Priformis Syndrome

          Sciatica pain, starting in the hip and extending from one or both legs to the feet; It is a type of pain that can cause pain, numbness and tingling. Sciatica pain is usually caused by pressure or irritation on the nerves in the lumbar region. One of the conditions that causes pressure on these nerves is piriformis syndrome.

         The piriformis muscle is a small muscle located deep in the hip (behind the gluteus maximus). It starts from the lower spine (sacrum) and attaches to the upper surface of the femur (thigh bone). It helps rotate the hip, rotate the leg and foot outward.

         Piriformis syndrome is a spasm of the piriformis muscle located in the hip area, causing hip pain. The piriformis muscle compresses the nearby sciatic nerve and can cause pain, numbness, and tingling in the back of the leg and foot (similar to sciatic pain).

                             Symptoms of piriformis syndrome

Sciatic pain is the main symptom of piriformis syndrome. Some other common symptoms of piriformis syndrome include:

• Decreased range of motion of the hip joint

• A dull pain and tenderness in the hip

• Pain when going down stairs or walking on an incline

• Pain worsened by sitting

• There is pain that worsens with activity

      In severe cases of piriformis syndrome, the pain in your hips and legs can be so severe that you may not be able to perform basic, daily tasks such as sitting in front of a computer, driving a car for any length of time, or doing household chores.

The exact causes of piriformis syndrome are unknown. Suspicious causes include:

• Muscle spasm in the piriformis muscle,

• Irritation and swelling in the piriformis muscle itself

• Irritation of a nearby structure such as the sacroiliac joint or hip joint

• Bleeding in the piriformis muscle area.

                                     Diagnosis of piriformis syndrome

             First of all, it is necessary to review your medical history and symptoms. It is necessary to determine which positions cause pain by doing your examination in detail.

               Some imaging tests may also be necessary to rule out other causes of your pain. Although magnetic resonance imaging (MRI) and computed tomography (CT) can reveal enlargement of the piriformis muscle, these imaging technologies are most useful in excluding disc and vertebral pathological conditions. Diagnostic imaging of the lumbar spine; necessary to exclude disc herniation, arthritis, fractures and pathological masses.

        Electrodiagnostic testing is useful in distinguishing piriformis from other conditions. Nerve entrapments in the lumbar region are usually accompanied by EMG abnormalities, muscle weakness, and atrophy of the distal and proximal muscles, whereas piriformis syndrome typically presents only distal muscle weakness and atrophy. Also, ultrasound of the piriformis muscle can be helpful in diagnosing the condition.

                              Piriformis syndrome treatment

• Range of motion exercises: A physical therapist and chiropractor can develop a customized program of stretching and range-of-motion exercises to stretch muscles and reduce spasm.

• Deep Massage: Deep massage therapy (manual release) by a qualified specialist is thought to enhance healing by increasing blood flow to the area and reducing muscle spasm.

• Ice and heat therapy: A simple way to relieve discomfort at home is to apply a cold compress or heating pad to the skin on the painful area. At the onset of pain, lie down in a comfortable position and place an ice pack on the painful area for about 20 minutes. Repeat every 2-4 hours.

         It may be more helpful to combine a light massage with ice. Lie facedown and have someone gently massage the painful area with a large ice cube. If certain activities are often accompanied by increased pain, it may be a good idea to apply ice immediately after the activity.

         Sometimes it may seem beneficial to replace cold with heat. If you use a heating pad, place it on the painful area for up to 20 minutes.

§ Medications: Since most pain attacks involve some form of inflammation, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen help reduce inflammation in the affected area

• Piriformis injection: Local anesthesia and corticosteroids can be injected directly into the piriformis muscle under ultrasound guidance to reduce spasm and pain. The purpose of an injection is usually to reduce acute pain to enable progress in physical therapy.

• Botox injection: For persistent piriformis spasm that is refractory to treatment with anesthetic / corticosteroid injections, injection of botulinum toxin, a muscle-attenuating agent (eg Botox®), may be helpful.The purpose of the injection is to help relax the muscle and help reduce pressure on the sciatic nerve.

          The purpose of both injections is to help the patient progress with stretching and physical therapy so that the muscle remains taut and relaxed when the injection is under its effect.