Testing For Piriformis Syndrome
Because piriformis syndrome symptoms mimic those of sciatica, your medical provider will perform specific tests to determine whether your symptoms are discogenic or caused by an impingement of the sciatic nerve by the piriformis muscle.
Your provider should examine your low back, hip, pelvis and sacroiliac joint and check your gait, posture and leg length. Theyll also test your reflexes, which should be normal if you have piriformis syndrome.
Other signs of piriformis syndrome include:
When testing for pain or weakness in specific positions, your provider will conduct each test until you experience symptoms or for up to 60 seconds, whichever comes first.
In addition to a physical exam, you might also need imaging to rule out other causes for your symptoms. Your doctor may order X-rays, an MRI, or a CT scan. In addition, injections into the piriformis muscle may be used to confirm the diagnosis, while simultaneously helping with treatment.
What Are The Symptoms
Classic sciatic pain starts in the low back and buttocks. It affects one leg traveling down the back of the thigh, past the knee, and sometimes into the calf and foot. The pain feels worse in the leg than in the back. It may range from a mild ache to severe burning or a shooting pain. Numbness or tingling can occur in your leg and foot. This usually is not a concern unless you have weakness in your leg muscles or foot drop.
Sitting usually causes the most pain because of the weight this position puts onto the discs. Activities, such as bending or twisting, worsen the pain, whereas lying down tends to bring relief. Running or walking may actually feel better than sitting or standing for too long.
Seek medical help immediately if you have extreme leg weakness, numbness in the genital area, or loss of bladder or bowel function. These are signs of a condition called cauda equina syndrome.
Herniated Disk In The Lower Back
A herniated, ruptured, or “slipped” disc means that a vertebral disc one of the soft pads of tissue that sit between each of the vertebral bones has becomes squeezed out of shape. Its cushioning material has been forced against, and possibly through, the ring of fibrous tissue that normally contains it. This causes pain, numbness, and weakness in the legs.
The normal aging process causes the discs lose moisture and become thinner, making them more vulnerable to “slipping.”
Most susceptible are men from ages 30 to 50. Smoking, obesity, lack of exercise, and improper lifting are also risk factors.
Symptoms include pain, weakness, numbness, and tingling in the back, leg, and foot.
Diagnosis is made through patient history, neurological examination, and MRI scan.
Treatment begins with rest, nonsteroidal anti-inflammatory drugs, physical therapy, and sometimes epidural steroid injections into the back to ease pain and inflammation.
Surgery to remove the herniated part of the disc the part that was squeezed out of place can also be helpful.
Top Symptoms: lower back pain, moderate back pain, back pain that shoots down the leg, back pain that gets worse when sitting, leg weakness
Urgency: Primary care doctor
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The Importance Of An Accurate Diagnosis
The physician will need to take a careful medical history and do a physical exam to look for certain red flags that indicate the need for an X-ray or other imaging test. In most cases, however, imaging such as X-ray, MRI , or CT scan is unnecessary.
There may also be certain clues in a patients medical history. Low back, nonradiating pain is commonly due to muscle strain and spasm. Pain that radiates into the buttock and down the leg may be due to , a condition in which a bulging disc presses on the sciatic nerve, which extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This nerve compression causes pain in the lower back radiating through the buttocks and down one leg, which can go to below the knee, often combined with localized areas of numbness. In the most extreme cases, the patient experiences weakness in addition to numbness and pain, which suggests the need for quick evaluation.
A persistent shooting or tingling pain may suggest lumbar disc disease. A pain that comes and goes, reaching a peak and then quieting for a minute or two, only to reach a peak again, may suggest an altogether different cause of back pain, such as a kidney stone.
When tumor or infection are suspected, the doctor may order blood tests, including a CBC and sedimentation rate. .
More Advanced Care Options
Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:
Implanted nerve stimulators
- Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
- Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
- Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.
Sciatica: A Common Condition With A Variety Of Causes
There are numerous reasons why a person may have sciatica. If you have pain in the back of your leg, you should consult a doctor to figure out what is causing the pain and see if any treatment can be offered. Other conditions such as peripheral nerve damage, vascular disease, and other muscular problems can all cause similar symptoms. You must be aware of the symptoms in order to seek treatment.
