Non-radiographic axial spondyloarthritis or nr-axSpA and non-radiographic ankylosing spondylitis/AS are related. However, non-radiographic axial spondyloarthritis can present AS symptoms with active inflammation of the spine and sacroiliac/SI joints, causing back and hip pain but does not reveal joint damage on X-rays or MRIs. Injury Medical Chiropractic and Functional Medicine Clinic can explain what it means to have non-radiographic axial spondyloarthritis, how it can be managed, and what to do to prevent it from turning into ankylosing spondylitis.
Non-Radiographic Axial Spondyloarthritis
Non-radiographic axial spondyloarthritis means there are early AS symptoms but have not developed enough joint inflammation or damage to show up on an X-ray or other form of imaging. Early evidence of joint inflammation includes blurring of the joint edges and localized regions of joint erosion. It can be difficult for physicians to see these subtle changes on an x-ray.
Ankylosing Spondylitis
Ankylosing spondylitis, or AS, is a form of inflammatory arthritis that affects joints in the spine and elsewhere.
It is a chronic, inflammatory, autoimmune disease.
Medical research is still ongoing to determine the exact cause, but a genetic component is believed to be contributing factor.
Around 85% of individuals with ankylosing spondylitis have inherited the HLA-B27 gene, which is associated with multiple autoimmune conditions.
In the early stages, individuals will present lower back pain around the sacroiliac joints or the joints that connect the spine to the pelvis.
Later stages have more obvious X-ray findings, like the fusing of the sacroiliac joints and the lower spine that takes place over time.
Joint inflammation can progress, causing permanent joint damage and spine rigidity.
Most individuals with the condition can manage their symptoms with NSAIDs, chiropractic care, physical and massage therapy, and range of motion exercises.
Stage 1
There is no evidence of spinal inflammation on x-rays.
MRI provides more detailed images of bones and may reveal bone marrow edema or accumulation of fluid in the structures of the spinal bones and joints.
Individuals with non-radiographic axial spondyloarthritis, you are here.
Stage 2
There is visible inflammation of the spinal joints on the x-ray.
The sacroiliac joints between the spine and the pelvis are the most affected.
Stage 3
Chronic inflammation of the joints has caused bone loss and permanent joint damage, resulting in spine rigidity.
Symptoms of Non-Radiographic Axial Spondyloarthritis
There are differences between back pain associated with muscle strain and arthritis. Back pain symptoms include:
Starts to present before age 40.
It has a gradual onset and can go unnoticed for years.
Improves with movement or activity.
Eases up throughout the day.
Starts up in the evening when resting.
Other symptoms include:
Joint stiffness
Swollen fingers
Heel pain
Bilateral buttock discomfort and pain
Slowing Progression
Progression from non-radiographic axial spondyloarthritis to ankylosing spondylitis occurs in 10% – 20% of individuals over a two-year period. Progression factors include genetics, gender, degree of joint damage, and level of inflammatory markers at the time of diagnosis.
Early diagnosis and treatment can slow the progression before significant joint damage with anti-inflammatory therapy, rheumatological therapy, and targeted exercise.
Work with a specialist like an orthopedic spine specialist and rheumatologist that understands the disorder and is up to date on the most recent treatment modalities.
Individuals with non-radiographic axial spondyloarthritis should expect to have serial X-rays to gauge the progression of the disease.
Staying healthy and active is recommended to slow the progression of nr-AxSpA and AS.
Recent medical advances and lifestyle adjustments can slow the progression in most cases.
axSpA
References
Six tips for living well with ankylosing spondylitis. Available at https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/in-depth/6-tips-for-living-well-with-ankylosing-spondylitis/art-20478753. Accessed 11/07/2022.
Ankylosing spondylitis. Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808. Accessed 11/05/2022.
