{"id":106855,"date":"2011-01-19T20:58:08","date_gmt":"2011-01-19T19:58:08","guid":{"rendered":"https:\/\/42krunning.com\/piriformis-syndrome\/"},"modified":"2011-01-19T20:58:08","modified_gmt":"2011-01-19T19:58:08","slug":"piriformis-syndrome","status":"publish","type":"post","link":"https:\/\/42krunning.com\/en\/piriformis-syndrome\/","title":{"rendered":"Piriformis Syndrome"},"content":{"rendered":"

Piriformis Syndrome<\/strong><\/h2>\n
\n\"\"<\/a><\/p>\n

<\/strong><\/p>\n

In runners, it is very common to find the cause in the piriformis: a small muscle located in the pelvis, used mainly in the running motion (stride, impacts, fast paces), and responsible for the symptoms of piriformis syndrome.<\/p>\n

It is due to entrapment of the sciatic nerve in the notch area. This nerve runs through that space between two muscles: one is the piriformis, located superoposteriorly; and the other is the obturator internus, located anteroinferiorly. In athletes with high muscle development and low body fat, such as distance runners, this space narrows\u2014mainly during internal rotation\u2014and the nerve is compressed. <\/p>\n<\/p>\n

CAUSES of piriformis syndrome<\/strong><\/h3>\n

\nThe causes that trigger pain in this sacral muscle are numerous:
\n– Running on hard surfaces, such as asphalt or sidewalks.
\n– Running on uneven terrain.\n<\/p>\n

– Starting an exercise program after a long period of inactivity. Increasing exercise intensity or duration too quickly.<\/p>\n

– Excessive overpronation when running, or worn-out running shoes.<\/p>\n

– Sitting for long periods of time. (Sitting in an incorrect posture produces eleven times more pressure on the third lumbar disc than a supine position. This working position is a necessity, but it is harmful when treating disc injuries.) <\/p>\n<\/p>\n

Other causes:<\/strong><\/p>\n<\/p>\n

Biomechanical alterations:<\/strong><\/h3>\n

The main biomechanical alterations that contribute to piriformis syndrome are faulty foot and body mechanics, gait alterations, and poor posture or sitting habits. Other causes may include spinal problems such as a herniated disc and spinal stenosis. <\/p>\n

Other biomechanical causes include:<\/em><\/strong> Poor mechanics when running or walking. Tight, firm, stiff muscles in the back of the lower back, hips, and buttocks.<\/p>\n

Running or walking with your toes pressed down<\/p>\n<\/p>\n

Overdoing glute exercises<\/em><\/strong><\/h3>\n

(kicks<\/a>, squats<\/a>) can cause \u201cpiriformis syndrome.\u201d This is more common in women<\/strong> between 20 and 50 who try to reduce their buttocks with intense exercises, which\u2014far from helping\u2014actually hypertrophy this muscle even more, with the added issue of \u201ctrapping\u201d the sciatic nerve within its muscle mass. Worst of all, it takes them a long time to realize what is happening and why. They only report pain when the process is already advanced. Later we will talk about step<\/strong> and its relationship to these problems. <\/p>\n

Many people, including doctors, confuse this syndrome with hip problems, bursitis, low back pain, thigh flexor tendinitis, and true sciatica. That is why you need to be cautious and use additional tests (MRI, X-ray, ultrasound, and electromyography) to find the exact diagnosis of these conditions. <\/p>\n<\/p>\n

The most common clinical signs of the syndrome<\/strong><\/h3>\n

They include pain in the buttocks, near the femur, when walking or when you stop walking suddenly; simple pains such as when standing up or sitting down; pain when the legs are stretched out while lying down; pain when doing more intense physical activity; and gluteal atrophy depending on how long symptoms have been present. Pain can increase even while lying in bed at complete rest, making restorative sleep uncomfortable. <\/p>\n

\u201cPiriformis syndrome can cause pain in the lower back, groin, perineum, buttocks, hips, and other areas, and it can even cause dyspareunia (painful intercourse) and rectal pain when defecating. Piriformis problems are very diverse and very common, and fortunately they respond very well to therapeutic massage.\u201d<\/p>\n<\/p>\n

