Piriformis Syndrome
What is piriformis syndrome?
Good question! No one really knows exactly what causes
piriformis syndrome, or if it really exists. Some physicians
believe that piriformis syndrome is the name given to
hip/buttock pain that cannot be otherwise diagnosed. Others
believe that piriformis syndrome is a very real
cause of
pain and disability.
What is the piriformis muscle?
The piriformis is a muscle that travels behind the
hip
joint. The piriformis muscle is small compared to other
muscles around the hip and thigh, and it aids in external
rotation (turning out) of the hip joint. The piriformis
muscle and its tendon have an intimate relationship to the
sciatic nerve--the largest nerve in the body--which supplies
the lower extremities with motor and sensory function. The
piriformis tendon and sciatic nerve cross each other behind
the hip joint, in the deep buttock. Both structures are
about one centimeter in diameter.
What do people think happens in piriformis syndrome?
It is thought that the piriformis muscle tendon may be
tethering the sciatic nerve, and causing an
irritation to
the nerve. While it has not be proven, the theory supported
by some physicians is that when the piriformis muscle and
its tendon are too tight, the sciatic nerve is choked. This
may
decrease the blood flow to the nerve and irritate the
nerve because of pressure.
What else may be causing this pain?
Sometimes referred to as "deep buttock pain," other causes
of this
type of pain include spine problems (including
herniated discs,
spinal stenosis, etc.),
sciatica, and
tendonitis. The diagnosis of piriformis syndrome is often
given when all of these diagnoses are eliminated as possible
causes of pain. Other signs of piriformis syndrome include
examination maneuvers that attempt to isolate the function
of this muscle, and the finding of pain directly over the
tendon of the piriformis muscle.
Is there any treatment for piriformis syndrome?
Unfortunately, the treatment of piriformis syndrome is quite
general, and often this is a difficult problem to recover
from. Some treatment suggestions are:
- Physical Therapy - Emphasis on stretching and
strengthening the hip rotator muscles
- Rest - Avoid the activities that cause symptoms for
at least a few weeks
- Anti-Inflammatory Medication - To decrease
inflammation around the tendon
- Deep Massage - Advocated by some physicians
On some occasions, when these treatment fail, patients
have
surgery to release, or loosen, the piriformis muscle
tendon. This surgery is not a small procedure, and generally
considered the last resort if a lengthy period of
conservative treatment does not solve the problem.
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