D. J. Pradeep, A. Keat, K. Gaffney, Predicting outcome in ankylosing spondylitis, Rheumatology, Volume 47, Issue 7, July 2008, Pages 942–945, https://doi.org/10.1093/rheumatology/ken195
Kucybała, Iwona, et al. “Radiologic approach to axial spondyloarthritis: where are we now and where are we heading?.” Rheumatology international vol. 38,10 (2018): 1753-1762. doi:10.1007/s00296-018-4130-1
Michelena, Xabier, López-Medina, Clementina, and Helena Marzo-Ortega. “Non-radiographic versus radiographic axSpA: what’s in a name?”.” National Center for Biotechnology Information. October 14, 2020. https://doi.org/10.1093/rheumatology/keaa422
Swift D. Ankylosing spondylitis: disease progression varies widely. Medpage Today. Accessed 11/05/2022.Available at https://www.medpagetoday.com/rheumatology/arthritis/49096
Back discomfort sensations and symptoms could indicate pulled-back muscles. Unless you’ve experienced the condition before, determining the cause can be difficult. A pulled-back muscle can start as a sudden, sharp sting when bending, reaching, or twisting. Or it can present gradually, worsening over a few days. It is a common injury, but if left untreated could take several weeks, and in severe cases, a few months, to heal correctly. Injury Medical Chiropractic and Functional Medicine Clinic can help diagnose the problem and develop a customized treatment plan to restore optimal function and health.
Pulled Back Muscles
A pulled muscle describes a strained muscle.
A strain is a muscle or tendon injury that happens when the tissue overstretches or tears.
When a ligament stretches or tears, it’s called a sprain.
Most cases can be managed and treated at home.
But if the symptoms are not improving or make it difficult to move, see a doctor or chiropractor.
Symptoms
Common signs and symptoms of a pulled-back muscle include:
Swelling
Tenderness
Soreness – Sore muscles that feel tight and achy usually indicate a condition that is likely to improve in a few days. More severe soreness could indicate a more significant injury.
Spasms – A sudden convulsive spasm in the muscle can also indicate a pull. This can feel like a sudden tightening that does not release. The muscle can continue to spasm and lead to other symptoms.
Cramping – A muscle can cramp can lead to increased tightness whenever trying to use the muscle.
Pain – Can be characterized as a constant dullness and/or soreness in most situations or, in severe cases, sharp and shooting.
Discomfort when moving around. If pain flares up when trying to move or use the back muscles is usually an indication that something is wrong.
Relief during inactivity and rest. When lying down to rest or taking a temporary break, and the symptoms disappear could also be an indication of a pulled-back muscle or another injury.
Causes
The most common causes are:
A Strained Muscle
This causes some damage to a region of muscle tissue, usually the result of being over-used or torn from another injury.
Sprained Ligaments
Involves damage to the ligaments in a joint, usually those in the spinal vertebrae.
A Herniated Disc
This involves damage to the discs that can leak out, irritating the surrounding tissues and nerves and can cause shifting and misalignment of the spine.
These conditions are distinct, but the symptoms can be similar.
Therapies
It is important to consult a medical professional before treating an injury because symptoms of other injuries, such as disc problems or a broken bone, can resemble strains and sprains. Most treatments will utilize:
Ice and Heat
Ice helps reduce inflammation.
The faster ice can be applied to a pulled-back muscle, the quicker pain and swelling are reduced, and the healing process can begin.
Apply a cold pack for 15-20 minutes as soon as the injury occurs.
Take a 20-minute break between each cold application.
After the first days, alternate cold therapy with heat to increase circulation.
Try a 20-20-20 rule: 20 minutes of an ice pack followed by a 20-minute break, then 20 minutes of heat.
Repeat as necessary, allowing 20 minutes between heat or ice therapy.
Limited Rest
Right after a muscle strain, limiting physical activity levels and avoiding movements are recommended for a short period.
After the initial pain subsides, partial activity levels are recommended to help prevent the muscles from weakening.
Compression
Applying compression bandages or using an active compression system can help reduce swelling and edema and repair damaged tissues faster.
Stretching
Returning to activities, gentle stretching exercises can improve tissue healing by increasing blood circulation to the injured area.
Applying heat to the area before stretching can also help.
Strength Training
Ask a doctor or chiropractor about the right strength exercises for your condition.
Strength training will develop the muscles to prevent future injuries.
Pain Medication
Pain levels are an important indicator during the recovery process.
Pain medications relieve symptoms but do not assist with healing and should only be used short-term to provide relief.
If you need pain medication, consult your physician to determine the appropriate type and dosage for your situation.
Massage
Blood circulation to the injured tissues is increased with massage therapy.
Chiropractic
A chiropractor can diagnose back pain from a muscle or disc injury and develop an individualized treatment plan.
