In piriformis syndrome, the piriformis muscle compresses the sciatic nerve. Patients complain of severe pain symptoms that radiate from the buttocks to the legs. Massages and stretching exercises are mainly used for treatment.
What is Piriformis Syndrome?
Piriformis syndrome is one of the so-called nerve compression syndromes. In these syndromes, a nerve is compressed and its function is impaired. Another name for this type of syndrome is bottleneck syndrome. Piriformis syndrome refers to compression of the sciatic nerve, also known as the sciatic nerve. See dictionaryforall for PANDAS in Dictionary.
It is a peripheral nerve of the lower extremities, arising from the sacral plexus and containing fibers from the L4 to S3 spinal cord segments. The sciatic nerve is one of the strongest nerves in the human body. Compression of this nerve was first described in 1947. Robinson is considered to be the first to describe it. To date, piriformis syndrome has been a controversial topic in neurology.
Different opinions exist, for example with regard to the definition, pathogenesis and therapy of the symptom complex. Due to the different opinions regarding the definition, the diagnostic procedure is sometimes not the same. This means that statements on epidemiology can hardly be made. However, it has been speculated that piriformis syndrome is a rather common syndrome, affecting women far more often than men.
Piriformis syndrome can have a variety of causes. Compression of the nerve is most likely at the bottlenecks that the cord has to overcome in its course. In the narrower definition, there is only talk of a piriformis syndrome when the sciatic nerve is compressed by the piriformis muscle. This muscle corresponds to a flat pyramidal to pear-shaped muscle of the skeletal muscle, which is part of the deep muscles of the hip.
The muscle is innervated by the sacral plexus or the sciatic nerve. A jamming of the sciatic nerve under the muscle can occur after trauma, for example. Trauma in the area of the gluteal region is sometimes the most frequently cited cause of nerve compression. Under certain circumstances, violent movements can also lead to nerve compression.
Other causes are chronically incorrect posture, especially in the form of prolonged and one-sided sitting. Depending on the cause, piriformis syndrome either occurs suddenly or its symptoms build up more gradually. In some cases, the syndrome has been causally linked to having money bags in the back pocket, overexertion, or lifting heavy objects.
Symptoms, Ailments & Signs
People with piriformis syndrome primarily suffer from pain symptoms, the severity of which can vary from case to case. One of the main symptoms of nerve compression is considered to be severe pain in the buttocks. In most cases, the patients describe pain that radiates, which can radiate to the dorsal part of the thigh, for example.
Sometimes the pain radiates beyond the knee. The pain gets worse with certain movements. These movements include, above all, the turning movement, as it is carried out when turning over in bed. Crossing their legs often increases the patients’ pain. A certain degree of pain also persists, independent of movement and stress.
In addition, patients sometimes complain of sensory disturbances due to the nerve compression, which primarily affects the legs. These sensory disturbances can range from numbness to tingling sensations of various kinds. Sometimes there is also pain in the loin area.
Diagnosis & course of disease
At first glance, the symptoms of piriformis syndrome resemble nerve root irritation of the sciatic nerve. A herniated disc can also cause similar symptoms. Therefore, the doctor must exclude these two phenomena in the differential diagnosis. Various tests are available to diagnose piriformis syndrome.
This includes, for example, the muscle test. When the hips are extended, the compressing muscle acts as an external rotator. When the hips are flexed, on the other hand, it acts as an abductor. When these movements are performed against resistance by the patient, they characteristically provoke the pain of piriformis syndrome. In addition to this provocation test, a pain-provoking stretch test is available as a diagnostic tool. The prognosis for patients with the syndrome depends on the cause.
In most cases, piriformis syndrome causes very severe and uncomfortable pain in the buttocks. This pain can often spread to the back or other parts of the body. They occur mainly when sitting or lying down and can significantly reduce the quality of life of those affected. It may also no longer be possible for the patient to carry out various activities without further ado.
It can also lead to paralysis or other disturbances of sensitivity. Sporting activities are also no longer possible for those affected in many cases. Furthermore, the patients are often irritable and slightly depressed. As a rule, the cause of the pain in piriformis syndrome cannot be localized directly. For this reason, targeted treatment is not possible.
The pain and symptoms can be treated and limited with the help of therapy or massage. There are also no particular complications. Various stretching exercises can also eliminate the symptoms of piriformis syndrome. The syndrome usually does not affect the life expectancy of the patient.
When should you go to the doctor?
