(Either way you slice it, it’s a Pain in the Butt!)
“When a patient experiences painful persistent sciatica – pain radiating down the leg – physicians often look only for a herniated lumbar disk relying upon lumbar MRI scanning. Surgery for the disk herniation is often carried out to treat the sciatica. Most spine specialist consider piriformis syndrome to be extremely rare. However, the authors conclude that although it is rarely diagnosed, it is actually a common cause of sciatica – possibly as common as the well known herniated disc syndromes.” From a press release by UCLA Cedars Sinai Medical Center for their study that was published in the February 2005 issue of Journal of Neurosurgery: Spine.
Dear Dr. Schierling,
I am a thirty something year old female who works in a law office. After about ten years of progressively worse lower back / sciatic type pain and seeing numerous professionals (chiropractors, physical therapists, medical doctors, back specialists, etc.) no one could conclude what the problem is. I have had numerous x-rays and MRIs but nothing is visible; spine looks good, no disc problems, no injuries, nothing. The general consensus from everyone I have seen is that I am suffering from some sort of chronic muscle tightness, but no one could pinpoint where.
I have been told that physical therapy, anti-inflammatory medication, and / or muscle relaxants are pretty much my best and only option for the rest of my life. Basically just try to manage it. Having taken matters into my own hands, I began extensive research to try and figure out how someone can have textbook sciatica symptoms and yet have no visible skeletal explanation for it.
Recently I discovered this condition known as Piriformis Syndrome, I had never heard of it before. I then began extensively researching Piriformis Syndrome and believe that it is most definitely my problem as it describes my symptoms perfectly. I have been performing various stretches targeting the piriformis and hamstrings (I also have extremely tight hamstrings) at home on my own and have experienced some relief but not entirely rectifying the problem like I need. My hope is to come see you………..
Back when I first got into practice, I was frustrated by these types of problem. Before walking in with a new patient, I look at their chart. The first thing I want to see is the where-does-it-hurt “Pain Diagram”. When I would see the ‘X’ in the buttock region, with a line going down to the foot indicating SCIATICA, I would mutter to myself, “Oh crap; not another one of these butt-based Sciaticas!” You see; this problem is common here in America to the point that I could legitimately call it an epidemic. Unfortunately, few practitioners are correctly diagnosing PIRIFORMIS SYNDROME — and even fewer are dealing with it effectively (Sorry; pain pills, anti-inflammatory medications, muscle relaxers and corticosteroid injections do not constitute “effective treatment” by any sense of the word (HERE).
If the problem is not really Piriformis Syndrome, it could very well be caused by FASCIAL ADHESIONS in the THORACOLUMBAR FASCIA. Or it could be caused by a HERNIATED DISC. The problem with diagnosing the pain as coming from a Herniated Disc is that the majority of American adults (50-80%) have Disc Herniations that show up on MRI, even though they have no low back pain or Sciatica. No; I certainly do not help every person who comes to me with Piriformis Syndrome. But I help a bunch of you. Feel free to EMAIL ME a detailed history of your situation. If I think I can help you, I will tell you so. IF NOT, I will tell you that also.