Piriformis Syndrome - a set of pain sensations in the gluteal region. The pain does not necessarily have a localized character, it can radiate to the genital area and even to the lower leg, in such a way that it will create a feeling that it hurts somewhere below.
Almost everyone has heard the phrase "inflammation (neuropathy) of the sciatic nerve" more than once. Let's see what the buttock is and what nerves can become inflamed there.
About the problem
Neuropathy of the sciatic nerve is a very common problem. As we noted above in the definition, in fact, this is severe pain in the pelvic region, which can occur absolutely out of the blue suddenly and will only progress over time. Any physical activity, even the most insignificant, in which tension is created in the buttocks, contribute to an increase in pain. On top of that, the pain radiates to the lower extremities, which, in turn, prevents the person from moving normally at all.
What comes with it?
All of the above pain symptoms may be accompanied by a feeling of fatigue, burning sensation or tingling in the pelvic region.
This is due to the fact that as a result of a violation of the correct functioning of the sciatic nerve and the vessels surrounding it, too much pressure is created, which, in turn, leads to a violation of the circulation of nutrients in the body. If the piriformis muscle experiences a long-term displacement, this leads to the occurrence of the complex of severe pain syndromes described above. This is Piriformis Syndrome.
Some anatomical facts
The piriformis muscle is the muscle of the inner pelvic region. It is a muscular system connecting the bones of the iliac-sacral joint. This muscle in the human body is represented by the shape of a triangle, and, in fact, resembles the shape of a pear, hence the name. It is connected to the pelvic bones with the help of tendons.
The piriformis sits under the gluteal muscle, which is the largest muscle in the human body. Next to the piriformis muscle there is a ligament that connects the sacral processes, or rather, their ends. Between the piriformis muscle and the ligament in the ischial foramen are blood vessels that provide nourishment to the muscles and nerves that we are talking about inflammation. So, if suddenly, for some reason, which we will consider in more detail below, an inflammatory process begins in the piriformis muscle, then the lumen of this very sciatic foramen canshrink noticeably. It is easy to guess that, in this way, the walls of the lumen begin to put pressure on the nerve itself. This is ischemia (neuropathy) of the sciatic nerve. In common language, a pinched nerve occurs, which leads to unbearable pain.
The symptoms and treatment of Piriformis Syndrome are interrelated.
Since the role of the piriformis muscle is to hold the bones of the pelvic region, any functional impairment leads to the creation of an overstrain. Pain during overstrain of this particular muscle is the strongest. It is for this reason that this pain and inflammatory syndrome is distinguished into a separate diagnosis, which is called the piriformis syndrome.
Causes of occurrence
As we noted above, piriformis syndrome often occurs absolutely suddenly, seemingly out of the blue. The causes of this syndrome can be completely elementary household factors. And these factors may have a rather complex nature of origin. Piriformis syndrome can cause even excessive physical activity. It leads to muscle overload.
Summarizing the anatomical prerequisites for the development of piriformis syndrome:
- inflamed muscle pinches the nerve in the sciatic foramen itself;
- there is a pinched sciatic nerve that passes through the piriformis muscle;
- Nerve processes of the sacral spine are under pressure.
The following causes of this syndrome can be distinguished:
- wrongfood;
- wrong and excessive exercise;
- tiredness and chronic stress;
- hypothermia;
- long static loads;
- stretching;
- various injuries in this area;
- osteochondrosis of the sacral and lumbar;
- tumor processes of any nature leading to anatomical deformities;
- Incorrect intramuscular injections.
Classification
In medical practice, it is customary to classify piriformis syndrome into primary and secondary.
- Primary inflammation is caused by the causes we listed above.
- Secondary inflammation occurs when the inflammatory process passes from the junction of the ilium and sacrum, or the pelvic organs to the piriformis muscle. In other words, the initial inflammation did not start in the piriformis but elsewhere.
Disease symptoms
We have already noted above that piriformis syndrome is always accompanied by a pronounced pain syndrome that cannot be overlooked. The disease does not have a latent form of the course. Symptoms are represented by signs of a local inflammatory process, ischemic signs of the sciatic nerve (pinching), as well as atrophic, arising from compression of the vessels of the nerve and the lower artery of the buttock.
Piriformis syndrome is very often accompanied by radicular syndrome.
Signs of local inflammatory processes
- Sharp pain in the pelvic region, which tends to increase in the standing position, as well as when walking and when trying to move the hip inward, for example, when trying to cross one leg. When spreading the legs in a horizontal position, the pain becomes noticeably less.
- Pain is variable. They are dull, aching, and can be shooting. Exacerbations of pain syndrome provoke weather changes or a long position in warmth, for example, under a blanket during a night's sleep. What other symptoms of piriformis syndrome are there?
- Above we noted that the infringement of the sciatic nerve is radiating. It may feel like it hurts the entire surface of the thigh, the gluteal region, and the pain can even spread down to the toes. This is because the sciatic nerve is one of the largest nerve formations in the human body, and it is he who innervates the entire pelvic area and lower extremities.
- The area where the nerve passes is also characterized by a complex of pain syndromes: tingling, numbness.
- Tactile sensitivity of the pelvis and lower extremities is reduced. The patient may not even feel pricks or touch hot.
- Pain can even spread to internal organs, such as difficulty urinating.
- The appearance of severe lameness is the result of squeezing the vessel. The skin in this area becomespale due to impaired blood supply.
Treating piriformis syndrome at home can be very effective. More on that later.
Sciatic nerve ischemia symptoms
- The nature of the pain is pressing. There may be a feeling of chills, burning, or feeling like the affected area is made of wood.
