Piriformis syndrome, sciatica

PAIN THAT RUNS OUTSIDE THE HIP AND GETS WORSE WHEN RUNNING OR WALKING UP THE STAIRS. CAN IT BE SCIATICA AND PIRIFORMIS SYNDROME?

It could be related to sciatica or it could be piriformis syndrome. Sciatica nerve roots come out of the spinal column low in the back and then pass behind the hip joint. Piriformis syndrome: The piriformis muscle typically runs on top of the sciatic nerve in the buttocks and can compress the sciatic nerve if the muscle becomes too tight. The symptoms may get worse after sitting for a long time, walking upstairs, walking, or running. https://www.nhs.uk/conditions/sciatica/

Annular tear, Piriformis syndrome

DIFFERENCES & TREATMENT OF ANNULAR TEAR AND 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 FOR ANNULAR TEAR

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). https://www.nice.org.uk/guidance/ipg506/ifp/chapter/The-condition

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

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. https://www.evidence.nhs.uk/search?q=piriformis%20syndrome

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.

TREATMENTS OF PIRIFORMIS SYNDROME

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.

Piriformis syndrome

PIRIFORMIS SYNDROME

Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).https://www.nhs.uk/live-well/exercise/exercises-for-back-pain/

SYMPTOMS OF PIRIFORMIS SYNDROME INCLUDES:

  • increased pain after prolonged sitting
  • dull ache in the buttock
  • pain down the back of the thigh, calf and foot
  • pain when walking up stairs and/or down stairs
  • reduced range of movement of the first

DIAGNOSING PIRIFORMIS SYNDROME:

  • MRI
  • ¬†nerve conduction tests may be carried out to exclude other condition that can cause similar symptoms to piriformis syndrome.
  • an injection of anesthetic with or without steroids may help to confirm if the piriformis muscle is the source of the symptoms.
  • ¬†physical assessment. Physical assessment should include an osteopathic structural examination with special attention to lumbar spine, pelvis, sacrum as well as any leg length disparities. Physical assessment should also include deep tendon reflex testing, strength and sensory testing.
  • leg length discrepancy warrants an investigation to distinguish between physiologic and anatomic causes.
  • diseases of hip, including arthritis and bursitis, as well as fracture should be considered in differential diagnosis.

TREATMENT OF PIRIFORMIS SYNDROME:

  • early conservative treatment is the most effective treatment.
  • stretching of the piriformis muscle and strengthening of the abduct and adductor muscles should be included in treatment plan.
  • non-steroidal anti-inflammatory drugs and acetaminophen have been considered the medication of choice.
  • muscle relaxants are another frequently prescribed medication.
  • local steroid injections can produce an anti-inflammatory effect.
  • as a last resort, surgery has been occasionally used in cases that have failed to resolve with the use of other treatment measures.