Allen, Laura. “Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain.” International journal of therapeutic massage & bodywork vol. 9,3 27-30. 9 Sep. 2016, doi:10.3822/ijtmb.v9i3.267
Kumar, Saravana et al. “The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews.” International journal of general medicine vol. 6 733-41. 4 Sep. 2013, doi:10.2147/IJGM.S50243
Back pain after eating is often the result of conditions and/or disorders in other areas of the body that radiate to the back. These problems range from unhealthy posture, digestive issues, bowel problems, ulcers, allergies, etc. This is because the nerves of the back and the abdominal area run through areas of the spine. In addition to the classic symptoms like bloating and gas, individuals can develop symptoms beyond the gut, including sleep problems, fatigue, headaches, urinating problems, muscle aches, pelvic discomfort, and back pain. Chiropractic care and functional medicine can realign the body, alleviate symptoms, and restore function.
Back Discomfort
Back pain after eating can be linked to the body’s digestive process.
Individuals in this group can experience inflammation after consuming specific foods.
Inflammation could worsen existing back problems.
Individuals with food intolerance will have uncomfortable but usually not dangerous symptoms.
Individuals with food allergies can experience life-threatening allergic reactions.
Heartburn
Heartburn results from acid reflux, when stomach contents and acid flow back into the esophagus. Heartburn’s key symptom is a burning sensation in the chest. However, heartburn and indigestion do not directly cause back pain. But for individuals with back problems, heartburn can worsen back discomfort.
GERD
Gastroesophageal reflux disease, or GERD, could cause back pain in individuals with more than two weekly heartburn episodes.
The digestive system condition results from the chronic backflow of stomach acid.
Over time, the powerful acid can inflame the esophageal lining.
A stomach or esophageal ulcer can develop if GERD is not managed.
Pain could be felt in the lower to middle back around the stomach and lower intestines.
Ulcers
Ulcers can also result from a bacterial infection of Helicobacter pylori (or H. pylori).
Long-term use of nonsteroidal anti-inflammatory drugs (or NSAIDs) can also enable ulcer formation.
A peptic ulcer (or open sore) can develop on your stomach’s interior lining.
The small intestine’s upper portion can also be affected.
Peptic ulcers cause burning pain in the stomach. These flare-ups can worsen existing back problems and pain. Spicy foods and stress don’t cause peptic ulcers but can worsen their effects. In severe cases, a peptic ulcer can cause referred back pain felt in another location than where the pain originates. This means pain could be felt in the lower to middle back adjacent to the stomach and lower intestines.
Kidney Infection
Back pain could result from a bacterial kidney infection.
Kidney dysfunction infections, kidney stones, and chronic kidney diseases can be mistaken for general back and side pain.
Other symptoms can include chills, fever, nausea, and vomiting.
Pancreatitis
Pancreatitiscan develop if the pancreas becomes inflamed, brought on by excess alcohol consumption or gallstones. This definitely can cause back discomfort and pain.
Pancreatitis is the inflammation of the pancreas.
After eating, individuals can experience worsening abdominal pain that can refer to the back.
The body’s network of interconnecting sensory nerves causes the pain to be felt in other areas.
Most individuals will experience pain in the upper left or middle abdomen.
When individuals with celiac disease consume foods with gluten, the small intestine gets damaged, and their bodies cannot properly absorb the necessary nutrients.
Besides the back discomfort, there could be a burning sensation during urination or other urinary tract symptoms. Stools could be dark or black, a possible ulcer symptom. To reduce the chances of back discomfort after eating, avoid sugary, spicy, fatty foods or anything that triggers heartburn and reduce alcohol consumption. If you are experiencing frequent episodes of back pain after eating or the pain worsens, contact your physician, healthcare provider, or a chiropractor.
Hormonal Dysfunction In Men
References
Celiac Disease Foundation. (n.d.) “What is celiac disease?” https://celiac.org/about-celiac-disease/what-is-celiac-disease/
Mayo Clinic. (n.d.) “Celiac disease.” https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220#:~:text=Celiac%20disease%2C%20sometimes%20called%20celiac,response%20in%20your%20small%20intestine
Pfizer. (April 25, 2022) “Heartburn, acid reflux, or GERD: what’s the difference?” https://www.pfizer.com/news/articles/heartburn_acid_reflux_or_gerd_what_s_the_difference#:~:text=The%20terms%20acid%20reflux%2C%20heartburn,meals%20or%20when%20lying%20down
Prairie Spine & Pain Institute. (n.d.) “What may cause back pain after eating: symptoms & prevention.” https://prairiespine.com/spine-care/5-things-that-may-cause-back-pain-after-eating-symptoms-and prevention/#:~:text=Exercises%20practiced%20in%20yoga%2C%20Pilates,chi%20may%20be%20particularly%20beneficial.&text=If%20a%20doctor%20cannot%20identify,ice%2C%20and%20taking%20pain%20relievers.
