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Fibromyalgia and Sciatica vs Piriformis Syndrome

Fibromyalgia and Sciatica vs Piriformis Syndrome

Fibromyalgia and sciatica are two well-known health issues which can commonly occur at seemingly the same time in people, however, these may also frequently require different treatment approaches to help manage their painful symptoms. Fibromyalgia is characterized by widespread pain throughout numerous regions of the human body. As complex as the diagnosis and treatment for fibromyalgia might be, it’s ultimately fundamental for patients to be aware of any other conditions which may subsequently develop due to the painful symptoms of these well-known health issues. �

 

Sciatica, also known as sciatic nerve pain, is a collection of symptoms rather than a single condition and it is one of the most common health issues to coexist together with fibromyalgia. In this instance, one condition doesn’t necessarily cause the other, however, they can basically be present together. Fibromyalgia�patients should understand how sciatica and its characteristic symptoms can affect their overall health and wellness. Many people with fibromyalgia may subsequently develop other health issues when these painful symptoms overlap with other conditions, such as piriformis syndrome. �

 

Piriformis Syndrome vs Sciatica and Fibromyalgia

 

People with sciatic nerve pain, or sciatica, will often report experiencing pain and discomfort, tingling sensations, and numbness anywhere along the length of the sciatic nerve. The sciatic nerve is the longest and largest nerve in the human body, which travels from the lower back into the hip and buttocks, down into the thighs, knees, legs, and feet. Healthcare professionals may perform a variety of evaluations and tests to determine the source of a patient’s symptoms. People with fibromyalgia and sciatica may also experience another common health issue known as piriformis syndrome. �

 

Piriformis Syndrome Diagram 2 | El Paso, TX Chiropractor

 

Sciatica is caused by the compression or impingement of the sciatic nerve, frequently due to a herniated disc. Piriformis syndrome can cause sciatica when a piriformis muscle spasm irritates the sciatic nerve. The piriformis is a muscle which extends from the front of the sacrum, or the triangle-shaped bone between the two hipbones in the pelvis, across the sciatic nerve and into the top of the femur, or the large bone in the upper leg.� The piriformis muscle is fundamental because it allows the thighs to move from side to side. When an injury or underlying condition causes the piriformis muscle to compress or impinge the sciatic nerve due to irritation and/or inflammation, the end result is typically piriformis syndrome. �

 

Sciatica Diagram 1 | El Paso, TX Chiropractor

 

Sciatica is the most common symptom associated with piriformis syndrome. Other common symptoms associated with piriformis syndrome include tingling sensations and numbness, muscle tenderness, pain and discomfort while sitting or engaging in physical activities, and difficulty sitting comfortably. Because fibromyalgia causes widespread pain and inflammation, it’s also fundamental for people with fibromyalgia to seek immediate medical attention to diagnose all of their symptoms and rule out the possibility of their sciatica symptoms being due to piriformis syndrome or any other health issue. �

 

Fibromyalgia Diagram 3 | El Paso, TX Chiropractor

 

 

As previously mentioned above, sciatica, or sciatic nerve pain, is a medical condition or rather a collection of symptoms which causes pain and discomfort anywhere along the entire length of the sciatic nerve. For both fibromyalgia sufferers and people with the health issue alone, the pain and discomfort will generally manifest on one or both sides of the hips, buttocks, and thighs, where it will then radiate down the back of the leg, knees, and feet. In some instances, other common symptoms may manifest along the lower extremities, including tingling sensations, burning sensations, numbness, and weakness.

 

Sciatic nerve pain is most frequently caused by a slipped disc, a bulging disc, a herniated disc, or any other health issue which ultimately causes nerve pain and discomfort, such as fibromyalgia. When sciatica due to piriformis syndrome and/or another medical condition is experienced by fibromyalgia sufferers, it may be difficult for healthcare professionals to find the true source of their painful symptoms. Also, the symptoms associated with sciatic nerve pain and piriformis syndrome are generally the same for fibromyalgia sufferers, however, the most common causes may not be responsible for the symptoms.

 

Differential Diagnosis in Hip Pain

 

Differential Diagnosis Proximal Hip Pain

 

Fibromyalgia is characterized as widespread pain and discomfort throughout the human body. People with this painful health issue can experience a variety of symptoms, including sciatic nerve pain, or sciatica. Healthcare professionals believe that fibromyalgia can increase the way the human body experiences painful sensations by affecting the way the brain processes pain signals. Fibromyalgia and sciatica are two well-known conditions which can commonly coexist together. However, many fibromyalgia sufferers have reported piriformis syndrome, a condition caused when the piriformis muscle irritates the sciatic nerve. Because fibromyalgia can often be associated with increased pain and inflammation, these painful symptoms and health issues can ultimately occur. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Fibromyalgia Magazine

 

Fibromyalgia Magazine April 2019

 


 

People with fibromyalgia experience widespread pain and discomfort as a result of their medical condition, however, healthcare professionals have demonstrated that fibromyalgia may also cause other symptoms and health issues to manifest, such as sciatica, or sciatic nerve pain, and piriformis syndrome. The purpose of the article above was to demonstrate and compare fibromyalgia and sciatica symptoms versus piriformis syndrome. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900�. �

 

Curated by Dr. Alex Jimenez �

 


 

Additional Topic Discussion: Severe Sciatica

 

Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain attributes to the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. Your spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of sciatica, or sciatic nerve pain. Sports injuries or automobile accident injuries are often the most frequent cause of painful symptoms, however, sometimes the simplest of movements can have these results. Fortunately, alternative treatment options, such as chiropractic care, can help ease sciatic nerve pain, or sciatica, through the utilization of spinal adjustments and manual manipulations, ultimately improving pain relief. �

 





 

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Piriformis Syndrome Management

Piriformis Syndrome Management

Sciatica is a collection of symptoms in the low back, which radiate down one or both legs. Sciatica is generally caused by the compression or irritation of the sciatic nerve, the largest nerve in the human body. One of the most common health issues that cause sciatic nerve pain is called piriformis syndrome. The piriformis muscle stretches from the front of the sacrum, the triangle-shaped bone between the hipbones on the pelvis.

The piriformis muscle extends to the top of the femur around the sciatic nerve. The femur, as previously mentioned, is the large bone in the upper leg. The piriformis muscle functions by helping the thigh move from side to side. A piriformis muscle spasm, or any other type of injury and/or condition along the piriformis muscle, can place pressure on the sciatic nerve and cause pain and discomfort. The result is piriformis�syndrome.