Since piriformis syndrome does not heal itself, this disease must always be examined and treated by a doctor. Pain can only be reduced with medical treatment. The doctor should be consulted for piriformis syndrome if severe pain occurs in the buttocks area. The pain can occur sporadically and for no particular reason, making life difficult for the sufferer and reducing the quality of life. Severe pain and difficulty sleeping can occur, especially at night. The doctor should also be consulted if the pain spreads to the thighs. Furthermore, a visit to a doctor is necessary for piriformis syndrome if the person concerned suffers from sensory disturbances or various abnormal sensations.
Piriformis syndrome can be treated by an orthopedist or by a sports medicine specialist. Complete healing cannot generally be predicted. However, the life expectancy of the patient is not negatively affected by the disease.
Treatment & Therapy
The goal of therapy for piriformis syndrome is to free the compressed nerve. This liberation takes place as early as possible to prevent permanent damage to the nerve. The therapy corresponds to a causal therapy. The cause of the pain symptoms should be eliminated by the individual therapy steps. As a rule, no invasive therapies are initially used to decompress the sciatic nerve.
Rather, treatment consists of conservative steps. These conservative treatment steps include, for example, targeted massages intended to relieve tension in the piriformis muscle and thus free the nerve from its compressed position. In addition to the massages, a so-called trigger point treatment can take place. This treatment also dissolves myofascial trigger points in the sense of locally limited muscle hardening of the skeletal muscles.
In combination with these treatments, movement therapy, which consists mainly of stretching exercises, usually takes place in the context of piriformis syndrome. Stretching the muscle can return the compressed nerve to its physiological position. Patients are usually given painkillers to relieve their pain. If the nerve cannot be freed from the compression by conservative therapy steps in the long term, a surgical intervention may take place under certain circumstances. Such interventions, however, almost never occur.
Outlook & Forecast
Since piriformis syndrome is a hereditary disease, it cannot be completely cured, so most of those affected are dependent on lifelong therapy to limit or alleviate the symptoms. The further course is strongly dependent on the severity and the type of pain, so that a general course cannot be predicted.
However, the piriformis syndrome cannot heal itself, so that a visit to the doctor is always necessary for this disease. However, the sooner a doctor is consulted, the better the further course of the disease. If the syndrome is not treated, those affected suffer from severe pain that can affect the entire body. Since the legs are primarily affected, there are significant restrictions in the everyday life of those affected.
The symptoms of piriformis syndrome can often be alleviated and limited by massage and physiotherapy measures. Stretching exercises can also be helpful. The syndrome is only very rarely treated by surgery and does not limit the life expectancy of the person affected. Correct posture and regular stretching of the affected areas can also prevent the syndrome.
Postural training and regular stretching of the piriformis muscle can at least moderately prevent the piriformis syndrome.
Because piriformis syndrome is a genetic disease, patients have very few or very limited follow-up care options. First and foremost, a doctor should be contacted at the first signs and symptoms of the disease so that there is an early diagnosis and subsequent treatment.
As a rule, self-healing cannot occur with piriformis syndrome, so that the person affected always has to rely on medical examination and treatment for this disease. Most patients with this disease are dependent on the measures of physiotherapy or physiotherapy. Some of the exercises from these therapies can also be performed at home, which often speeds up treatment.
Care and support from one’s own family is often necessary in everyday life. This can also prevent depression or other mental upsets. Likewise, those affected should avoid strenuous exertion so as not to unnecessarily strain the muscles. In general, a healthy lifestyle with a healthy diet has a positive effect on the further course of this disease. As a rule, piriformis syndrome does not reduce the life expectancy of the person affected.
You can do that yourself
This syndrome varies in severity and can accordingly lead to varying degrees of pain and restricted mobility. Depending on the severity of the symptoms, the doctor will prescribe massages to relieve tension and bottlenecks and thus improve the symptoms. Stretching exercises also help to eliminate the bottleneck in the sciatic nerve area. Patients can have their physiotherapist show them the appropriate exercises. There are also many stretching exercises in yoga that alleviate piriformis syndrome, such as “the dove”.
If you do not want to fight the pain exclusively with medication, you can also rub the painful areas. Various ointments or gels containing diclofenac or ibuprofen can be used. There are also ointments to which homeopathic remedies are added and have also proven effective in piriformis syndrome. These include, for example, ointments with Schuessler salts or mixtures of medicinal plants. Pain gels have the advantage that they pleasantly cool the painful areas. However, if they are used frequently, they dry out the skin. Ointments, on the other hand, also care for the skin and are therefore more recommended for continuous use.
All these classic treatment measures take time to work. However, the piriformis syndrome only needs to be treated surgically in the rarest of cases. Patience and the necessary compliance therefore pay off for the patient.