Piriformis syndrome also called as Sciatica is a neuromuscular disorder that occurs when the muscles of piriformis exerts pressure on the sciatic nerve. Piriformis muscle is a bundle of flat muscle found in the buttocks which manages the muscular movement of the lower body. It is the muscles that are responsible for walking with balanced movement. This disorder occurs in one side of the body causing inflammation and numbness on the affected leg. Conservative treatment is enough for controlling mild to moderate pain and surgery is done only for severe case of the syndrome.
Symptoms :
The initial symptoms of piriformis syndrome are pain and tingling feeling in the buttocks. Sometimes the pain can become serious to extend all through the length of sciatic nerve. For some people there can be numbness for short period on the buttocks area. Pain is felt during actions of sitting, running and climbing staircase. Pain usually begins from the lower spine and proceeds till the buttock and goes beyond till the end of your legs. There will be low back pain in the buttocks and back side of the thigh muscle most of the time.
Pain will range from mild type to sharp burning pain causing great discomfort. For some people it can be felt as an electric shock. The pain increases when you sneeze or cough. Lumbar spine has two nerve roots in it called L4 and L5 and set of three nerve endings (S1-S3) which bind together to constitute sciatic nerve. When the L4 nerve root ending gets affected it causes pain on the thigh and jerk in the knee. If the L5 nerve root gets affected it causes intense pain or numbness on the top surface of the foot, and also on the region between the big toe and second toe.
When to Consult a Doctor?
You can wait for some days to verify if the mild pain subsides on its own. You need to consult your GP if you have sudden sharp pain on the lower back and legs area with numbness or tingling sensation. For some people controlling bowel movements become a problem very often during this condition.
Causes :
Piriformis syndrome occurs due to the pressure exerted by the piriformis muscle on the sciatic nerve. Sometimes the sciatic nerve gets pinched because of development of tumor or due to chronic diabetes. There are six back problems that frequently cause this syndrome.
- Lumbar herniated disc develops when the soft tissue of the inner disc protrudes out to irritate the nerve root.
- Degenerative disc disease occurs due to old age. It is the condition when the nerve root extends to cause irritation of the sciatic nerve.
- It can also be caused due to isthmic spondylolisthesis which occurs due to stress fracture that pinches the sciatica nerve endings.
- Lumbar spinal stenosis is a condition occurs due to aging process when the spinal canal gets narrowed.
- Piriformis syndrome also develops if the piriformis muscle pinches the nerve root of the sciatic nerve.
- Finally when the sacroiliac joint gets irritated for some reasons, it can affect the L5 nerve causing leg pain.
- Sciatic pain can occur due to muscle strain, scar tissue and spinal tumor and also due to serious infection on the lower back.
Who are at risk?
Aging and obesity are the main factors that increase the risk of developing periformis syndrome. People whose job involves constant twisting of back portion like driving vehicle can also develop this disorder. Sitting for extended periods and chronic disease like diabetes is likely to cause periformis syndrome. In rare cases, complications like weakness and lack of feeling on the lower legs develops due to this disorder.
Tests :
No concrete tests are available for detecting piriformis syndrome. The symptoms are common for other diseases and so your doctor will request for imaging tests like magnetic resonance, computerized topography test, and X-ray of the affected leg for detecting how far sciatic nerves are affected.
Treatment :
For milder forms of pain caused by prolonged sitting hours, you can change position frequently. Apply ice pack on the buttocks or thighs to reduce pain. You can also practice stretching exercises to reduce the compression of sciatic nerve.
Medications like muscle relaxants, anti-inflammatory drugs, narcotics and anti seizure medicines are prescribed. But the medications have to be combined with physical therapy for fast recovery. Steroid injections are given on the affected nerve root to reduce inflammation and pain but the pain may come back after few weeks.
Surgical Methods :
Surgery is done only for severe case of pain with problems like bowel incontinence. Microdiscectomy is a procedure done when the sciatic pain is caused due to lumbar disc herniation. In this process the protruding part of the herniated disc that pinches the sciatic nerve is removed surgically. Very often there will be complete relief from symptoms after surgery.
Lumbar laminectomy is another process where the root cause for piriformis syndrome is lumbar spinal stenosis. Here small region of the bone or disc that puts pressure on the nerve is removed surgically. Surgery is considered as the last option for this problem and it depends on the patient’s decision. The doctor would consider surgery only if there is severe leg pain for extended weeks and the patient does not respond to non surgical methods.
Lifestyle Changes :
Mild to moderate types of leg pain can be managed by making small changes and applying home remedies. Apply cold packs on the affected area for several times a day to get instant relief from pain and inflammation. Alternatively you can also apply hot packs on the legs for decreasing the pain. Both hot and cold packs can be altered for managing pain considerably.
Stretching exercises can offer relief from nerve compression on the sciatic nerves. Active exercise is vital for managing acute pain caused by piriformis syndrome. Movement of legs and thigh muscles help exchange of fluids and nutrients to keep them healthy. It is possible for the person to recover quickly from flare-ups of sciatica by active stretching exercises. In case you still have pain you can use over the counter medicines like ibuprofen or Motrin.
Alternative Treatment :
Some experts believe that acupuncture is highly useful for relieving the symptoms and managing back pain. Similarly you can approach chiropractors for effective body massage and making spinal adjustments.
Prevention :
You cannot prevent piriformis syndrome but you can manage from the symptoms by doing exercise regularly and sitting in proper posture. Give firm support to your back portion using a pillow or rolled towel to maintain the curved position of the spine. When lifting heavy objects always hold it close to your body and use your lower extremities for this work. Do not lift anything in awkward position.