Whiplash-associated disorders, or WAD, describe injuries sustained from sudden acceleration/deceleration movements. It is a common outcome after a motor vehicle collision but can also be caused by sports injuries, falls, or assaults. Whiplash refers to the mechanism of the injury, while WAD refers to the presence of symptoms like pain, stiffness, muscle spasm, and headaches. A WAD prognosis is unpredictable, with some cases remaining acute with a full recovery, while others progress to chronic conditions with long-term symptoms and disability. Early intervention recommendations include rest, chiropractic care and physical rehabilitation, massaging and stretching exercises, and an anti-inflammatory diet.
Whiplash Associated Disorders
Cervical hyperextension injuries happen to drivers and passengers of moving, slow-moving (less than 14 miles per hour), and stationary vehicles when struck from behind.
The individual’s body is thrown forward, but the head does not follow the body and instead whips forward, resulting in hyperflexion or extreme forward movement of the neck.
The chin limits forward flexion, but the momentum can be sufficient to cause cervical distraction and neurological injuries.
When the head and neck have reached maximum flexion, the neck snaps back, resulting in hyperextension or extreme backward movement of the neck.
Pathology
Most WADs are considered soft tissue-based injuries with no fractures.
Stages
The injury goes through stages:
Stage 1
The upper and lower spine experiences flexion in stage one.
Stage 2
The spine takes on an S-shape while extending and eventually straightens, causing lordosis.
Stage 3
The entire spine is hyperextending with an intense force that causes the facet joint capsules to compress.
Symptoms
Whiplash-associated disorders can be classified through grades by the severity of symptoms, including neck pain, stiffness, occipital headache, cervical, thoracic, and lumbar back pain, upper-limb pain, and paraesthesia.
Grade 0
No complaints or physical symptoms.
Grade 1
Neck complaints but no physical symptoms.
Grade 2
Neck complaints and musculoskeletal symptoms.
Grade 3
Neck complaints and neurological symptoms.
Grade 4
Neck complaints and fracture and/or dislocation.
Most cervical fractures occur predominantly at C2 or C6, or C7.
A chiropractor will identify areas of restricted joint motion, muscle tension, muscle spasm, intervertebral disc injury, and ligament injury.
They will analyze posture, and spinal alignment, check for tenderness, tightness, and how well the spinal joints move.
This will allow the chiropractic physical therapy team to understand the injured body mechanics and how the spine is operating to make a thorough diagnosis.
The doctor will order imaging tests like an x-ray or an MRI to evaluate any degenerative changes that may have existed before the whiplash injury.
Once the injury has been accurately diagnosed, the chiropractor will design a personalized treatment plan.
Spinal Adjustments
Spinal manipulation is applied to areas of the spine that are out of alignment to realign the spine and activate the healing process.
Flexion-distraction technique is a gentle technique that uses slower, less intense pushing motions on the discs used to treat disc herniations that often occur after a whiplash injury.
Instrument-assisted manipulation utilizes special instruments to apply various forces or massage settings to the area.
Targeted spinal manipulation targets specific areas to rework, release, and rebuild the structures.
Massage Therapy stimulates the affected muscles to relax them from their tense state.
A treatment plan may utilize:
Instrument-assisted therapy
Trigger point therapy
Resistance-based stretches to rehabilitate soft tissue damage.
Our chiropractic team is ready to help you feel your best so you can return to normal activities and get on with your life.
