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not all piriformis syndrome is piriformis syndrome



Piriformis Syndrome

Photo by Anatiomist90

I have previously written that not all cases of PIRIFORMIS SYNDROME are alike.  There is a broad spectrum of severity of this problem, ranging from mild to those that truthfully, I do not believe will ever improve without surgery.  The problem is that although Piriformis Syndrome Release Surgeries have improved, they are notorious for poor results.  What does most of the medical profession think of Piriformis Syndrome?  The average doctor has no idea what it is or how to go about diagnosing it (as far as they are concerned, you have a disc problem).  Dr. Loren Fishman recently verified this in an article he wrote for the Huffington Post,
“About 5 million of the 26 million Americans who suffer from low back pain each year have piriformis syndrome. Piriformis syndrome produces an intense, sometimes crippling pain deep in the butt cheek, usually just on one side…..    Even though your back is flawless, the piriformis muscle in the buttock may tighten, go into spasm and entrap the sciatic nerve, causing the same symptoms and misery that come with herniated disks. Those who compile statistics declare that piriformis syndrome may account for as much as 50 percent of the pain that strikes in the backside and radiates down the back of the leg…..  Many internists, neurologists and pain specialists aren’t very familiar with this problem, and mistakenly think the source of the pain is in spinal nerve roots. Because it is so easy to confuse with herniated disk, piriformis syndrome can be extremely difficult to diagnose, partially because MRIs and X-Rays don’t pick it up.”
Notice that Dr. Fishman says that as much as 50% of all sciatica could be due to Piriformis Syndrome.  Although there are a growing number of statistics that verify that what he is saying is true (HERE), this is a huge increase from the 2 – 6% that doctors used to tout.   One of the first studies to really cause experts to pause and question the old statistics came from neurosurgeon Dr. Aaron Filler of Los Angeles.  In 2005, a study by Dr. Filler and his team of doctors working at UCLA’s Medical School, said that Piriformis Syndrome is the number one cause of Sciatica in America; accounting for almost 4 out of 10 cases.  Just understand that Sciatica is one of the single most common conditions I see in my clinic, day after week, after month, after year.  If your doctor does not have a handle on recognizing and treating Piriformis Syndrome with something other than shots and pills, you have poor odds of ever seeing your Sciatica improve —- 50 / 50 at best.

Of this Piriformis Syndrome, not all of it is alike.  Some Piriformis Syndrome is caused by congenital issues or poorly understood factors that I have no answer for.  These people are more likely to show positive findings with specific EMG testing.  However, I would argue that the majority of the cases of Piriformis Syndrome will never test positive on an EMG.  These are the people whose Piriformis Syndrome is largely the result of FASCIAL ADHESIONS and / or TENDINOSIS.  I also believe that a fair number of these people have SYSTEMIC FASCIAL ADHESIONS as well; or maybe THORACOLUMBAR ADHESIONS.   For more information on Piriformis Syndrome, take a few minutes to read my PIRIFORMIS SYNDROME BLOG POSTS.

I certainly do not claim to have all the answers when it comes to successfully treating Piriformis Syndrome.  However, I can tell you that if your pain is being caused by problems in the Fascia or Tendons, you will see positive results after just one treatment.  This is what I told “E” who out of sheer desperation, made a tough 3 hour drive to see me on Monday after doing THIS TEST.  Here is the email I got from her last evening. She has a disc problem (VERIFIED WITH MRI) and a Piriformis Syndrome —- the later of which was being worsened by Spinal Decompression Therapy; something I have discussed many times on previous blog posts on this topic.

Hi Dr. S!
The pain I felt in my calf muscle after the tissue remodeling has remained and even intensified.  The pain in my hip / glute is noticeably decreased.  I’m even not feeling the pain with coughing that I was having before.  I feel confident that the treatment did something positive for me even though it may not save me from surgery.  Thank you!
My best guess at this point is that E will get better — how much remains to be seen.  Interestingly enough, her positive Dejarine Sign (one of the classic signs of a disc problem HERE) is gone after treating her Piriformis.  Not sure why.  Hopefully she improves enough to warrant a second treatment.  By the way, one of the things that muddies up the water on this issue is ASYMPTOMATIC DISC HERNIATIONS.  Click on the link to learn more.

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