Annular tear, Piriformis syndrome


The annular tear is a tearing of the disc external surface that occurs with injury or the aging process. The L4-L5 and L5-S1 discs are the most commonly affected. The annulus may thin or bulge or weaken to the point that disc material may extrude into the spinal canal.


Treatment of annular tears depend on whether the tear is asymptomatic annular tear, symptomatic annular tear without disc herniation (or protrusion) or symptomatic annular tear with disc herniation (or protrusion).

Below are the brief descriptions of the treatments:

Asymptomatic annular tear:

If the annular tear is identified incidentally, most commonly on MRI imaging, then no treatment is needed. Such annular tear may resolve itself spontaneously over time and are frequently due to the stress applied to the spine.

Symptomatic annular tear without disc herniation (or protrusion):

The understanding of this type of tear is that it is caused by local inflammatory reactions from the annular tear that lead to irritation of adjacent nerve fibres or traversing nerve roots. The treatment for this condition is anti-inflammatory medications aiming to decrease the inflammatory reaction at the annular tear which in turn decrease stimulation or irritation of adjacent nerve fibre or traversing nerve roots.

In addition to anti-inflammatory medications a low-impact physical therapy may be used. The low-impact physical therapy may help to develop strength in the core muscles to mitigate the forces which may have originally led to the annular tear.

Symptomatic tear with disc herniation (or protrusion):

If there is a herniation (or protrusion) it is usually the protruding or herniated disc material itself which causes the clinical symptoms. Treatment options for disc herniation include conservative measures, nonsteroidal anti-inflammatory medications, physical therapy and local injections. If symptoms fail to improve or patient develops weakness, surgical treatment is considered including laminectomy, foraminotomy, laminotomy, discectomy, fusion, or combination thereof.


Piriformis syndrome is a neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. Piriformis is a small muscle located deep in the buttock behind the gluteus maximus. It runs diagonally from the lower spine to the upper surface of the femur, with the sciatic nerve running underneath or through the muscle. The pirifomis muscle helps the hip rotate, turning the leg and foot outward.

Piriformis syndrome usually starts with pain, tingling or numbness in the buttocks. The pain is due to the pirifomis muscle compressing the sciatic nerve, such as while sitting on a car seat. Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle or sitting for long periods of time. Diagnosis of piriformis syndrome is made by the patients report of symptoms and by physical examination using a variety of movements to elicit pain to the piriformis muscle. Because symptoms can be similar to other conditions, radiologic tests such as MRI may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.


Rest, ice and heat may help relieve symptoms. A doctor or physical therapist can suggest a program or exercises and stretches can help reduce sciatic nerve compression. Osteopathic manipulation treatment has been used to help relieve pain and increase range of motion.