Ritchie, C., Ehrlich, C. & Sterling, M. Living with ongoing whiplash-associated disorders: a qualitative study of individual perceptions and experiences. BMC Musculoskelet Disord 18, 531 (2017). https://doi.org/10.1186/s12891-017-1882-9
Sterling, Michele. “Whiplash-associated disorder: musculoskeletal pain and related clinical findings.” The Journal of manual & manipulative therapy vol. 19,4 (2011): 194-200. doi:10.1179/106698111X13129729551949
Wong, Jessica J et al. “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.” The spine journal: official Journal of the North American Spine Society vol. 16,12 (2016): 1598-1630. doi:10.1016/j.spinee.2015.08.024
Woodward, M N et al. “Chiropractic treatment of chronic ‘whiplash’ injuries.” Injury vol. 27,9 (1996): 643-5. doi:10.1016/s0020-1383(96)00096-4
Ankylosing spondylitis is an inflammatory condition that causes pain and stiffness in the spine’s joints. Over time, it can progress to fusing the bones of the spine/vertebrae, limiting the spine’s mobility and leading to discomfort symptoms. The condition is more common in men but also affects women. There is not a known, singular cause, but individuals with a particular gene, HLA-B27, have an increased risk of developing the condition. However, the gene itself does not mean an individual has ankylosing spondylitis; genetics and other outside and environmental factors also play a role. DMARDs, or Disease-Modifying Antirheumatic Drugs, suppress inflammation. An emerging DMARD treatment uses biologics that further target and suppresses specific inflammatory compounds.
Biologics
Unlike regular medications, which are synthesized, biologics are made from and inside living sources.
They are grown in cultures or harvested from blood.
Biologics are complex and expensive.
Biologics provide some of the most powerful treatments for many conditions.
Two biologics commonly used to treat ankylosing spondylitis are:
TNF – tumor necrosis factor, TNF inhibitors are a biological medication that targets and suppresses TNF, which is involved in inflammatory processes throughout the body.
Blocking or suppressing TNF decreases inflammation and can delay the progression of ankylosing spondylitis.
It could be administered through an injection or infusion to provide the medication.
Side Effects
Side effects associated with this medication, along with other conditions, include:
IL – interleukin – IL-17 is a protein involved in inflammatory processes and conditions.
IL-17 inhibitors suppress inflammation which are newer medications that have been shown to benefit those with ankylosing spondylitis.
Doctors often administer IL-17 inhibitors through an injection.
Side Effects
Minor side effects include:
Headaches
Runny nose
Irritation at the injection site.
More serious side effects include:
Certain cancers
Severe infections
High blood pressure
Other Treatments
Treatment goals for ankylosing spondylitis include:
Slowing the disorder’s progression.
Decreasing inflammation.
Reducing pain.
Improving or maintaining joint and spinal range of motion.
Biologics are not the first-line treatment for ankylosing spondylitis.
Providers usually first treat an initial diagnosis with anti-inflammatory medications, like NSAIDs, to decrease inflammation and slow the condition’s progression.
Chiropractic care and physical therapy are recommended to maintain and/or improve posture, muscle strength, and endurance.
Recommended lifestyle and nutritional modifications.
Posture training stretches and exercises.
Optimal movement strategies to safely and confidently complete everyday tasks.
Biologic Medications
Biologics for ankylosing spondylitis may or may not be suitable. These medications are meant to help relieve the inflammation associated with the condition and slow the disorder’s progression. Your healthcare team will work with you to determine the right treatment option/s and explain the benefits, risks, and types of treatment. They will monitor the condition, track progress, and adjust the plan accordingly.
Assessing Hormone Therapy
References
Ankylosing spondylitis. (n.d.) National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services. Available at: https://www.niams.nih.gov/health-topics/ankylosing-spondylitis#:~:text=Ankylosing%20spondylitis%20is%20a%20type,the%20spine%20can%20cause%20stiffness (Accessed: October 12, 2022).
Chen C, Zhang X, Xiao L, Zhang X, Ma X. Comparative Effectiveness of Biologic Therapy Regimens for Ankylosing Spondylitis: A Systematic Review and a Network Meta-Analysis. Medicine (Baltimore). 2016 Mar;95(11):e3060. doi: 10.1097/MD.0000000000003060. PMID: 26986130; PMCID: PMC4839911.