Piriformis Syndrome Causes and Symptoms

Sciatic nerve pain,�or sciatica, is one of the most prevalent�symptoms of piriformis syndrome. The pain and discomfort, however, may be felt in another part of the body. This is known as referred pain. Other common symptoms of piriformis syndrome include tingling sensations and numbness; tenderness;�difficulty sitting along with�pain while sitting and pain in the buttocks and thighs with physical activities.

The piriformis muscle can easily become damaged or injured from periods of inactivity or an excessive amount of exercise. Some common causes of piriformis syndrome include overuse; repetitive movements involving the legs; sitting for lengthy periods of time; lifting heavy objects; and extensive stair climbing. Sports injuries or automobile accident injuries can also harm the piriformis muscle and cause it to compress the sciatic nerve.�

 

Piriformis Syndrome Diagnosis

A doctor appointment for diagnosis of piriformis syndrome may include a review of the patient’s health history, their symptoms, and other probable causes of their pain and discomfort. If you recall straining a muscle during physical activity, be sure to share that information with your doctor. The�doctor may also perform a physical exam. The patient will participate in a series of range of movements to determine the cause of symptoms.

Some imaging tests may also be essential to help rule out other causes of piriformis syndrome. A CT scan or an MRI scan may help the healthcare professional determine whether even a herniated disc or arthritis is causing the patient’s pain and discomfort. An ultrasound of the piriformis muscle may also be helpful in diagnosing the problem if it seems that piriformis syndrome is causing the patient’s overall symptoms.

 

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Piriformis syndrome is a health issue associated with the compression or impingement of the sciatic nerve around the piriformis muscle. Symptoms may include pain and discomfort, tingling sensations and numbness along the low back, or sciatica. Chiropractic care is a well-known alternative treatment option which can help reduce the compression of the sciatic nerve and improve piriformis syndrome.

Dr. Alex Jimenez D.C., C.C.S.T.

Piriformis Syndrome Treatment

Piriformis syndrome may often not need any treatment to�relieve its symptoms. Just avoiding the physical activities which caused the pain and discomfort to manifest and rest can help improve the health issue. If symptoms do persist, however, alternating between ice and heat can help decrease pain. Apply ice for 15 to 20 minutes then use a heating pad on the affected area. Try that every couple of hours to help relieve symptoms.

Over-the-counter painkillers�may also help decrease pain and discomfort. The symptoms associated with piriformis syndrome can go away with no additional treatment, however, if it doesn’t, the patient might benefit from alternative treatment options, such as chiropractic care or physical therapy. Chiropractic care is a treatment approach which utilizes spinal adjustments and manual manipulations to treat a variety of injuries and/or conditions.

A chiropractor,�or doctor of chiropractic, may also provide piriformis syndrome relief through the use of transcutaneous electrical nerve stimulator, or TENS, treatment. A TENS device is a handheld unit which sends electrical charges directly to the affected region of the piriformis muscle. The nerves are then stimulated by the electric energy, which interferes with pain signals being transmitted to the brain.

The chiropractor or physical therapist may also recommend a series of lifestyle modifications, including physical activity guidance and nutritional advice. Various stretches and exercises can help improve the strength, flexibility, and mobility of the�piriformis muscle. In severe cases of piriformis syndrome, corticosteroid injections or even surgical interventions may be required to help alleviate the symptoms.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.

Curated by Dr. Alex Jimenez

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Additional Topics: Chiropractic for Athletes with Back Pain

Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain is the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.

 

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EXTRA IMPORTANT TOPIC: Piriformis Syndrome Chiropractic Treatment

Scientific Specialist: 5 Common Causes of Sciatica Pain

Scientific Specialist: 5 Common Causes of Sciatica Pain

Several lumbar spine (lower back) disorders can cause sciatica. Sciatica is often described as moderate to intense pain at the left or right leg. Sciatica is caused by compression of at least one of the 5 places of nerve roots in the lower spine. Sometimes physicians call a radiculopathy sciatica. Radiculopathy is a term used to refer to pain, numbness, tingling, and weakness in the arms or legs brought on by a nerve root issue. If the nerve problem is in the neck, then it is called a cervical radiculopathy. However, because the low back is affected by sciatica, it is called a lumbar radiculopathy.

 

Pathways to Reduce Nerve Pain

 

Five sets of nerve roots at the lumbar spine combine to produce the sciatic nerve. Beginning at the back of the pelvis (sacrum), the sciatic nerve runs from the trunk, beneath the buttocks, and downward through the hip place into every leg. Nerve roots aren’t “solitary” structures but are a part of the body’s entire nervous system capable of transmitting pain and sensation to other areas of the human body. Radiculopathy occurs when compression of a nerve due to a disc rupture (herniated disc) or bone spur (osteophyte) occurs in the lumbar spine prior to it joining the sciatic nerve.

 

What Causes Sciatic Nerve Compression?

 

Several spinal disorders can lead to nerve compression or lumbar radiculopathy. The 5 are:

 

  • a bulging or herniated disc
  • lumbar spinal stenosis
  • spondylolisthesis
  • Injury
  • piriformis syndrome

 

Lumbar Bulging Disc or Herniated Disc

 

 

A bulging disc is also called a contained disc disorder. This usually means the gel-like center (nucleus pulposus) remains “contained” inside the tire-like outer wall (annulus fibrosus) of the disc.

 

A herniated disc occurs when the nucleus breaks throughout the annulus fibrosus. It’s known as a “non-contained” disc disease. Whether a disc herniates or bulges, disc material can press against an adjacent nerve root and compress lead to sciatica and nerve tissue.

 

Bulging and Herniated Discs MRI - El Paso Chiropractor

 

A disc’s consequences are somewhat worse. Not only does the herniated disc cause direct compression of the nerve root from the interior of the bony spinal canal, but also the disc material itself also contains an acidic, chemical irritant (hyaluronic acid) which causes nerve inflammation. In both situations, nerve wracking and irritation cause pain and swelling, muscle weakness, tingling, and often leading to extremity numbness.

 

Lumbar Spinal Stenosis

 

Spinal stenosis is a neural compression disease. Leg pain may happen as a result of lumbar spinal stenosis. The pain is usually positional, frequently brought on by activities such as walking or standing and relieved by sitting down.

 

Spinal nerve roots branch out in the spinal cord called foramina comprised of bone and ligaments. Between each set of vertebral bodies, situated on the right and left sides, is a foramen. Nerve roots pass through these openings and extend outward beyond the spinal column to innervate different parts of the human body. Whenever these passageways become obstructed causing nerve compression or lean, the expression foraminal stenosis is utilized.

