If you are one among the people who carry a fat wallet and sit over it, then there are chances that over a period of time, you may develop pain your buttocks which may radiate to the legs. Very surprising, isn’t it? One of the muscles that are present in our buttocks, is piriformis muscle. From the buttocks, it gets attached to the thigh bone. Due to any reason, if this muscle exerts pressure on the underlying sciatic nerve, there is pain in the buttocks that radiates to the legs. This is called as Piriformis syndrome; and carrying a fat wallet is one of the reasons for it!
Understanding Piriformis syndrome
The piriformis is a muscle that runs from the base of the spine to the top part of the thigh bone. The sciatic nerve runs from the spinal cord, traces through the buttock and goes down the back side of each leg. When the piriformis muscle presses on the sciatic nerve, then it causes numbness and pain in the lower part of body which is known as the piriformis syndrome.
The piriformis syndrome occurs when pressure is applied on the sciatic nerve due to activities like sitting for long periods of time. It can also occur due to tightness of piriformis muscle itself. It can also occur as a combination of both causes. Traumatic events like a steep fall or a car accident can also cause piriformis syndrome.
In the piriformis syndrome, there is deep pain in the buttock that radiates to the lower part of back, legs and foot on the side of the body that is affected. The pain increases when the person is walking, climbing stairs, running, squatting, bending the knees, and even when sitting for long periods of time. Other symptoms include neck pain, headache, abdominal pain, pelvic pain, groin pain, dyspareunia (pain during sexual intercourse) in women, and pain during bowel movements.
Diagnosis
The doctor may perform several tests to diagnose Piriformis syndrome. Signs like Lasegue, Frieberg and PACE help in diagnosing piriformis syndrome. Lasegue sign refers to the pain that arises when pressure is applied on piriformis muscle and its associated tendon, by flexing hip at 90 degrees with knee extended. When the passive internal rotation of the hip causes pain, this is called as the Frieberg sign. In case of PACE sign, The FAIR test is performed where the doctor performs Flexion, Adduction and Internal Rotation movements( type of rotations) of affected hip and knee and checks for the reaction of the patient. If the patient experiences symptoms like that of sciatica which is caused by compression of spinal nerve, then the FAIR test is positive. Magnetic Resonance imaging (MRI) and Computerized Tomography (CT scan) are done only to rule out any other causes that may be causing pressure on the sciatic nerve.
Treatment
The doctor may prescribe non steroidal anti inflammatory drugs (ibuprofen, aspirin, naproxen) and acetaminophen for pain relief. Apart from this, muscle relaxants are also prescribed to reduce the symptoms. In case of severe pain, narcotics provide much relief to the patients, but they are given only as a short term medication. To reduce severe inflammation, steroid injections are given which reduce the inflammation (swelling) in the affected area. All the medications have to be taken only under doctor’s prescription.
Some patients may find physical therapy to be beneficial. Various stretching exercises are taught to the patient who has to do them regularly as advised by the doctor. If there is any difficulty in doing the exercises, the patient is referred to a physical therapist. Multiple small sessions of physical exercises have to be done at home regularly for a few minutes daily. The main aim of physical therapy is to increase the movement of joints, muscles and strengthening the muscles of the hip.
Other treatments used to relieve pain and other associated symptoms are heat therapy, cold therapy, BTX-A injections (botulinum toxin injections), iontophoresis (use of electric current to take medication into skin), sonophoresis (using ultrasonic sound energy to transport medication into skin). If none of the treatments provide any relief, the last resort is to perform surgery in which the pressure on the sciatic nerve is released.
Prevention
To prevent Piriformis syndrome from recurring, one must make certain healthy lifestyle changes. Exercising regularly is a must. A good posture should be maintained when standing, sitting or driving. One must not continuously sit in the same position for a long time as it causes pressure on the sciatic nerve. When one needs to lift an object one must bend the knees and squat to pick up the object. The back should be kept straight and twisting the body must be avoided while lifting the object. Exercise regimens have to be changed, if the person feels that the symptoms are worsening or the piriformis syndrome is going to recur.
Calling Your Doctor
One must call the doctor if the pain persists for more than few weeks; if there is sudden severe pain in the lower back and leg leading to numbness in the leg; there is difficulty in controlling bladder and bowel movements; the pain has started after an injury or accident.