Gerriets V, Goyal A, Khaddour K. Tumor Necrosis Factor Inhibitors. [Updated 2022 July 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482425/
Lindström, U., Olofsson, T., Wedrén, S. et al. Biological treatment of ankylosing spondylitis: a nationwide study of treatment trajectories on a patient level in clinical practice. Arthritis Res Ther 21, 128 (2019). https://doi.org/10.1186/s13075-019-1908-9
Yin, Y., Wang, M., Liu, M. et al. Efficacy and safety of IL-17 inhibitors for the treatment of ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Res Ther 22, 111 (2020). https://doi.org/10.1186/s13075-020-02208-w
Subluxation is when a joint shifts out of alignment, which can happen to any joint in the body. Spinal subluxation indicates a misalignment of one or more portions of the spinal vertebrae. It is common in the spine from all the reaching, bending, twisting, and flexing the body goes through. Spinal subluxations, if left untreated, can cause disc degeneration, permanent nerve damage, neurological conditions, and chronic pain symptoms. A subluxation chiropractor will realign and decompress the spine combined with massage therapy to relax the muscles and restore mobility and function.
Subluxation Chiropractor
Some subluxations don’t cause any problems or pain, but that doesn’t mean they aren’t affecting the back and body. A spinal subluxation can cause long-term problems by:
Research shows that spinal subluxations can affect many facets of the body. Long-term effects may include:
Sleep problems
Low energy
Brain fog
Mood swings
Anxiety and depression
Digestive issues
Respiratory problems
Bone spurs
Spinal arthritis
Chiropractic Care
When the spine is out of alignment, it can cause issues throughout the body. Changes in one area affect the rest of the body. A subluxation chiropractor looks at the spine’s neurological and mechanical components and aims to reset everything back into its proper position. Similar to the way a massage helps the mind and body relax and de-stress, a spinal adjustment helps by:
Increasing circulation
Relieving discomfort and pain
Releasing tension
Improving mood
Reducing stress levels
Improving sleep function
Increasing energy levels
When the spine is properly aligned, the body can operate at its full potential.
Adrenal Dysfunction
References
Brian S. Budgell, Reflex effects of subluxation: the autonomic nervous system, Journal of Manipulative and Physiological Therapeutics, Volume 23, Issue 2,
2000, Pages 104-106, ISSN 0161-4754, https://doi.org/10.1016/S0161-4754(00)90076-9. (https://www.sciencedirect.com/science/article/pii/S0161475400900769)
Green, J D et al. “Anterior subluxation of the cervical spine: hyperflexion sprain.” AJNR. American journal of neuroradiology vol. 2,3 (1981): 243-50.
Meyer, S. “Thoracic spine trauma.” Seminars in roentgenology vol. 27,4 (1992): 254-61. doi:10.1016/0037-198x(92)90004-l
Neva MH, Häkkinen A, Mäkinen H, et al. High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopedic surgeryAnnals of the Rheumatic Diseases 2006;65:884-888.
Nourollahi, Maryam, et al. “Awkward trunk postures and their relationship with low back pain in hospital nurses.” Work (Reading, Mass.) vol. 59,3 (2018): 317-323. doi:10.3233/WOR-182683
Vernon, Howard. “Historical overview and update on subluxation theories().” Journal of chiropractic humanities vol. 17,1 (2010): 22-32. doi:10.1016/j.echu.2010.07.001
The lumbar region of the spine has various muscles and nerve roots that work together with the lower body extremities, like the hips, buttocks, legs, knees, and feet, for mobility and walking function. The various muscles in the buttock region include the gluteal muscles. They have a casual relationship with the hip muscles as they work together for hip mobility and erect good posture in the body. These various muscles and nerves also supply sensory-motor function for the legs to be mobile and provide hip mobility. The piriformis is one of the muscles assisting in the hips and buttock region. When this muscle becomes overused, it can cause mobility issues in the legs and affect a person’s ability to walk. Today’s article looks at the piriformis muscle, how trigger points are associated with piriformis syndrome, and how to manage piriformis syndrome associated with trigger points. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like sciatic pain and piriformis syndrome treatments related to trigger points, to aid individuals dealing with pain symptoms along the piriformis muscle. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer
What Is The Piriformis Muscle?
Have you been having issues walking from one place to another? Do you feel muscle tightness in your hips or buttock region? Or are you experiencing radiating pain traveling to your knees and feet? These pain symptoms are correlated with trigger points affecting the piriformis muscle. The piriformis is a flat, pear-shaped muscle, one of the six short rotator muscle groups in the gluteal region of the hips and thighs. The rotator muscle groups consist of the following:
Gemelli
Quadratus Femoris
Obturator Internus
Obturator Externus
This muscle is parallel to the posterior margins of the gluteus medius and deep into the gluteus maximus. This muscle is very important to the body as it provides lower-body movement by stabilizing the hip joint and can lift and rotate the thighs away from the body. The piriformis muscle also surrounds the sciatic nerve, as this long nerve runs deep beneath the piriformis and enters the gluteal region of the rear. When the piriformis muscle becomes overused or suffers from associated traumatic factors, it can aggravate the sciatic nerve and even develop tiny nodules known as trigger points, causing mobility issues.