 

Spondylolisthesis

 

Spondylolisthesis is a disorder that most often affects the lumbar spinal column. It’s characterized by a single vertebra slipping forward over an adjacent vertebra. A vertebra slips and is displaced, when, spinal nerve root compression often triggers sciatic leg pain and happens. Spondylolisthesis is categorized as developmental (found at birth, develops during childhood) or acquired from spinal degeneration, injury or physical strain (eg, lifting weights).

 

Trauma and Injury

 

Sciatica can result from nerve compression brought on by external forces to the lumbar or sacral nerve roots. Examples include motor vehicle accidents. The impact may injure the nerves or, sometimes, the nerves may be compressed by fragments of bone.

 

Piriformis Syndrome

 

piriformis-detail400

 

Piriformis syndrome is named after the muscle and the pain caused when the sciatic nerve irritates. The piriformis muscle and the thighbone is located in the lower portion of the spine, connect, and aids in cool rotation. The sciatic nerve runs beneath the piriformis muscle. When muscle aches grow in the muscle compressing the nerve, Piriformis syndrome develops. It may be difficult to diagnose and treat due to the deficiency of x ray or magnetic resonance imaging (MRI) findings.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�Green-Call-Now-Button-24H-150x150-2.png

 

By Dr. Alex Jimenez

 

Additional Topics: Sciatica

 

Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.

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El Paso Scientific Chiropractor: Piriformis Syndrome vs Herniated Discs

El Paso Scientific Chiropractor: Piriformis Syndrome vs Herniated Discs

Pain that travels from the back down the leg and into the foot is known as sciatica, which is an overall expression for pain that is excruciating. The term does not clarify why, or what tissue is injured. In reality accidents can cause gastrointestinal pain, together with piriformis syndrome, lumbar spinal disc herniations, and sprains being the three most frequent types of injuries and conditions affecting health and wellness.

 

Piriformis syndrome is commonly misdiagnosed as a spinal disc herniation, because the pattern of radiating pain, in the back to the lower elevation, is similar in both cases. With both injuries, individuals experience pain with the same type of motions, particularly rising from a seated position, standing for prolonged period of time, or sleeping. At the same time, the pain related to both injuries feels better once you curl up in the fetal position on your side.

 

A spinal disc herniation occurs when the jelly-like substance from inside the lumbar disc compresses the spinal cord or nerve. Either the disc material compresses the nerves when squeezed out of this disc, or else the compression of the nervous tissue is caused by inflammation. A spinal disc herniation is generally considered a severe injury, causing a massive amount of restriction and back pain. Some folks lose sensation in their legs. They can experience numbness and tingling through the day. Several have tingling, burning, dull, or pain in leg, glutes, and their own back. These are all symptoms associated with sciatica. Compression of particular nerves causes muscle fatigue and loss of feeling.

 

 

piriformis_syndrome_sciatic-nerve - El Paso Chiropractor

Herniated Disc Treatments

 

Therapy entails helping the body break down the spinal disc material, and relieving the compression of the nerves. Spinal disc decompression treatments are treatments for disc herniations. Flexion distraction therapy is also a way of decreasing pressure in the low back. Patients benefit from at-home utilization of inversion tables. Improve movement in the back joints and stretches and light exercises are used to decrease muscle spasms.

 

Massage treatment is focused on the back, buttocks, and hamstring muscles to decrease spasms and to reach the lumbar spine and pelvis. Individuals with disc herniations have weakness within their muscles, which need to be strengthened with therapy in order to increase strength, endurance, and muscle coordination patterns. Patients with a history of previous disc herniations or back injuries benefit immensely from strengthening therapy to prevent injuries.

 

Piriformis Syndrome and Treatment

 

The piriformis muscle is a really strong and powerful muscle that runs from the sacrum into the femur. It runs beneath gluteal muscles the nerve travels beneath them. If this muscle goes into spasm, then the nerve creates radiating pain, numbness, tingling, or burning out of the buttocks to the leg and foot. People do experience pain together with the syndrome. Other people develop the syndrome while dealing with chronic low back pain.

 

Activities and motions that cause the piriformis muscle to contract further compress the sciatic nerve, causing pain. This muscle can be contracted once we squat, or stand, walk , go up steps. It tends to tighten when we sit at any position for more than 20 to 30 minutes.

 

Individuals who have a history of chronic low back pain frequently assume that their radiating sciatic pain is traceable to their lower spine. Their history of disc herniations, or sprains, strains has taught them to assume that it will go away like normal, and that the pain is out of their spine. It is just when the pain doesn’t respond as usual that individuals seek therapy, thus delaying their recovery.

 

Piriformis Syndrome Image - El Paso Chiropractor

 

piriformis-detail400

 

Treatment for piriformis syndrome entails decreasing the intensity of the piriformis muscle spasm that’s controlling the sciatic nerve. Trigger point therapy, massage therapy, ice, heat, electrical, and stretching are involved with the early stages of care. Deep massage therapy is not advised in the first phases of piriformis syndrome. Some of the pain may be relieved during the therapy, but individuals experience worsening symptoms the following day. After the piriformis muscle is worked deeply it might relax for a short time period before it goes to a bigger spasm, further worsening the gastrointestinal pain.

 

Chiropractic Therapy for Sciatica Symptoms

 

Chiropractic therapies and treatment goals are to increase joint selection of motion and reduce muscle spasms. Muscle spasms increase tension and pressure on the lumbosacral and sacroiliac regions, which raises back pain. Treatment restores motion in these regions. Treatment and remedies to improve flexibility and reduce spasms accelerate healing and healing times for many types of back pain.

 

Often, people aggravate their piriformis muscle when they’re protecting or protecting their low back. They may have strength and capacity to compensate, bend, turn, and twist — thus, to squat, they overwork piriformis muscles and their glutes. Treatment should focus on increasing strength and endurance of their muscles, to reduce strain and injury.

 

Both piriformis syndrome and spinal disc herniations produce radiating pain in the very low back and to the leg. They are two different injuries, requiring treatments for recovery and regular healing. They are both commonly associated with flexibility and low back weakness. Treatment should address the acute traumas but also the core weaknesses that resulted in the condition.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�Green-Call-Now-Button-24H-150x150-2.png

 

By Dr. Alex Jimenez

 

Additional Topics: Sciatica

 

Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.

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Choosing a Chiropractor to Diagnose Piriformis Syndrome

Choosing a Chiropractor to Diagnose Piriformis Syndrome

Sciatica is generally described as a set of symptoms, primarily characterized by pain and discomfort, along with tingling sensations and numbness. Athletes frequently report experiencing symptoms of sciatica, however, there are many factors as well as a variety of injuries and conditions which can manifest these well-known symptoms. Piriformis syndrome is a disorder that is frequently confused with symptoms of sciatica.

