other flat wall surface, keeping your heel down to the floor.
Lean your upper body forward to place a stretch on the back of the calf.
Do the exact opposite to achieve a stretch of the left calf area. Hold
each stretch for a minimum of 30 seconds. Any less than 15 seconds and the
muscle will not conform to the new increase in length. Do 3 reps, 3-6
times a day. Any pain you feel with this exercise should only be a local
stretching sensation to the calf area of the leg, without aggravating your
condition.
Psoas Stretch
Click picture to
increase size
and quality
Start with stretching the right Psoas muscle. While
standing, place your right leg in front of you and your left foot directly
behind you as far as you can comfortably stretch it. Shift your lower body
forward, while simultaneously pushing your upper body backwards with your arms.
Do the exact opposite to achieve a stretch of the right Psoas portion of your
front upper thigh area. Hold each stretch for a minimum of 30 seconds.
Any less than 15 seconds and the muscle will not conform to the new increase in
length. Do 3 reps, 3-6 times a day. Any pain you feel with this
exercise should only be a local stretching sensation to the Psoas area of the
upper thigh, without aggravating your condition.
Quadriceps Stretch
Click picture to
increase size
and quality
Regardless of the current situation your back is in, relaxing could be
key to helping it heal. While meditation can always be useful for
achieving this, Yoga can at times be irritating if caution is not taken.
Yoga is a series of slow movements combined with stretches and meditation to
allow for an increase in flexibility and relaxation to the muscles and joints,
as well as to help optimally integrate the connection between the mind and
body. However, what might seem to be easy maneuvers should still be
treated cautiously, as your individual situation may prohibit certain Yoga
moves. One simple meditation practice that is usually met with good success
is to close your eyes and visualize yourself in the most happy and relaxing
place you know of. Sometimes just taking the time to do this can be what
you need to begin the healing process.
While walking is one of the overall best exercises for your health, the shoes
you choose to stroll in may just be the difference between hurting your back
and helping to keep it strong and loose. High heel shoes put your spine in
extension, which can impact the joints further when the vertebrae are already in
a compressed state. Lack of shock absorption will further impact the
joints with every step you take. Shoes that contain proper arch support
can help take the pressure off those tired feet and add to increase overall
shock absorption. Shoes with pressurized air or other cushioning chambers
are necessary to protect the spine during the much harder impact a person will
experience during exercise.
During standing a proper balance is needed between both hips to keep the back
in correct alignment. When one leg is slightly longer, or the hip becomes
fixated in a higher position, it may be necessary to supplement the lower side
of the hips with a heel lift worn inside the shoe. When the spine is
tilting to the lower hip side, a lift may allow the spine to realign properly,
and thus take pressure off the back. If one leg actually grew shorter than
the other, a lift may be needed on a permanent basis to prevent the spine from
moving back to its incorrect position. A health practitioner should be
the one to evaluate the situation and assess the correct size heel lift
needed.
Chiropractors have the level of education befitting their title as
doctors. Their focus is primarily on diagnosing and treating dysfunction of the muscles, nerves, and skeletal system without the use of drugs or
surgery. As a particular back condition may at times warrant more aggressive
forms of treatment, many chiropractors have developed good working relationships with medical doctors to
enable a system of cooperative care to optimally benefit their
patients. Chiropractic care helps increase the
flexibility of the soft tissue of the spine and reduces the pressure that occurs
from any restricted and minor misalignments of individual vertebral joint
segments. This in turn helps to
eliminate any nerve interference created from the dysfunctional area. This
can
be achieved by breaking down scar tissue through techniques which adjust the
spine, re-aligning the attached vertebrae, as well as performing release techniques to
the fibrous portion of the soft tissue. Many doctors of chiropractic also use therapeutic measures such as ultrasound, electric stimulation, and heat
therapy. A doctor of chiropractic should take the time to diagnose your
condition and help determine its cause.
Many chiropractors have recognized the benefit of working in conjunction with
massage therapists to loosen their patient's muscles as a precursor to
treatment. This relationship works so well because the patient can be
treated after becoming more relaxed and euphoric due to the natural release of
endorphins, as well as the loosening of the musculature due to all the benefits
of massage. Other benefits of massage depend on the type of massage being
given.
Swedish massage is usually a more superficial, relaxing form, and therefore
is less likely to break down scar tissue and trigger a release of spasmodic
musculature as a deeper type of massage would accomplish. It should be
noted that due to the increase in circulation and release of lactic acid (a
natural chemical irritant that is a byproduct of muscle utilization without
oxygenation) with massage, it is possible that the area can feel more inflamed
and tender temporarily.
Eastern philosophy proposes that acupuncture utilizes needles to stimulate
energy points and are referred to as meridians. The Western
scientific explanation is that the stimulation from the needle puncture triggers
natural pain relieving chemicals from the brain, a reduction in inflammation to
the area through an increase in circulation, and a relaxation response to the
musculature. As no scar tissue is being broken down from the injured
tissue, increase in flexibility will be less likely than with a manual tissue
and joint mobilizing type of therapy.
Physical Therapy utilizes a variety of modalities such as ultrasound,
electric stimulation, massage, and thermal therapy to help relieve muscular
spasms. Manual tissue and joint mobilizing types of therapy can be used to
help increase tissue flexibility. Physical Therapy excels in the use of muscular strengthening
exercises to build stability to weaken tissue. It should be noted that
irritated muscles can become further damaged with strengthening exercises that
are premature to the healing of the area. A prescription from a doctor is
often needed prior to treatment with a physical therapist for most health
insurances to pay for any care rendered.
A doctor of medicine can take the time to evaluate your condition and confirm your specific
diagnosis. Medical doctors prescribe either over the counter or
prescription only medication. They can prescribe medications that
temporarily relieve inflammation, temporarily relax muscles, and temporarily
relieve pain. Many medical doctors work with physical therapists and
chiropractors to provide conservative management for the many back pain
conditions a patient can experience. Orthopedic doctors have extended training in joint-related conditions such as
this. While Orthopedic doctors can perform back surgery, this drastic step
should only be used when all other treatment options have been exhausted, as
back surgery carries many risks, and not usually recommended for most
conditions.