From a podiatry perspective<\/strong><\/h4>\n

Check whether your gait is PRONATED<\/strong>, since piriformis syndrome and pronation go hand in hand: the foot causes internal rotation of the femur and, consequently, piriformis contracture\u2014where the sciatic nerve is as thick as the big toe.<\/em><\/p>\n<\/p>\n

Which parts of the body are involved?<\/strong><\/h4>\n

The lowest lumbar spinal nerves exit the spine and join together to form the sciatic nerve. The sciatic nerve leaves the pelvis through an opening called the sciatic notch. <\/p>\n

The piriformis muscle begins inside the pelvis. It connects to the sacrum, the triangular bone that sits between the pelvic bones at the base of the spine. The connection from the sacrum to the pelvic bones forms the sacroiliac joint. <\/p>\n<\/p>\n

What causes this problem?<\/strong><\/h4>\n

Sciatica symptoms come from irritation of the sciatic nerve. It remains a mystery why the piriformis muscle sometimes begins to irritate the sciatic nerve. Many believe the condition begins when the piriformis muscle goes into spasm and tightens against the sciatic nerve, squeezing the nerve against the pelvic bone. <\/p>\n

In some cases, the muscle can be injured due to a fall onto the buttock. Bleeding in and around the piriformis muscle forms a hematoma, with blood pooling in that area. The piriformis muscle begins to swell and put pressure on the sciatic nerve. Soon the hematoma dissolves, but the muscle goes into spasm; that is, it remains contracted. <\/p>\n

The sciatic nerve remains irritated and continues to be a problem. The muscle eventually heals, but some of the muscle fibers within the piriformis are replaced by thin scar tissue. Thin scar tissue is not as flexible and elastic as normal muscle tissue. The end result is that the piriformis tightens and applies constant pressure against the sciatic nerve. <\/p>\n

Symptoms:<\/strong><\/h3>\n

Piriformis syndrome commonly causes pain that radiates down the back of the leg<\/em><\/strong>. The pain may be felt on only one side, although it is sometimes felt on both sides. The pain can radiate all the way to the foot and may be confused with a herniated disc in the lumbar spine. Changes in sensation and weakness in the leg or foot are rare. Some people feel a sensation like a \u201cvague buzzing\u201d in the lower, back part of the leg. <\/p>\n

How you sit:<\/em><\/strong> some patients try to sit leaning onto the painful side buttock without sitting fully in the chair.<\/p>\n<\/p>\n

Diagnosis:<\/strong><\/h3>\n

A good medical history is essential, looking for family history (for example, any arthritis in the family), a thorough physical examination, and clarifying what the pain<\/em><\/strong> is like: whether it affects your daily life, which positions or activities worsen your symptoms, and past injuries. Your posture, how you walk, and where your pain is located are then examined. <\/p>\n

Doctors use examination maneuvers to help identify the cause of sciatica:<\/p>\n

When the straight leg raise (A) reproduces the pain, a herniated disc is often the cause. If raising the leg has no effect, the crossed leg test shown below (B) can be used to stretch the piriformis muscle to locate pelvic entrapment of the sciatic nerve. <\/p>\n

Your skin sensation, muscle strength, and reflexes are also tested, because it is difficult to distinguish pain coming from the sacroiliac joint from pain coming from other spinal conditions.<\/p>\n

If any joints might be affected (infection or arthritis), a blood test would be requested.<\/p>\n

X-rays<\/em><\/strong> can give an idea of how much wear the sacroiliac joint shows, but they cannot detect whether the nerve is irritated in the piriformis muscle.<\/p>\n

MRI<\/em><\/strong> would further refine the diagnosis, providing a more detailed picture of soft tissues, including the piriformis muscle and the sciatic nerve. Increased muscle volume, narrowing of the passage with hardly any fat, and\u2014using specific sequences\u2014perineural edema can be seen. <\/p>\n

Treat back pain by massaging the buttock muscles using a tennis ball against a wall. Work the entire area covered by the pocket. Place your feet 30 cm (1 foot) or more away from the wall. <\/p>\n<\/p>\n

