Quite literally a pain in the butt

I seriously love my job. Yes of course I have days where my sunny courtyard is much more appealing than the inside of a physio practice, If I didn’t I wouldn’t be normal. The thing I love most; apart from the insanely awesome team I work with, is that no two days are the same. It’s a mixed bag; jam packed full of interesting people, fascinating stories and a vast array of injuries. Every case is different and everyone’s story is unique. The only common thing? They are all suffering pain.

It’s bizarre how life goes, and this has happened to me several times now. I’ll have someone present with a condition that I haven’t seen for a AGES; suddenly within that week 2-3 more people will walk through the door with the exact same problem. It’s as if it becomes the ‘trending’ injury for that week.. and then I won’t see another one for another few months!!! I think of it like the situation where you’re considering buying a new car and suddenly every second car you drive past is the exact car you want. Fascinating.

I have had one of those months. This months ‘trending’ injury is quite literally a pain in the ass.

Piriformis Syndrome:

People with this problem usually come in complaining of ‘sciatica’ that starts deep in their bottom. Just to clear a few things up because people often get this confused, sciatica is not a diagnosis as such; but a set of symptoms. Basically if someone says they have sciatica it means they have pain running down the back and/or outside of their leg. This can originate in the lower back due to a variety of things or it can start deep in buttock area. It’s caused by an irritation of the sciatic nerve at some point along its windy path from the lumbar spine (lower back) to the foot.1

The piriformis is a muscle located deep in the gluteal region. The sciatic nerve descends through this region sitting directly in front of the piriformis muscle. Interestingly in 10% of the population an anatomical variation exists and the sciatic nerve actually pierces the belly of the piriformis passing directly through it. These people are unlucky and probably more prone to suffering from this problem at some stage in their lives.

So to answer the question what is piriformis syndrome? I think the name piriformis ‘impingement’ is a little more appropriate BUT basically it’s an irritation or impinging of the sciatic nerve as it passes in front of or through the piriformis muscle.

Why does this happen? This little muscle is pretty damn important. Its active in just about every lower limb movement we perform in our day to day lives, whether it be walking, running, going up and down stairs and most definitely during most sports and activities. When this muscle gets tight or goes into spasm it can begin to irritate the sciatic nerve.

What will you feel? People usually present with vague pain that starts deep in the buttocks. Depending on the severity there may be tingling and numbness caused by irritation of the nerve. There is sometimes associated leg pain usually felt at the back of the thigh and potentially down into the calf. One thing 80% of people I see with this complain of is that sitting in a car and driving aggravate their symptoms.

What can be done? In terms of diagnosis, your physio can usually do this based on your clinical symptoms and assessment. The frustrating thing for the patient is that there is no definitive diagnostic criteria for this condition; no specific test, not even an over-priced state of the art MRI scan. These things may highlight inflammation within the area but it won’t show the nerve impingement itself because at the end of the day it’s all the result of over tight, overworked muscles.

Treatment of this problem involves deep tissue massage of the muscles in the gluteal region. It’s not pleasant, but it’s good pain…. That pain you just know is doing something. Heat and gentle stretching can assist with short term relief of symptoms.

I have found that acupuncture and trigger point dry needling is very effective also to help relax and calm the muscle spasm found throughout this region. There are a variety of home techniques that I often teach my patients to try and replicate the massage that I give them when they come and see me. A tennis ball will pretty soon become your bestie; and trust me it’s a love hate relationship.

Surgery is advocated in severe cases where conservative management fails to offer adequate relief, however this rare and a very last resort.

My advice would be to get it assessed properly. Pain in the buttock can be the result of many things other than piriformis syndrome.

Happy Thursday and have a FABULOUS weekend 🙂

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