Piriformis Syndrome or Sciatica?

The Piriformis Muscle

The piriformis muscle is a small muscle located deep in the buttock (behind the gluteus maximus).

The piriformis muscle: 

Piriformis muscle 2

Starts at the lower spine and connects to the upper surface of each femur (thighbone)

Functions to assist in rotating the hip and turning the leg and foot outward

Runs diagonally, with the sciatic nerve running vertically directly beneath it (although in some people the nerve can run through the muscle).

Causes of Piriformis Syndrome

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

Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip

Tightening of the muscle, in response to injury or spasm

Swelling of the piriformis muscle, due to injury or spasm

Anyone or combination of the above problems can affect the piriformis muscle (causing buttock pain) and may affect the adjacent sciatic nerve (causing pain, tingling, or numbness in the back of the thigh, calf, or foot).

Almost every treatment approach for piriformis syndrome will include a focus on carefully and progressively stretching the piriformis muscle.

Depending on the severity of the client’s sciatica-type pain and other symptoms, a number of treatment options may be recommended.

A comprehensive approach to managing piriformis syndrome may include a combination of the following nonsurgical treatments:

Massage is one of the most effective modalities to manage the Piriformis Syndrome

WaveStone Massage

The ‘WaveStone’ is a therapy tool that has changed the way massage treatments are administered at Healthy Harmony. The WaveStone’s unique and ergonomic shape, carved from Jade, replaces conventional massage tools and has the ability to retain extreme heat and cold temperatures

It stimulates the circulatory system and harnesses the power of Jade to promote self-healing 
It softens and relaxes the muscles, using Far Infrared to pass heat smoothly into the body
It encourages the breakdown and release of toxins from the muscles
It helps relieve pain and muscle spasms

Following any treatment at Healthy Harmony, we provide an aftercare and home treatment plan including Stretches for Piriformis these will include hamstrings and hip extensors as they help decrease the painful symptoms along the sciatic nerve and return the range of movement.

Ice and Heat Therapy for onset of Piriformis Syndrome

Ice Packs and Ice Massage

At the onset of pain, lie in a comfortable position on the stomach and place an ice pack on the painful area for approximately 15 minutes. Repeat as needed (every 15 minutes within an hour).

It may be more helpful to combine a gentle massage with the ice. Lie on the stomach and have someone gently massage the painful area with a large ice cube. If ice is applied directly to the skin (instead of a cold pack), limit it to 5 to 8 minutes to avoid an ice burn.

If specific activities are usually followed by increased pain, it may be a good idea to apply ice immediately following the activity.

Heat Therapy

Some people find it helpful to alternate cold with heat. If using a heating pad, lie on the stomach and place the heating pad on the painful area for up to 20 minutes. Be sure to avoid falling asleep on a heating pad, as this may lead to skin burns.

However, if the pain is due to inflammation the use of ice is preferable.

Medications

Since most episodes of pain include some type of inflammation, anti-inflammatory medications, such as ibuprofen or naproxen, may help decrease inflammation in the affected area.

Alternatively, there are Herbal Medications

Turmeric acts as an anti-inflammatory, which can help relieve swelling and pain associated with sciatica and other types of lower back pain.

Turmeric alone may not be enough to relieve moderate to severe pain, but it can help take the edge off when combined with other natural treatments, such as heat or ice therapy, gentle stretches and strengthening exercises. 

Devil’s Claw’s is quite a potent anti-inflammatory, working like ibuprofen and similar drugs to inhibit substances that drive inflammation.

Take note that the supplement is well tolerated by most people but should be avoided by clients with peptic ulcers or on blood thinning medications.

Severe cases of Piriformis Syndrome it is likely that injections will be the only option

Piriformis injection

A local anaesthetic and corticosteroid may be injected directly into the piriformis muscle to help decrease the spasm and pain. The purpose of an injection is usually to decrease acute pain to enable progress in soft tissue therapy such as massage.

Botox injection

For persistent piriformis spasm that is resistant to treatment with anaesthetic/corticosteroid injections, an injection of botulinum toxin (e.g. Botox®), a muscle weakening agent, may be useful. The goal of the injection is to help the muscle relax and help reduce pressure on the sciatic nerve.

The goal with both injections is to help the patient progress with stretching and soft tissue therapy so that when the effect of the injection is over the muscle will be remain stretched and relaxed.

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