Piriformis syndrome

[MariaG]

My mom was diagnosed with Piriformis syndrome. She is in alot of pain. No doc has been able to help her so far. Does anyone know anything about this syndrome? Is a PM&R doc the right person to go see for this problem??

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[axm397]

I don't feel comfortable giving medical advice but...

I heard about pyriformis syndrome when I did an interventional spine/pain management rotation with a fellowship trained PM&R doc. From what I understand, it is a proximal neuritis of the Sciatic nerve - believed to be caused by compression on the nerve by the pyriformis muscle - which can evolve into a chronic condition. The physiatrist I worked with - used physical therapy and other more conservative modalities first - then moved on to injections. Surgical treatment is the last resort treatment - and the doc I worked with was part of an Ortho/Spine practice so he would refer refractory cases to the surgeons or vice versa.

So, you could try to look for a physiatrist like the above... Just be careful of needle jocks looking to do lots of injections. For all you know, your mom may not even have pyriformis syndrome. A good and thorough physical exam is definitely indicated - and a trial of conservative therapy would be beneficial if she already has not had any...

hope this helps.

 

[Buster Douglas]

I am by no means an authority on the matter but..

There are a few OMT Muscle Energy techniques that've shown to yield promising results in the treatment of piriformis syndrome/"pseudo-sciatica". I don't know how familiar you are with OMT or osteopathic medicine as a whole, but an osteopathic physician (D.O.) who often utilizes, or even specializes in, Osteopathic Manipulative Treatment is something worth looking into.

 

[MadPuppy2005]

OMT would be excellent for piriformis syndrom, several of the muscle energy techniques would be helpful. I'm a student who actually saw a case that respondes to OMT in 2 to 3 sessions. another things to try is to sit on a tennis ball and roll the piriformis muscle on it several times a day. Injections and other drugs probably just relieve the symptoms ; but not really treating the cause, which is probably piriformis muscle spasm in most of the cases. Finding a good DO is important too, you'll get better results in fewer sessions.

 

[drvlad2004]

With OMT, counterstrain of the piriformis syndrome seems to yield very good results. If your mom has sciatica, most often it is due to piriformis syndrome. The piriformis can get very tight that it impinges on the sciatic nerve.

 

[spinaldoc]

i really dont know what omm will do. i know i treat this fairly often and that is by chiropractic care. if it is truely piriformis syndrome then there will be a positive hibbs SLR with internal rotation to determine between a nerve root irritation or a pirirformis involvement. either resisted external rotation of the hip or passive medial rotation of the hip may increase the pain. postisometric relaxation techniques or myofascial relese techniquesare often helpful. in rare cases, injection of the piriformis trigger point may be needed. she may simply need a chiropractic adjustment or a heel lift.

 

[rehabdoc]

This syndrome, although controversial, has a good prognosis. It is simply due to myofacial disease of the pirifimis muscle. As a result of tightness in this muscle, the structures passing beneath it are compromised including the sciatic nerve. End result will be pain in the gluteal region with often radiating pain to the extremity. It is not associated with low back pain and lacks exam finding of classic radiculopathy.

Treatment is fairly easy.

First choice will be rehab based exercise, focused on stretching the piriformis muscle. Often improves symptoms when combined with a touch of muscle relaxants, application of heat and short term NSAID's.

If the symptoms persist, intramuscular injection could be helpful. Since it is deep muscle, this should be done under fluoroscopy guidance for best result and prevention of complication like nerve damage.

In non responding cases, intramuscular injection with Botulism toxin, which is done EMG guided is the treatment of choice. This later is usually helpful.

Best people to address this is a physiatrist with interventional skills or EMG skills. Your mom will do well just find the right person to do it.

good luck

 

[DrMom]

With OMT, counterstrain of the piriformis syndrome seems to yield very good results. If your mom has sciatica, most often it is due to piriformis syndrome. The piriformis can get very tight that it impinges on the sciatic nerve.

I've seen excellent results with counterstrain.

 

[bigdan]

For what it's worth, I'd suggest throwing PT into the treatment mix. There's a fairly simple "figure 4" stretch that one could do at home to assist in stretching the muscle.


dc

 

[hany helmi]

Maria G,

I have to agree with spinal doc regarding chiropractic treatment for a piriformis syndrome. I suggest you seek out a chiropractor who has undergone post graduate training in neurology. Without going into too much detail. Piriformis syndrome is usually secondary to aberrant joint mechanics regarding the femoral acetabular joint as well as the SI joint. Such an imbalance in the pelvis places considerable strain on the piriformis to maintain normal resting tone regarding it's primary function of shunt stabilization to counterbalance the internal rotation/flexion of the iliopsoas muscle. Like any weak muscle, this predisposes the muscle to work harder in the abscence of adequate mitochondrial stores which further predisposes the piriformis to undergo anearobic mechanisms resulting in the production of lactic acid. Lactic acid is a noxious chemical irritant which sensitizes type c nociceptive afferents which @ the L5/S1 level can create a scatic referred pain perception so called "pseudo sciatica". Remeber it is the posterior femoral cutaneous not the sciatic that relays cutaneous information regarding the posterior aspect of the thigh. Furthermore, there is considerable breakdown of the Sarcoplasmic reticulum of the fatigued agonist muscle which allows sequestration of calcium and creates one hell of a spastic contracture in the piriformis.

Treatment, should involve
1. Fast Long axial distraction of the ipsilateral lower extremity in full extension with internal rotation- Negative Y translation with negative theta Z rotation above the ankle. This will facilatate an increased frequency of firing from golgi tendon organs of the piriformis therefore causing a dysynaptic cord inhibition to the agonist muscle and facilitate a reduction of myotonia as well as a hyperpolarization of the nociceptive pool(remember Melzack and Wall's pain gate theory). The very opposite may need to be addresed to the contralateral psoas to maintain cross-crawl cord inhibition.

2. Appropriate coupled reduction( ie chiropractic manipulation) of the pelvis in relation to the ipsilateral lower extremity, ankle, and lumbar spine.

3.Last but not least Post Isometric Relaxation to further reduce any residual spastic tone, Myofascial therapy to strip the muscle of any chemical irritants in the fascia and Ipsilateral Brain exercises to maintain Neocortical-pontine reticulospinal modulation of extensor tone.

4.Lets not forget nutrition any good CoQ10, lots of water, and plenty of good leafy greens.

Sorry I can't write more but I have to jet. If you would like me to refer someone to you locally please let me know. I hope this helps.

"The greatest trick the devil ever pulled was making the world think he didn't exist and then poof he was gone"

 

[MariaG]

Just to update...

My mom got a transvaginal ultrasound to take a look at some ovarian cysts that showed up on an MRI. Turns out she has not had any symptoms since the US..WTF?? Its seems that after everything the incidental US cured her.. Is it possible that they hit the piriformis with the probe and freed the sciatic nerve??

 

[paz5559]

Botox plus PT

Lang, AM, Am J Phys Med Rehabil. 2004 Mar;83(3):198-20