Piriformis syndrome is a condition where the piriformis muscle (located in posterior) compresses the sciatic nerve, the result being pain starting in the buttocks and often extending down the thigh. There is debate within the medical community as to the existence of piriformis syndrome, but acceptance is increasing within the medical community.
Causes and Symptoms
When the piriformis muscle contracts too much, is oversized, or otherwise rubs up against the sciatic nerve, irritating or compressing it. What causes the piriformis muscle to suddenly start irritating the sciatic nerve is not widely agreed upon. It can be a result of trauma, such as a sharp fall onto the buttocks, as well as overuse injuries. Piriformis syndrome is sometimes called "fat wallet" syndrome, as it can occur as a result of sitting down repeatedly with a large wallet in your back pocket.
Weak surrounding muscles can cause the piriform to contract and eventually gain in size, as it must "pick up the slack" of those weakened surrounding muscles. A gain in size can lead to pressure upon and irritation of the sciatic nerve, leading to piriformis syndrome.
Repetitive forward-bearing exercises, such as running (especially on an incline) and cycling can also cause the adductors to tighten much more so than the abductors, leading to contracting and shortening of the piriformis muscle, leading to piriformis syndrome.
Piriformis syndrome is often confused with sciatica, which also affects the sciatic nerve and creates very similar symptoms, which include gluteal pain (pain in the buttocks), and pain down the back of the leg, where the sciatic nerve is present. It may also present as numbness in the same areas.
Diagnosis and Treatment
Diagnosis of prifirmis syndrome is generally one of exclusion--it is often diagnosed once other causes have been ruled out. Effective diagnosis of priformis syndrome first relies on effectively ruling out sciatica, which occurs when the root of the sciatica nerve in the lower spine is irritated, compressed or otherwise aggravated. This occurs further up in the body that piriformis syndrome, and is often caused by a herniated disc in the lower back. The location of the sciatic nerve irritation or compression is the main difference between sciatica and piriformis syndrome. Once sciatica is ruled out, generally a diagnosis is made.
Treatment for piriformis syndrome is myriad. To help alleviate pain, over-the-counter non-steroidal anti-inflammatory medication, such as naproxen sodium or ibuprofen, can be used, but this does little to help cure the ailment.
Injecting the piriformis muscle with corticosteroids can help relieve pressure on the nerve, and more recently botulinum toxin has been effectively used to paralyze parts of the piriformis to relieve compression and irritation of the sciatic nerve.
If the cause of the initial condition was overuse or related to a specific activity or activities, simply ceasing that activity can bring relief in several weeks time. Accompanied by proper stretching and exercise techniques, this can lead to permanent relief. If all else fails, surgery can be used as a last resort. It often simply entails removal of part of the piriformis muscle, to keep it from compressing and irritating the sciatic nerve. Recovery time is minimal and causes no disability after the procedure.
Tags: sciatic nerve, piriformis muscle, gain size, irritating sciatic, irritating sciatic nerve, irritation sciatic, irritation sciatic nerve