The piriformis muscle is commonly known among athletes and healthcare professionals as a significant muscle in the posterior hip. This muscle functions to control hip joint rotation and abduction and it is also a distinguishable muscle due to its inversion of action in rotation. The piriformis muscle also raises awareness as the various causes of piriformis syndrome, a condition suspected to be a potential source of pain and dysfunction, not only in athletes, but in the general population as well.

Anatomy of the Piriformis Muscle

 

Anatomy of the Piriformis Muscle - El Paso Chiropractor

 

The piriformis muscle originates on the anterior surface of the sacrum and it is securely held to it by three tissue attachments found between the first, second, third and fourth anterior sacral foramina. Occasionally, its origin may be so broad that it joins the capsule of the sacroiliac joint with the sacrotuberous and/or sacrospinous ligament. The piriformis muscle is a thick and strong muscle that travels out of the pelvis through the greater sciatic foramen, dividing the foramen into the suprapiriform and infra-piriform foramina. As it courses through the greater sciatic foramen, the muscle decreases to a point where it forms a tendon that attaches to the superior-medial surface of the greater trochanter, frequently integrating with the tendon of the obturator internus and gemelli muscles.

The nerves and blood vessels found within the suprapiriform foramen are known as the superior gluteal nerves and vessels, and those found in the infra-piriforma fossa are known as the inferior gluteal nerves and vessels, including the sciatic nerve. Because of its broad size in the greater sciatic foramen, there�s a risk the numerous vessels and nerves that exit the pelvis may become compressed.

The piriformis muscle is closely associated with other short hip rotators as well, such as the superior gemellus, obturator internus, inferior gemellus and obturator externus. The primary difference between this muscle and other short rotators is its connection to the sciatic nerve. The piriformis muscle passes behind the nerve while the other rotators pass before it.

 

The PM and the SN - El Paso Chiropractor

 

Anatomical Variants

Several anatomical variations have been previously diagnosed among the piriformis muscle. First, there may be additional medial attachments to the first and fifth sacral vertebrae and to the coccyx. Second, the tendon may merge with the gluteus medius or minimus or with the gemellus. Also, in approximately less than 20 percent of cases, the piriformis muscle may be divided into two different segments, through which part or all of the sciatic nerve may travel. Then, the muscle may blend with the posterior hip joint capsule as a conjoined tendon with the obturator internus. Additionally, the distal attachment of the piriformis muscle has been demonstrated to vary in proportion and position on the supero-medial surface of the greater trochanter. It can stretch across 25 to 64 percent of the anterior-posterior length along the greater trochanter, with 57 percent of it attaching more anteriorly and 43 percent more posteriorly. Last but not least, researchers studied its insertion point broadly and discovered that four types of insertions existed and these were characterized based on the relationship to the obturator internus. The variation of placement and width of the distal attachment of the piriformis muscle may influence the effectiveness of the concept known as the inversion of action.

Furthermore, the connection between the piriformis muscle and the sciatic nerve has been a highly debated complication. It�s been previously concluded that there are several anatomical variations among the piriformis muscle and its connection to the sciatic nerve. The sub-types of this variation include: type 1-A, where the muscle is pear shaped with the nerve running anteriorly and inferiorly to this, found in 70 to 85 percent of cases; type 2-B, where the piriformis muscle is divided into two sections with the common peroneal nerve running between the two parts and the tibial nerve travels anteriorly and below, found in 10 to 20 percent of cases; type 3-C, where the peroneal portion loops over the top of the muscle and the tibial portion is found below, found in 2 to 3 percent of cases; and type 4-D, where the undivided nerve passes through the piriformis muscle, found in approximately 2 percent of cases.

 

Variations of the PM to SN - El Paso Chiropractor

 

Moreover, it is also speculated that two other, very rare variations may occur, demonstrated by letters E and F in the diagram. Type 1-A is the most common variation, displaying the sciatic nerve as it passes below the piriformis muscle.

Function of the Piriformis Muscle

The fundamental functions of the piriformis muscle are to provide hip external rotation and allow abduction at 90 degrees of hip flexion. During weight-bearing, the piriformis muscle restricts femoral internal rotation in the stance phase of walking and running. Also, it assists the short hip rotators in compressing the hip joint and stabilizing it. Because it can exert an oblique force on the sacrum, it may produce a strong rotary shearing force on the sacroiliac joint. Otherwise, this would dislocate the ipsilateral base of the sacrum forward and the apex of the sacrum backwards.

Since the piriformis muscle is the furthest behind of the hip external rotators because of its attachment on the anterior surface of the sacrum, it has the greatest influence to apply a rotation effect on the hip joint. Occasionally, healthcare specialists have found issues with the piriformis muscle where it appears to be tight and hypertonic, while the other short hip rotators which are found closer to the axis of rotation become inhibited and hypotonic.

Inversion of action

The most argumentative complication relating to the function of the piriformis muscle is its reversal-of-function role, best referred to as the inversion of action role. Researchers have suggested that as the hip approaches angles of 60 to 90 degrees and greater, the tendon of the piriformis muscle shifts on the greater trochanter. As a result, its line of pull becomes ineffective as a hip external rotator, however, it does contribute to internal hip rotation. Consequently, it reverses its rotation function at high hip flexion angles.

The role of the piriformis muscle at several joint angles is an essential consideration for healthcare professionals who evaluate and treat the causes of piriformis syndrome. Frequently, it�s recommended to stretch the hip into flexion, adduction and external rotation to stretch the piriformis muscle over the glutes by utilizing the reversal of function concept.

Nonetheless, more recent studies conducted through anatomical dissection have demonstrated that the attachment of the piriformis muscle onto the greater trochanter can change and, in some instances, it may insert in a position by which it may be unable to reverse its function, for example, in a more posteriorly placed attachment. Thus, stretching the piriformis muscle into external rotation when the hip is flexed beyond 90 degrees, based on the inversion of action role, would be ineffective as a treatment or misleading as an examination technique.

MSK Dysfunction and Causes of Piriformis Syndrome

Many decades ago, it was suggested that in some cases, sciatica symptoms may originate outside the spine as a result of the piriformis muscles. This hypothesis was supported soon after when specialists successfully improved an individual�s symptoms of sciatica by surgically dividing the piriformis muscle. Based on cadaver anatomical dissections, the researchers believed that the spasm of the piriformis muscle could be responsible for the irritation of the sciatic nerve.

