piriformis syndrome or disc?

I had a patient come in yesterday for a second visit.  She was a fit, middle aged woman with pain in the left SACROILLIAC REGION and buttock.  The severity of her x-ray had somewhat fooled me.  She had a compensatory curve in her low back, with a couple of severely thinning discs at the very bottom.  On top of that, she had a severely wedged disc and a lateralisthesis (her 4th lumbar vertebrate had slipped sideways on the 5th).  There was plenty of calcification and bone spurring as well.  I had a hunch that it was yet another case of Piriformis Syndrome, but wanting to be sure, I only adjusted her on her first visit (no TISSUE REMODELING).  I let her know what was going through my mind and how we would proceed to treat her, as well as giving her a couple of specific webpages to read.

When she came in yesterday, complaining of zero improvement and an epicenter of pain at the area of her Piriformis Muscle, I knew for certain were looking at a case of Piriformis Syndrome.  She could barely tolerate me even touching the area at first, but as I continued to treat, her Piriformis settled down.  Within a few minutes, she was 75% improved.  Every day is a learning experience.  An important thing for everyone (doctors and patients) to remember is that study after study after study shows that x-ray and MRI findings like those mentioned above, can be extremely difficult (often times impossible) to correlate to a person’s pain (HERE).  To muddy up the waters even further, we have the issue of ASYMPTOMATIC DISC HERNIATIONS.  If you are truly seeking an answer to the question posed in the title of this post, you need to read this link.  (HERE) is a simple test that might help you differentiate between the two problems.