What Does It Mean When Your Right Side Of Body Hurts
Symptoms you experience with pain can be very important for you and your doctor in figuring out the potential cause of your pain. They can include nausea, cramping, diarrhea, fever and constipation. Common causes of right-sided abdominal pain include: Liver disease, liver cancer, or liver infection.
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Standing Iliotibial Band Stretch
This exercise strengthens the outer hip.
- As support, stand close to a wall.
- Cross behind your other leg the leg that is closest to the wall.
- Lean your hip toward the wall until a stretch occurs on the outside of your hip. Maintain the stretch for 2030 seconds.
- Cross the leg that is farther away from the wall behind the leg that is closest to the wall.
- Repeat on the other side, then continue the process four times more.
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Causes Of Piriformis Syndrome
Your anatomy may be behind your piriformis syndrome. This is known as primary piriformis syndrome and occurs when you have a split piriformis muscle, split sciatic nerve, and/or an atypical sciatic nerve path.
Secondary piriformis syndrome is far more common and is caused inflammation of soft tissues, or both, resulting in nerve compression. Direct trauma to the buttock can lead to inflammation, scarring and contractures of the piriformis muscle
This might be the result of a major event like a car accident or a fall. However, the most common cause is likely the gradual tightening of the piriformis muscle due to poor muscle fitness. Activities, such as long distance running or prolonged standing without proper stretching and strengthening of piriformis muscle is a common scenario in patients with piriformis syndrome.
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What Is The Best Position For Sleeping And Lying Down
- The best lying or sleeping position might vary. No matter in what position you lie, place a pillow under your head, but not your shoulders. The pillow should be a thickness that allows your head to be in a normal position to avoid training your back. You might also want to put a pillow between your legs for support.
- Try to sleep in a position that helps you maintain the curve in your back . Do not sleep on your side with your knees drawn up to your chest. Avoid sleeping on your stomach.
- Select a firm mattress and box spring set that does not sag. If necessary, place a board under your mattress. You can also place the mattress on the floor temporarily if necessary. If you have always slept on a soft surface, it might be more painful to change to a hard surface. Try to do what is most comfortable for you.
- Try using a back support at night to make you more comfortable. A rolled sheet or towel tied around your waist might be helpful.
- When standing up from the lying position, turn on your side, draw up both knees towards your chest and let your legs gently drop off the bed. Sit up by pushing yourself up with your hands. Avoid bending forward at your waist.
When Should You See A Healthcare Professional
An inability to control your bowels or bladder or to urinate
Sudden, intense pain in your legs or lower back with numbness or muscle weakness in your legs
The pain follows a severe injury, such as a fall from a height or car accident
Difficulting walking, using your lower body muscles, or paralysis
Loss of feeling in your lower body
Tingling or numbness in your genitals or buttocks
Pain that is severe enough to prevent sleep
If your pain doesnt ease within a couple of weeks of gentler activity and pain relief, make an appointment to speak to your doctor. They will be able to get to the bottom of your symptoms and start appropriate treatment.
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Referred Pain To And From The Lumbar Spine
Pain in the area of the lumbar spine may be due to important problems that are actually unrelated to the back. Referred pain occurs when a problem in one place in the body causes pain in another place. The pain travels down a nerve.. Sources of referred pain to the low back may include abdominal aneurysm , tubal pregnancy, kidney stones, pancreatitis, and colon cancer. Clues to these maladies include pain that waxes and wanes over a short period, with frequent peaks of intense pain, weight loss, abnormalities found during abdominal exam, and trace amounts of blood in the urine. On the other hand, pain can be referred from the low back and be felt in another location, as is often the case with . For example, it is not rare for a patient with a slipped disc in the lower back to have pain in the back of the thigh, or in the calf or even the foot, and not have any low back pain. This situation requires a doctor to sort out the type of pain and to do the examination required to show that the pain is actually coming from the spine .