The medical term piriformis syndrome then became associated to sciatica symptoms, believed to be caused by a usually traumatic abnormality in the piriformis muscle with a focus on ruling out more common causes of sciatica, such as nerve root impingement caused by a disc herniation. It soon became an accepted interpretation but with no consensus about the exact clinical signs and diagnostic tests to differentiate it from other sources of sciatica.

Understanding the Causes of Piriformis Syndrome

Piriformis syndrome can be defined as a clinical entity whereby the interaction between the piriformis muscle and the sciatic nerve may irritate the nerves and develop posterior hip pain with distal referral down the posterior thigh, resembling symptoms of true sciatica. Distinguishing the damage to this region typically follows exceptions of the more common causes of sciatica and buttock pain.

More specifically, reports of buttock pain with distal referral of symptoms are not unique to the causes of piriformis syndrome. Similar symptoms are prevalent with the more medically evident lower back pain syndromes and pelvic dysfunctions. Therefore, a complete evaluation of these areas must be performed to rule out any underlying pathology. It has been suggested that the causes of piriformis syndrome can be held responsible for approximately 5 to 6 percent of sciatica cases. In the majority of instances, it develops in middle-aged individuals, an average or 38 years and it�s more common among women.

Pathogenesis of Piriformis Syndrome

 

Myofascial Trigger Point Location - El Paso Chiropractor

 

The causes of Piriformis syndrome can be associated to three primary causing factors: First, the referred pain may be the result of myofascial trigger points. Second, the entrapment of the nerve against the greater sciatic foramen as it passes through the infrapiriform fossa or within a variating piriformis muscle. And third, sacroiliac joint dysfunction causing piriformis muscle spasms.

Other researchers presented an additional number of factors behind the causes of piriformis syndrome as follows: gluteal trauma in the sacroiliac or gluteal regions, anatomical variations, myofascial trigger points, hypertrophy of the piriformis muscle or spasms of the piriformis muscle, secondary to spinal surgery such as laminectomy, space occupying lesions such as neoplasm, bursitis, abscess and myositis, intragluteal injections and femoral nailing.

Symptoms

The general symptoms described with the causes of piriformis syndrome include: a tight or cramping sensation in the buttock and/or hamstring, gluteal pain in up to 98 percent of cases, �calf pain in up to 59 percent of cases, aggravation through sitting and squatting if the trunk is inclined forward or the leg is crossed over the unaffected leg and possible peripheral nerve signs such as pain and paresthesia in the back, groin, buttocks, perineum and back of the thigh in up to 82 percent of cases.

Physical findings and examinations

When palpable spasm within the surrounding piriformis muscle occur and there is obturator internus pain and external tenderness over the greater sciatic notch, found in approximately 59 to 92 percent of cases, the individual must perform the Sims position to follow up an evaluation. The piriformis line should overlie the superior border of the piriformis muscle and extend immediately from above the greater trochanter to the cephalic border of the greater sciatic foramen at the sacrum. The examination will continue where the line is divided into equal thirds. The fully rendered thumb presses on the point of maximum trigger-point tenderness, which is usually found just lateral to the junction of the middle and last thirds of the line.

It�s important to keep in mind that hip flexion with active external rotation or passive internal rotation may aggravate the symptoms of dysfunction. Additional findings for the evaluated causes of piriformis syndrome have demonstrated a positive SLR that is less than 15 degrees on the normal side. Other tests used to evaluate the causes of piriformis syndrome include, positive Freiberg�s sign, used in 32 to 63 percent of cases, involves the reproduction of pain on a passively forced internal rotation of the hip in the supine position, believed to result from passive stretching of the piriformis muscle and pressure of the sciatic nerve at the sacrospinous ligament. Pacers sign, used in 30 to 74 percent of cases, involves reproducing pain and weakness on resisted abduction and external rotation of the thigh in a sitting position. Pain in a FAIR position used to evaluate dysfunction, involves the reproduction of pain when the leg is held in flexion, adduction and internal rotation. Furthermore, an accentuated lumbar lordosis and hip flexor tightness predisposes an individual to increased compression of the sciatic nerve against the sciatic notch by a shortened piriformis. Electro-diagnostic tests may also prove useful to diagnose piriformis muscle complications.

Investigations

Conventional imaging, such as X-ray, CT scan and MRI, tend to be ineffective in diagnosing the presence and causes of piriformis syndrome. However, some value may exist in electro-diagnostic testing. The purpose of these tests is to find conduction faults in the sciatic nerve. Findings such as long-latency potentials, for instance the H reflex of the tibial nerve and/or peroneal nerve, may be normal at rest but become delayed in positions where the hip external rotators are tightened.

It�s been established that the tibial division of the sciatic nerve is typically spared, the inferior gluteal nerve that supplies the gluteus maximus may be affected and the muscle becomes atrophied. However, testing of the peroneal nerve may provide more conclusive results as they�re more likely to be the impinged portion of the sciatic nerve. The H-wave may become inactive during the painful position of forced adduction-internal rotation of the affected leg.

Piriformis Syndrome Myths

Researchers argued that piriformis syndrome is a frequently over-used term to describe any non-specific gluteal tenderness with radiating leg pain. It was discussed that only in rare cases is the piriformis muscle involved in nerve compression of the sciatic nerve to legitimately qualify as one of the causes of piriformis syndrome. It was cited that there is only limited evidence and cases where the diagnosis of the causes of piriformis syndrome can be made. First, where there is compressive damage to the sciatic nerve by the piriformis muscle. In several isolated studies, the sciatic nerve was seen to be compressed by the piriformis muscle in instances such as hypertrophy of the muscle, general anatomical abnormalities such as a bifid piriformis muscle and due to compression by fibrous bands.

Also, trauma and scarring to the piriformis muscle can involve the sciatic nerve. It is possible that rare cases of true piriformis syndrome have been caused by direct heavy trauma to the piriformis muscle due to a blunt trauma to the muscle. This is termed as post- traumatic piriformis syndrome.

Researchers supported this argument by stating that it is more likely that, given the anatomical relationship of the piriformis muscle to the various nerves in the deep gluteal region, the buttock pain represents entrapment of the gluteal nerves and the hamstring pain entrapment of the posterior cutaneous nerve of the thigh, rather than the sciatic nerve alone. This demonstrates the medically analyzed circumstance in the absence of distal sciatic neurological signs. Whether the piriformis muscle is the cause of the compression has not been clearly established. It is possible that the obturator internus/gemelli complex is an alternative cause of neural compression. The researchers have suggested utilizing the term deep gluteal syndrome rather than piriformis syndrome.

