Piriformis Syndrome: Pseudosciatica (What to do?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

And if your buttock pain that radiated into the leg came from the piriformis muscle? Piriformis syndrome, often confused with sciatica, could be the source of your problem.

What is piriformis syndrome, and how do you recognize it? How long does it last? What are the ways to treat it?

This easy-to-read article tells you the difference between piriformis syndrome and other conditions that cause leg pain, and offers treatment strategies to help you get better.

Definition and anatomy

Before talking about piriformis syndrome, it is worth discussing the anatomy of the piriformis muscle, this small muscle located in the deep part of the buttock, and its relationship with the sciatic nerve.

The piriformis originates from the sacrum and attaches to the greater trochanter of the femur. It allows rotation of the hip and contributes to the stability of this joint in a standing position.

The sciatic nerve, on the other hand, originates from vertebrae L4 to S3 of the spine, where the nerve roots of these vertebrae join to form the sciatic nerve.

One of its peculiarities is that the sciatic nerve passes directly under the fibers of the piriformis muscle. In some people, however, the nerve passes directly through the fibers of this muscle.

In some situations, the muscle may be compressed, spasmed, injured, tight, or swollen. In short, any injury to the piriformis muscle can lead to piriformis syndrome, and cause symptoms directly to the muscle or surrounding structures (such as the sciatic nerve).

Symptoms of the disease

Here are the typical symptoms associated with piriformis syndrome:

• Pain and stiffness in the buttock
• Irradiations to the back of the thigh, calf and foot (like a sciatica)
• Numbness, tingling or burning sensation in the lower limb
• Worse pain when climbing stairs or climbing a slope
• Pain worse after prolonged sitting (especially when crossing the legs)
• Decreased hip range of motion
• Relief of symptoms while lying down

Diagnosis of piriformis syndrome

There is no single test that can diagnose piriformis syndrome. Moreover, it is common to see nothingmedical imaging despite the presence of pain.

If a test of x-ray, scanner or MRI, it is more to eliminate disc or nerve damage than to identify a piriformis syndrome.

Moreover, since the symptoms are similar to sciatica, the herniated disc or sacroiliac dysfunction, it is not uncommon to overlook this diagnosis.

It should be mentioned that this diagnosis is not unanimous among doctors and the scientific community.

The following are clinical features that may indicate damage to the piriformis muscle:

• Painful hip movement
• Pain reproduced on palpation of the piriformis muscle
• Pain when stretching the piriformis muscle
• Pain on contraction of the piriformis muscle
• In extreme cases, an infiltration at trigger point can be given to the piriformis muscle to see if the symptoms improve.

How long does piriformis syndrome last?

The question of the prognosis and the duration of healing is certainly legitimate, but it is difficult to answer it in an exact way.

In general, it is estimated that recovery will take place within a month if the symptoms are localized in the buttocks, and can extend to a few months if the pain radiates further down the leg.

Stop! Before applying this hypothetical healing time to your condition, consider the following factors:

First, it must be remembered that the intensity of the pain is not necessarily proportional to the severity of the condition. Even if the symptoms are intolerable, healing can be accelerated with proper treatment.

Hope that reassures you!

On the other hand, the duration of the symptoms generally influences the prognosis. If you've had pain for months, it's probably "crystallized" in your central nervous system (your brain), which means it will take more time to disappear.

Then, the location of the pain is often related to the severity of the attack. Most often, the further the symptoms radiate into the leg, the more advanced the condition. And above all, if the irradiations do not respond to any treatment aimed at centralization of symptoms, it is estimated that the healing time will be longer.

Finally, it should be noted that back pain is multi-factorial. This means that several factors can influence pain and healing. Surprisingly, we discovered that the stress, le lack of sleep or inactivity could aggravate the symptoms of low back pain.

With this in mind, taking charge of the emotional component and others can greatly influence the duration of the piriformis symptom.

Piriformis Syndrome Rehabilitation

Rehabilitation of piriformis syndrome is based on a progressive approach aimed at controlling pain and inflammation, then toning and softening the piriformis muscle.

Here are some treatment modalities used in the treatment of this syndrome:

Medication

Turnkey pharmaceuticals as anti-inflammatories and painkillers can act on pain. In addition, muscle relaxants can reduce tension and spasms in the piriformis muscle.

Heat/Ice

Ice is generally used to calm inflammation and pain. Heat, on the other hand, relaxes tense muscles.

To learn more about using ice vs heat, read the following article.

Massage and passive treatments

A qualified therapist can use various massage techniques to relax the piriformis muscle (myofascial release, trigger point, etc.).

In addition to massage, passive stretching of the piriformis and surrounding muscles can provide significant relief. Hip mobilizations can also help.

Alternative treatments 

Although there is little scientific evidence supporting this kind of modality, alternative techniques are often used to treat piriformis syndrome..

Alternative treatments include:

• acupuncture
• acupressure mat
• suction cup (cupping therapy)
• myotherapy
• Quinton plasma
• percutaneous hydrotomy
• therapeutic yoga
• craniosacral therapy

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used as an alternative to medication to treat buttock pain associated with piriformis syndrome, in particular for their anti-inflammatory properties. It is essential to consult a doctor beforehand, mainly to avoid drug interactions and side effects.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation. The products are available on the site Country. Use promo code LOMBAFIT15 if you wish to obtain one of the following products, or any remedy aimed at relieving your symptoms and improving your quality of life:

• Turmeric. Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
• Ginger. In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. the gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
• Omega-3s. Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 
• Lemon eucalyptus. Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
• wintergreen. Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

Remember that these products do not replace medical treatment. Do not hesitate to consult for support adapted to your condition.

Exercices

Once the pain is under control, it is important to maintain the piriformis muscle to avoid the risk of recurrence. Of the activities dStrengthening and stretching such as these allow you to resume daily activities:

One-sided bridge

1. Lie on your back
2. Extend the non-painful leg so that the knee is straight and maintain full extension.
3. Raise the buttocks off the ground by pushing off with the heels of the affected leg.
4. Slowly lower back to the starting position.
5. Do these movements for about twenty repetitions. Take breaks as needed.

Piriformis stretch

1. Lie on your back.
2. Cross the symptomatic leg so that the heel rests on the opposite leg.
3. Pull the non-symptomatic leg towards you. At this point, you should feel a stretching sensation behind the symptomatic buttock.
4. Hold the stretch for 30 seconds, then repeat 3 times, taking breaks between each set

Infiltration

In some extreme cases, the doctor will try to resort to infiltration to relieve the symptoms. This is usually the last resort before the surgery.

There are several possible types of infiltration. Although the main one is cortisone infiltration at the injured site, it is possible to use botox injections for the relaxation effect caused.

Conclusion

Piriformis syndrome is a condition that affects the piriformis muscle. Symptoms felt in the buttock and leg often stem from secondary irritation of the sciatic nerve anatomically connected to the piriformis muscle.

The diagnosis is not easy to make, mainly because sciatica of disc origin, or even damage to the sacroiliac joint, can cause similar symptoms.

The treatment aims to calm inflammation, reduce muscle tension and indirectly nervous pressure, tone and relax the piriformis muscle.

A health professional is best able to treat this syndrome, and reduce the healing time.

Good recovery !