- There is a decrease in the Achilles ligament reflex, as well as a decrease in skin sensitivity.
- Pain sensations are concentrated mainly in the area of innervation of the tibia - large and small. Palpation of the muscles of the ankle joint, as well as walking, lead to a noticeable increase in pain.
- As with symptoms of local significance, the unpleasant symptoms of ischemia of the sciatic nerve are provoked by changes in weather conditions, as well as prolonged exposure to heat.
Symptomatics of compression of the lower gluteal artery and blood vessels
- Similar to the previous symptoms, the vertical position provokes increased pain: vasospasm and severe lameness appear. In a horizontal and sitting position, the pain subsides.
- As a result of impaired blood supply, there is a pronounced pallor of the skin in the buttocks and limbs.
Diagnostic Methods
Diagnostic methods of inflammatory processes of the piriformis muscle are aimed at differentiation with other diseases with a similar set of symptoms. For example, arthritis, osteochondrosis, intervertebral hernia, as well as a number of other diseases of the pelvic area,having similar symptoms.
In the diagnosis of piriformis syndrome on the right and left, they rarely resort to hardware-instrumental methods, since there are no criteria that would clearly determine the degree of pathologies. In addition, there are no well-defined norms for the ratio of musculovascular and nerve plexuses in the gluteal region. The reasons for the impossibility of developing such norms are related to the anatomical features that do not allow the devices to visualize this area.
Which are the most affordable?
List available diagnostic techniques:
1. Manual examination reveals some characteristic manifestations:
- difficulty getting into a cross-leg position;
- spreading the legs through resistance causes severe colic and leg fatigue and trembling;
- Bonnet syndrome;
- provocation motor tests reveal shortening of muscle fibers;
- symptom according to the Vilenkin method;
- symptom by Grossman's method;
- the most difficult cases may require a vaginal or rectal examination.
2. The most important diagnostic criterion is the use of novocaine blockade: an injection into the piriformis muscle of the drug of the novocaine group. After the injection, there is a noticeable weakening or disappearance of all pain syndromes. Carrying out the above manual examinations after novocaine blockade also does not reveal any pain syndromes.
3. Application methodsComputed tomography and magnetic resonance imaging are indicated in cases where it is necessary to exclude or confirm the presence of neoplasms that create pressure on the pelvic area. MRI is also used to clarify a detailed picture of the degree of damage to muscle fibers in the acute period of the disease. MRI scans clearly show areas of edema, atrophic lesions and infiltrations.
MRI can be used to differentiate piriformis syndrome from other conditions with similar symptoms, such as herniated discs.
Treatment
Usually treatment is complex:
Medication involves:
- Taking non-steroidal anti-inflammatory drugs. Examples are drugs based on diclofenac: Voltaren, Meloxicam, Dicloberl, Ketanov. Drugs are prescribed for intramuscular injection or oral administration. The course of treatment is determined by the doctor.
- To relieve pain, antispasmodics and painkillers are used: Baralgin, Tempalgin, Sedalgin and other drugs that remove muscle spasms and reduce pressure on the nerve and blood vessels, as well as the well-known No-Shpa, which is administered intramuscularly.
- In the event of a complication of inflammation in the form of bone deformity, muscle relaxants are used. In such cases, the above antispasmodics do not cope with pain relief. Muscle relaxants relieve muscle tone, thereby releasing strangulated blood vessels and nerves. An example is most often Mydocalm.
Massage. ATTogether with exercises for stretching muscles, it helps to relieve painful tone, and also improves vascular trophism, accelerates the metabolic processes of myofibrils. Piriformis massage can be performed in the form of self-massage, rectal massage, as well as stretching exercises. Not everyone knows how to treat piriformis syndrome.
Manual therapy. It is an alternative method of alternative medicine. Recently, it has become an increasingly popular method of treating diseases of the spine and muscles. Manual therapy is carried out by an osteopathic doctor, the choice of which must be approached very, very carefully.
Physiotherapeutic treatment of piriformis syndrome. The most popular physiotherapy procedures with a good warming effect are: electrophoresis, phonophoresis, amplipulse and UHF.
Reflexology. This group of methods also belongs to the methods of non-traditional treatment of many diseases. It combines the methods of ancient Eastern medicine and modern practice in the treatment of musculoskeletal diseases. In general, reflexology is a unifying concept for a number of techniques: acupuncture, blockade, work with active points, massaging of a point-linear nature, laser and pulse therapy, etc.
LFK (Therapeutic exercise). There are a number of therapeutic exercises for piriformis syndrome that help to cope with pain symptoms and contribute to the normalization of the general condition of the body during the inflammatory process of the muscle. They shouldn't cause pain.sensations.
Wearing special corrective clothing and shoes: orthopedic insoles, special buttock pads, etc.
Recently, a combination of both drug treatment methods for relieving acute pain syndromes, and physical therapy and general he alth practices for preventive purposes has been considered popular and effective.
Piriformis syndrome - home treatment
Various folk remedies for grinding are highly effective:
- Amanita tincture. For its preparation, fresh mushrooms are needed, they are washed and placed in a jar. Everything is filled with vodka to the top. Infused for a week. Compresses are also applied for one week.
- Horse chestnut tincture. 50 g of horse chestnut are soaked in 0.5 l of wine alcohol. Gauze is soaked and applied overnight. Continue for ten days.
- Turpentine (1 tablespoon) and protein. Everything is mixed, applied to the fabric and applied to the sore spot. Change the bandage twice a day.
- Horseradish ointment - the root is rubbed, 2 tbsp. l. root mixed with 1 tbsp. l. honey. Apply to gauze and apply for four hours.
We looked at the symptoms and treatment of Piriformis Syndrome.