Treatment

When it is believed that a factor which is considered one of the several causes of piriformis syndrome exists and a healthcare professional feels that a proper diagnosis has been made, the treatment will usually depend on the cause behind the dysfunction. If the piriformis muscle is tight and it spasms, then initially conservative treatment will focus on stretching and massaging the tight muscle to remove the piriformis muscle as being the source of the pain. If this fails, then the following have been suggested and may be attempted: local anesthetic block, typically performed by an anesthesiologist who has expertise in pain management and in performing nerve blocks; steroid injections into the piriformis muscle; botulinum toxin injections in the piriformis muscle; and surgical neurolysis.

Therapist-directed interventions, such as stretching of the piriformis muscle and direct trigger point massage, can also be used as treatment. It�s been encouraged that piriformis muscle stretches are done in positions of hip flexion greater than 90 degrees, adduction and external rotation to utilize the inversion of action effect of the piriformis muscle to isolate the stretch to this muscle independent of the other hip external rotators.

However, recent evidence utilizing ultrasound investigation demonstrated that there was no interaction between hip flexion angle and the thickness of the piriformis muscle tendon in both internal and lateral hip rotation stretching, which suggests that the piriformis muscle does not invert its action. Furthermore, researchers who performed cadaveric studies found that the piriformis muscle insertion is a lot more complex and varied than initially believed. It is possible that the piriformis muscle may invert its action only in some subjects but not in others.

As a result, due to the disagreements and confusions over the inversion of action concept, it is recommended that healthcare professionals should performs two variations of a piriformis muscle stretch: stretches in flexion, adduction and external rotation and stretches in flexion, adduction and internal rotation.

Pigeon Stretch for left piriformis muscle: hip flexion, neutral adduction and maximal hip external rotation.

 

Pigeon Stretch for PM - El Paso Chiropractor

 

Stretch for left piriformis muscle: hip is in flexion, neutral adduction and maximal external rotation.

 

Stretch for Left PM Continued - El Paso Chiropractor

 

Short leg posterior chain stretch for right piriformis muscle: hip is in 90 degree flexion, adduction and neutral rotation.

 

Short Leg Chain Stretch for PM - El Paso Chiropractor

 

Trigger Points and Massage

 

Location of PM Trigger Points - El Paso Chiropractor

 

The most appropriate suggestion to palpate the piriformis muscle trigger points is in the following recommended position. In this posture, the healthcare professional can feel for the deep piriformis muscle trigger points and apply a constant pressure to relieve the trigger points as well as apply a flush massage to the muscle in this position. In this position, the large gluteus maximus is relaxed and it is easier to feel the deeper piriformis muscle.

The piriformis muscle is a deep posterior hip muscle that is closely related anatomically to both the sacroiliac joint and the sciatic nerve. It is a muscle that is a dominant hip rotator and stabilizer, with a tendency to shorten and become hypertonic. Therefore, stretching and massage techniques are best recommended and utilized to reduce the tone through the muscle. In conclusion, it has also been suggested in compression and irritation of the sciatic nerve, most commonly referred to as piriformis syndrome.

In athletes, piriformis syndrome is a common disorder identified by the irritation and inflammation of the piriformis muscle which can generally result in the compression of the sciatic nerve. This impingement of the nerves and its surrounding tissues can cause the symptoms of sciatica to manifest, characterized by pain and discomfort, along with tingling sensations and numbness, affecting an athlete’s performance.

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .Featured Provider - Wellness.com

By Dr. Alex Jimenez

 

Additional Topics: Headache After Auto Injury

After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. Whiplash is a common result of an auto collision, affecting the bones, muscles, tendons, ligaments and other tissues around it, causing symptoms such as head pain. Headaches are a common symptom after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.

 

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Causes of Piriformis Syndrome and Sciatica

Causes of Piriformis Syndrome and Sciatica

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The piriformis muscle is commonly known among athletes and healthcare professionals as a significant muscle in the posterior hip. This muscle functions to control hip joint rotation and abduction and it is also a distinguishable muscle due to its inversion of action in rotation. The piriformis muscle also raises awareness as the various causes of piriformis syndrome, a condition suspected to be a potential source of pain and dysfunction, not only in athletes, but in the general population as well.

Anatomy of the Piriformis Muscle

 

Anatomy of the Piriformis Muscle Diagram - El Paso Chiropractor

 

The piriformis muscle originates on the anterior surface of the sacrum and it is securely held to it by three tissue attachments found between the first, second, third and fourth anterior sacral foramina. Occasionally, its origin may be so broad that it joins the capsule of the sacroiliac joint with the sacrotuberous and/or sacrospinous ligament. The piriformis muscle is a thick and strong muscle that travels out of the pelvis through the greater sciatic foramen, dividing the foramen into the suprapiriform and infra-piriform foramina. As it courses through the greater sciatic foramen, the muscle decreases to a point where it forms a tendon that attaches to the superior-medial surface of the greater trochanter, frequently integrating with the tendon of the obturator internus and gemelli muscles.

The nerves and blood vessels found within the suprapiriform foramen are known as the superior gluteal nerves and vessels, and those found in the infra-piriforma fossa are known as the inferior gluteal nerves and vessels, including the sciatic nerve. Because of its broad size in the greater sciatic foramen, there�s a risk the numerous vessels and nerves that exit the pelvis may become compressed.

The piriformis muscle is closely associated with other short hip rotators as well, such as the superior gemellus, obturator internus, inferior gemellus and obturator externus. The primary difference between this muscle and other short rotators is its connection to the sciatic nerve. The piriformis muscle passes behind the nerve while the other rotators pass before it.

 

The PM and the SN Diagram - El Paso Chiropractor

 

Anatomical Variants

Several anatomical variations have been previously diagnosed among the piriformis muscle. First, there may be additional medial attachments to the first and fifth sacral vertebrae and to the coccyx. Second, the tendon may merge with the gluteus medius or minimus or with the gemellus. Also, in approximately less than 20 percent of cases, the piriformis muscle may be divided into two different segments, through which part or all of the sciatic nerve may travel. Then, the muscle may blend with the posterior hip joint capsule as a conjoined tendon with the obturator internus. Additionally, the distal attachment of the piriformis muscle has been demonstrated to vary in proportion and position on the supero-medial surface of the greater trochanter. It can stretch across 25 to 64 percent of the anterior-posterior length along the greater trochanter, with 57 percent of it attaching more anteriorly and 43 percent more posteriorly. Last but not least, researchers studied its insertion point broadly and discovered that four types of insertions existed and these were characterized based on the relationship to the obturator internus. The variation of placement and width of the distal attachment of the piriformis muscle may influence the effectiveness of the concept known as the inversion of action.