Treatment<\/strong><\/h3>\n

Piriformis syndrome can be painful, but it is rarely dangerous and rarely leads to the need for surgery. Most people with this condition can reduce pain and manage the problem with simple methods, such as physical therapy<\/em><\/strong>. Alongside these treatments by the physiotherapist\u2014aimed at relaxing the muscle\u2014and stretching<\/em><\/strong>, there are anti-inflammatories<\/em><\/strong> and local anesthetic injections<\/em><\/strong> (lidocaine) for temporary relaxation, which helps us diagnose whether relaxing the muscle makes the radiating pain disappear because the sciatic nerve was trapped. <\/p>\n

Cortisone<\/em><\/strong>, for example, can be mixed with the anesthetic medication to reduce inflammation in the sciatic nerve.<\/p>\n

Botulinum injection therapy (also known as Botox injections) can be used to actually paralyze the piriformis muscle.<\/p>\n

Botulinum toxin<\/em><\/strong> inhibits muscle contraction by blocking the release of acetylcholine into the neuromuscular space and, consequently, produces muscle relaxation in the region of the injected muscle. For more than a decade, it has been used in adults and children with neurological diseases involving spasm, hypertonia, and\/or muscular dystonia. Botulinum toxin has been shown to reduce pain and improve muscle function, increasing the functional capacity of many patients with different neurological disorders. <\/p>\n

This causes the muscle to relax, thus preventing pressure on the sciatic nerve. The effect of a Botox injection is not permanent; it only lasts a few months. In the meantime, however, a stretching program is expected to be used to correct the problem. That is, when the injection stops working, the muscle may have been stretched enough times so that symptoms do not return. <\/p>\n

Surgery<\/em><\/strong> can be considered, but generally only as a last resort. There are two procedures. The first is to cut the piriformis tendon where it attaches to the greater trochanter. The other method is to cut through the piriformis muscle to relieve pressure on the sciatic nerve. These procedures are generally done on an outpatient basis, meaning you can go home the same day as the surgery. In some cases, you may need to stay in the hospital overnight. Both procedures can be done under general anesthesia or under a spinal type of anesthetic (epidural). <\/p>\n

Back with the physiotherapist<\/em><\/strong>, what they should do is assess your physical condition, examining your back, the sacroiliac joint, and the hip. Physical therapy treatments for piriformis syndrome often begin with the use of heat. Heat is used to help the muscle relax, reducing spasm and pain. <\/p>\n

Ultrasound<\/em><\/strong> is another treatment option that can be set up for deep heating in the buttock area. Ultrasound uses high-frequency sound waves directed through the skin. The deep thermal effect of ultrasound is ideal for preparing the piriformis muscle for massage and for achieving a deeper stretch. Deep massage and specialized forms of muscle tissue mobilization can be used initially. Your physiotherapist can also position your hip and leg in a way that helps calm the signals the sciatic nerve sends to the piriformis. <\/p>\n

At home, stretching<\/em><\/strong> will often be done once you have learned it in physiotherapy sessions. One more, this time: Chair stretch <\/p>\n

The goal of a rehabilitation program<\/em><\/strong> is for you to return to your sport or activity safely as soon as possible. If you return too early, your injury can worsen, with the risk that the damage becomes permanent. Each person recovers from their injury at a different pace. Your return to sport or activity will depend on how quickly your nerve recovers, not on how many days or weeks have passed since your injury. In general, the longer you wait to start treatment after symptoms begin, the longer it will take you to heal. <\/p><\/p>\n","protected":false},"excerpt":{"rendered":"

Piriformis Syndrome In runners, it is very common to find the cause in the piriformis: a small muscle located in the pelvis, used mainly in the running motion (stride, impacts, fast paces), and responsible for the symptoms of piriformis syndrome. It is due to entrapment of the sciatic nerve in the notch area. This nerve […]<\/p>\n","protected":false},"author":4,"featured_media":106856,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_joinchat":[],"footnotes":""},"categories":[1602],"tags":[],"class_list":["post-106855","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nutrition-sports-health"],"_links":{"self":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/posts\/106855","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/comments?post=106855"}],"version-history":[{"count":0,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/posts\/106855\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/media\/106856"}],"wp:attachment":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/media?parent=106855"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/categories?post=106855"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/tags?post=106855"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}