Think You Have Sciatica Its Not As Common As People Assume Says Physical Therapy Expert
U of A researcher recommends exercise over painkillers for treating the painful nerve condition.
Although 85 per cent of people will experience back pain in their lives, only two to 10 per cent will suffer from true sciatica, according to a U of A master’s student in rehabilitation medicine.
While sciatica is one of the most common forms of back pain, people often assume they have it when they don’t, says U of A physical therapy researcher Greg Kawchuk.
That’s because the condition-named for the sciatic nerve running down the spine and through the leg-is a general term for many different situations. It can come on suddenly in an acute, disabling way, resolving after a couple of months, or it can fluctuate over time, he said.
Since the pain tends to radiate, it can be felt in a number of places, from the lower back to the buttocks, groin and down the back or front of the leg. It usually results from compression of the nerve roots as they exit the spine, which is caused when jelly-like cushions between vertebrae herniate, said Kawchuk.
“Sometimes the jelly comes out and it will either push on the nerve root or create inflammation that bothers the nerve. What’s nice is that we know that in the majority of patients, it usually resolves and goes away over time-just not that quickly.”
It’s also possible to have sciatica without back pain, he said, just as it is possible to have symptoms of sciatica without involvement of the back.
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What Is The Sciatic Nerve
The sciatic nerve originates near the base of the spine, where nerve roots at the L4, L5, S1, S2, and S3 vertebrae exit the bony opening of the spine and join into a single, large nerve and exits a bony arch called the sciatic notch. The sciatic nerve travels through the pelvis, passing under the front surface of the piriformis muscle as it travels through the pelvis.
It then cuts into two branches before going down each leg, branching out at the back of the knee to divide into the tibial and peroneal nerves, both of which supply the lower leg and foot. The sural nerves branch off from the tibial and peroneal nerves, terminating in the foot.
The sciatic nerve is responsible for bending the knee, bringing the thighs together , and flexing and extending the ankles and toes. It also provides sensation to the back of the thigh, the entire lower leg, the ankle, and the sole of the foot.
Visualizing the piriformis muscle and the sciatic nerve
The piriformis muscle originates at the front of the sacrum near the sacroiliac joint capsule and attaches to a bony knob on the femur at the outermost part of the hip.
The piriformis helps externally rotate and abduct the hip, fancy words for turning your hip outward and bringing your thigh outward to one side while your hip is bent, such as when raising your knee and bringing your leg out when getting out of a car seat. It also offers stability while walking, running and standing.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
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Back Problems That Cause Leg Pain
Almost everyone at some point in their life develops lower back pain. This part of your back includes your lumbar spine, which is responsible for supporting much of your upper body weight.
Aging and the stress of your body weight leads to degeneration of the components that make up your spine, including the discs, ligaments, cartilage, and vertebrae. These degenerative changes are often the source of lower back pain, as well as your leg pain. Back problems that cause leg pain include:
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How Do I Know If I Have Sciatica Or Muscle Pain
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If your back pain moves or radiates down the leg, it is an indication that you have a pinched nerve. sciatica is one of the most likely causes of numbness, tingling, or weakness in your leg.
Low back pain is the third most common type of disability in adults, affecting 80% of them in their lifetimes. Most people experience Sciatica when they walk down their buttock or lower back. The term scarfic refers to tingling, numbness, and weakness in your lower body, especially buttocks, legs, and feet. If you experience difficulty elevating your feet, it could be due to sciatica. When you stretch the hamstrings muscles, you may also feel sciatic pain down the leg. The cause of cauda equina is compression of the nerve sac in the lower spine. The use of new pain management techniques has made it easier than ever before to diagnose and treat chronic pain. The dry needling procedure, which is non-medicated and is used in conjunction with muscle relaxers, can help to alleviate the tension within a tight muscle bundle. You can use regenerative factors from your blood to inject them into a disc if you isolate them.
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Complications Related To Sciatica
If you develop a loss of bladder or bowel control, contact your doctor right away. This can be a sign of a medical emergency that requires surgery to avoid permanent damage. Fortunately, this complication is rare. Most cases of sciatica go away within a few days or weeks and cause no lasting harm.