Furthermore, the connection between the piriformis muscle and the sciatic nerve has been a highly debated complication. It�s been previously concluded that there are several anatomical variations among the piriformis muscle and its connection to the sciatic nerve. The sub-types of this variation include: type 1-A, where the muscle is pear shaped with the nerve running anteriorly and inferiorly to this, found in 70 to 85 percent of cases; type 2-B, where the piriformis muscle is divided into two sections with the common peroneal nerve running between the two parts and the tibial nerve travels anteriorly and below, found in 10 to 20 percent of cases; type 3-C, where the peroneal portion loops over the top of the muscle and the tibial portion is found below, found in 2 to 3 percent of cases; and type 4-D, where the undivided nerve passes through the piriformis muscle, found in approximately 2 percent of cases.

 

Variations of the PM to SN Diagram - El Paso Chiropractor

 

Moreover, it is also speculated that two other, very rare variations may occur, demonstrated by letters E and F in the diagram. Type 1-A is the most common variation, displaying the sciatic nerve as it passes below the piriformis muscle.

Function of the Piriformis Muscle

The fundamental functions of the piriformis muscle are to provide hip external rotation and allow abduction at 90 degrees of hip flexion. During weight-bearing, the piriformis muscle restricts femoral internal rotation in the stance phase of walking and running. Also, it assists the short hip rotators in compressing the hip joint and stabilizing it. Because it can exert an oblique force on the sacrum, it may produce a strong rotary shearing force on the sacroiliac joint. Otherwise, this would dislocate the ipsilateral base of the sacrum forward and the apex of the sacrum backwards.

Since the piriformis muscle is the furthest behind of the hip external rotators because of its attachment on the anterior surface of the sacrum, it has the greatest influence to apply a rotation effect on the hip joint. Occasionally, healthcare specialists have found issues with the piriformis muscle where it appears to be tight and hypertonic, while the other short hip rotators which are found closer to the axis of rotation become inhibited and hypotonic.

Inversion of action

The most argumentative complication relating to the function of the piriformis muscle is its reversal-of-function role, best referred to as the inversion of action role. Researchers have suggested that as the hip approaches angles of 60 to 90 degrees and greater, the tendon of the piriformis muscle shifts on the greater trochanter. As a result, its line of pull becomes ineffective as a hip external rotator, however, it does contribute to internal hip rotation. Consequently, it reverses its rotation function at high hip flexion angles.

Nonetheless, more recent studies conducted through anatomical dissection have demonstrated that the attachment of the piriformis muscle onto the greater trochanter can change and, in some instances, it may insert in a position by which it may be unable to reverse its function, for example, in a more posteriorly placed attachment. Thus, stretching the piriformis muscle into external rotation when the hip is flexed beyond 90 degrees, based on the inversion of action role, would be ineffective as a treatment or misleading as an examination technique.

The role of the piriformis muscle at several joint angles is an essential consideration for healthcare professionals who evaluate and treat the causes of piriformis syndrome. Frequently, it�s recommended to stretch the hip into flexion, adduction and external rotation to stretch the piriformis muscle over the glutes by utilizing the reversal of function concept.

MSK Dysfunction and Causes of Piriformis Syndrome

Many decades ago, it was suggested that in some cases, sciatica symptoms may originate outside the spine as a result of the piriformis muscles. This hypothesis was supported soon after when specialists successfully improved an individual�s symptoms of sciatica by surgically dividing the piriformis muscle. Based on cadaver anatomical dissections, the researchers believed that the spasm of the piriformis muscle could be responsible for the irritation of the sciatic nerve.

The medical term piriformis syndrome then became associated to sciatica symptoms, believed to be caused by a usually traumatic abnormality in the piriformis muscle with a focus on ruling out more common causes of sciatica, such as nerve root impingement caused by a disc herniation. It soon became an accepted interpretation but with no consensus about the exact clinical signs and diagnostic tests to differentiate it from other sources of sciatica.

Understanding the Causes of Piriformis Syndrome

Piriformis syndrome can be defined as the interaction between the piriformis muscle and the sciatic nerve, where these may irritate the nerves and develop posterior hip pain with distal referral down the posterior thigh, resembling symptoms of true sciatica. Differentiating�the damage to this region typically follows exceptions of the more well-known causes of sciatica and buttock pain.

More specifically, reports of buttock pain with distal referral of symptoms are not unique to the causes of piriformis syndrome. Similar symptoms are prevalent with the more medically evident lower back pain syndromes and pelvic dysfunctions. Therefore, a complete evaluation of these areas must be performed to rule out any underlying pathology. It has been suggested that the causes of piriformis syndrome can be held responsible for approximately 5 to 6 percent of sciatica cases. In the majority of instances, it develops in middle-aged individuals, an average or 38 years and it�s more common among women.

Pathogenesis of Piriformis Syndrome

 

Myofascial Trigger Point Location Diagram - El Paso Chiropractor

 

The causes of Piriformis syndrome can be associated to three primary causing factors: First, the referred pain may be the result of myofascial trigger points. Second, the entrapment of the nerve against the greater sciatic foramen as it passes through the infrapiriform fossa or within a variating piriformis muscle. And third, sacroiliac joint dysfunction causing piriformis muscle spasms.

Other researchers presented an additional number of factors behind the causes of piriformis syndrome as follows: gluteal trauma in the sacroiliac or gluteal regions, anatomical variations, myofascial trigger points, hypertrophy of the piriformis muscle or spasms of the piriformis muscle, secondary to spinal surgery such as laminectomy, space occupying lesions such as neoplasm, bursitis, abscess and myositis, intragluteal injections and femoral nailing.

Symptoms

The general symptoms described with the causes of piriformis syndrome include: a tight or cramping sensation in the buttock and/or hamstring, gluteal pain in up to 98 percent of cases, �calf pain in up to 59 percent of cases, aggravation through sitting and squatting if the trunk is inclined forward or the leg is crossed over the unaffected leg and possible peripheral nerve signs such as pain and paresthesia in the back, groin, buttocks, perineum and back of the thigh in up to 82 percent of cases.

Physical findings and examinations

It�s important to keep in mind that hip flexion with active external rotation or passive internal rotation may aggravate the symptoms of dysfunction. Additional findings for the evaluated causes of piriformis syndrome have demonstrated a positive SLR that is less than 15 degrees on the normal side. Other tests used to evaluate the causes of piriformis syndrome include, positive Freiberg�s sign, used in 32 to 63 percent of cases, involves the reproduction of pain on a passively forced internal rotation of the hip in the supine position, believed to result from passive stretching of the piriformis muscle and pressure of the sciatic nerve at the sacrospinous ligament. Pacers sign, used in 30 to 74 percent of cases, involves reproducing pain and weakness on resisted abduction and external rotation of the thigh in a sitting position. Pain in a FAIR position used to evaluate dysfunction, involves the reproduction of pain when the leg is held in flexion, adduction and internal rotation. Furthermore, an accentuated lumbar lordosis and hip flexor tightness predisposes an individual to increased compression of the sciatic nerve against the sciatic notch by a shortened piriformis. Electro-diagnostic tests may also prove useful to diagnose piriformis muscle complications.