Trigger Points Associated With Piriformis Syndrome
When abnormal factors affect the piriformis muscles, they can develop into trigger points associated with piriformis syndrome and cause issues in the pelvic and hip regions of the body. According to Dr. Janet G. Travell, M.D., “Myofascial Pain and Dysfunction,” trigger points can be activated when repetitive strain affects the piriformis muscle and causes symptoms of muscle weakness and pain in the hips. This causes overlapping issues in the surrounding muscles and the sciatic nerve, making diagnosing tricky for trigger points. Studies reveal that trigger points associated with piriformis syndrome may potentially cause muscle spasms or an inflammatory process to irritate the sciatic nerve that may be presented as identical to lumbar disk syndrome without neurological findings. Trigger points associated with piriformis syndrome may mimic chronic issues like fibromyalgia. Even though trigger points are tricky to pinpoint in a thorough examination, there are various ways to reduce the pain and prevent trigger points from affecting the piriformis muscle causing sciatic nerve pain.
Trigger Point Of The Week: Piriformis Muscle- Video
Have you been dealing with sciatic nerve pain? Have you found it difficult to walk for a short period? Or are you dealing with muscle tenderness or soreness in your buttock or hips? People experiencing these symptoms could be dealing with piriformis syndrome associated with trigger points. The piriformis is a small, fan-shaped muscle, one of the six short rotator muscle groups that help with hip and thigh mobility through stabilization. The piriformis muscles also surround the sciatic nerve and can succumb to injuries. When traumatic forces affect the hips and thighs, the piriformis muscle develops nodules known as trigger points, causing the muscle to irritate the sciatic nerve and cause pain in the legs. The video above shows where the piriformis muscle is located and how trigger points can mimic sciatic nerve pain in the leg without neurological findings. Studies reveal that trigger points could be a rare anatomical variation that can correlate with piriformis syndrome associated with sciatica. However, there is some good news, as there are ways to manage piriformis syndrome associated with trigger points.
Managing Piriformis Syndrome Associated With Trigger Points
Various techniques can help manage piriformis syndrome associated with trigger points to relieve the piriformis muscle. Studies reveal that Kinesio tape on the piriformis muscle can help reduce pain and improve many individuals’ hip joint range of motion. Other techniques like stretching or deep tissue massage can help loosen up the stiff muscles and relieve trigger points from forming on the piriformis. For sciatica pain associated with trigger points along the piriformis muscle, decompression therapy can help the piriformis muscle lay off pressure on the sciatic nerve and reduce aggravated pain. These techniques can help improve hip joint mobility and increase the range of motion to the hips and lower extremities.
Conclusion
The piriformis is a small muscle that provides hip and thigh mobility. This small muscle surrounds the sciatic nerve, which helps give motor function to the legs. When traumatic factors affect the piriformis muscle, it can develop trigger points and cause sciatic pain in the hips. This causes mobility issues and pain around the hips. Various treatments are provided to help reduce the trigger points along the piriformis muscle and reduce sciatic nerve pain from causing more problems to the hips and legs mobility.
References
Chang, Carol, et al. “Anatomy, Bony Pelvis and Lower Limb, Piriformis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 3 Oct. 2022, https://www.ncbi.nlm.nih.gov/books/NBK519497/.
Pfeifer, T, and W F Fitz. “[The Piriformis Syndrome].” Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, U.S. National Library of Medicine, 1989, https://pubmed.ncbi.nlm.nih.gov/2618150/.
R;, Hashemirad F;Karimi N;Keshavarz. “The Effect of Kinesio Taping Technique on Trigger Points of the Piriformis Muscle.” Journal of Bodywork and Movement Therapies, U.S. National Library of Medicine, 8 Feb. 2016, https://pubmed.ncbi.nlm.nih.gov/27814861/.
Ro, Tae Hoon, and Lance Edmonds. “Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging.” Journal of Clinical Imaging Science, Medknow Publications & Media Pvt Ltd, 21 Feb. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843966/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
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