When palpable spasm within the surrounding piriformis muscle occur and there is obturator internus pain and external tenderness over the greater sciatic notch, found in approximately 59 to 92 percent of cases, the individual must perform the Sims position to follow up an evaluation. The piriformis line should overlie the superior border of the piriformis muscle and extend immediately from above the greater trochanter to the cephalic border of the greater sciatic foramen at the sacrum. The examination will continue where the line is divided into equal thirds. The fully rendered thumb presses on the point of maximum trigger-point tenderness, which is usually found just lateral to the junction of the middle and last thirds of the line.

Investigations

Conventional imaging, such as X-ray, CT scan and MRI, tend to be ineffective in diagnosing the presence and causes of piriformis syndrome. However, some value may exist in electro-diagnostic testing. The purpose of these tests is to find conduction faults in the sciatic nerve. Findings such as long-latency potentials, for instance the H reflex of the tibial nerve and/or peroneal nerve, may be normal at rest but become delayed in positions where the hip external rotators are tightened.

It�s been confirmed that the tibial division of the sciatic nerve is usually spared, the inferior gluteal nerve that supplies the gluteus maximus may be affected and the muscle can become atrophied. However, testing of the peroneal nerve may provide more conclusive results as they�re more likely to be the impinged portion of the sciatic nerve. The H-wave may become inactive during the painful position of forced adduction-internal rotation of the affected leg.

Piriformis Syndrome Myths

Researchers discussed that piriformis syndrome is a commonly over-used term used to describe any non-specific gluteal tenderness with radiating leg pain. It was argued that only in rare cases is the piriformis muscle involved in nerve compression of the sciatic nerve which may then accurately qualify as one of the causes of piriformis syndrome. It was cited that there is only limited evidence and cases where the diagnosis of the causes of piriformis syndrome can be made, foremostly, where there is compressive damage to the sciatic nerve by the piriformis muscle. In several isolated studies, the sciatic nerve was seen to be compressed by the piriformis muscle in instances such as hypertrophy of the muscle, general anatomical abnormalities such as a bifid piriformis muscle and due to compression by fibrous bands.

Also, trauma and scarring to the piriformis muscle can involve the sciatic nerve. It is possible that rare cases of true piriformis syndrome have been caused by direct heavy trauma to the piriformis muscle due to a blunt trauma to the muscle. This is termed as post- traumatic piriformis syndrome.

Researchers supported this argument by stating that it is more likely that, given the anatomical relationship of the piriformis muscle to the various nerves in the deep gluteal region, the buttock pain�may be caused by an entrapment of the gluteal nerves and the hamstring pain may be due to an entrapment of the posterior cutaneous nerve of the thigh, rather than an entrapment of the sciatic nerve alone. This demonstrates the medically analyzed circumstance in the absence of distal sciatic neurological signs. Whether the piriformis muscle is the cause of the compression has not been clearly established. It is possible that the obturator internus/gemelli complex is an alternative cause of neural compression. The researchers have suggested utilizing the term deep gluteal syndrome rather than piriformis syndrome.

Treatment

When one of the several causes of piriformis syndrome is discovered and a healthcare specialist feels that an appropriate diagnosis has been made, the treatment will generally depend on the cause behind the dysfunction. If the piriformis muscle is tight and it spasms, then initially conservative treatment will focus on stretching and massaging the tight muscle to clear the piriformis muscle from being the source of the pain. If this fails, then the following have been suggested and may be attempted: local anesthetic block, typically performed by an anesthesiologist who has expertise in pain management and in performing nerve blocks; steroid injections into the piriformis muscle; botulinum toxin injections in the piriformis muscle; and surgical neurolysis.

Therapist-directed interventions, such as stretching of the piriformis muscle and direct trigger point massage, can also be used as treatment. It�s been encouraged that piriformis muscle stretches are done in positions of hip flexion greater than 90 degrees, adduction and external rotation to utilize the inversion of action effect of the piriformis muscle to isolate the stretch to this muscle independent of the other hip external rotators.

However, recent evidence utilizing ultrasound investigation determined that there was no connection between hip flexion angle and the thickness of the piriformis muscle tendon in both internal and lateral hip rotation stretching, which implies that the piriformis muscle does not invert its action. Furthermore, researchers who performed cadaveric studies concluded that the piriformis muscle insertion is different and a lot more complex than it was first believed to be. It is possible that the piriformis muscle may invert its action only in some individuals but not in others.

Accordingly�due to the disagreements and confusions over the concept of inversion of action, it is suggested that healthcare professionals should perform two variations of a piriformis muscle stretch: stretches in flexion, adduction and external rotation and stretches in flexion, adduction and internal rotation.

Pigeon Stretch for left piriformis muscle: hip flexion, neutral adduction and maximal hip external rotation.

 

Pigeon Stretch for PM - El Paso Chiropractor

 

Stretch for left piriformis muscle: hip is in flexion, neutral adduction and maximal external rotation.

 

Stretch for Left PM Continued - El Paso Chiropractor

 

Short leg posterior chain stretch for right piriformis muscle: hip is in 90 degree flexion, adduction and neutral rotation.

 

Short Leg Chain Stretch for PM - El Paso Chiropractor

 

Trigger Points and Massage

 

Location of PM Trigger Points Diagram - El Paso Chiropractor

 

The most appropriate suggestion to palpate the piriformis muscle trigger points is in the following recommended position. In this posture, the healthcare professional can feel for the deep piriformis muscle trigger points and apply a constant pressure to relieve the trigger points as well as apply a flush massage to the muscle in this position. In this position, the large gluteus maximus is relaxed and it is easier to feel the deeper piriformis muscle.

The piriformis muscle is a deep posterior hip muscle that is anatomically similar to both the sacroiliac joint and the sciatic nerve. It is a muscle that functions as a dominant hip rotator and stabilizer, with a propensity to shorten and become hypertonic. For that reason, stretching and massage techniques are best utilized and often recommended to reduce the tone through the muscle. In conclusion, it has also been implied in compression and irritation of the sciatic nerve, most frequently referred to as piriformis syndrome.

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Sourced through Scoop.it from: www.dralexjimenez.com

By Dr. Alex Jimenez