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piriformis syndrome; yesterday and today


Scar Tissue Regular muscle fibers run parallel to each other in a neat, orderly route. When scar tissue forms, it is a knotty, tangled and twisted mess, which is where pain may occur.  When connective tissue is injured, the nerve tissue in that surrounding area is injured as well. When nerve tissue is damaged, it reacts by growing smaller, immature nerve branches, which the Doctor Schierling website explains are up to 1,000 times more pain sensitive than normal tissue.

The scar tissue forms as a protective measure that will avoid overstretching the muscle, which is sometimes how the injury may have originally occurred. Therefore, stretching of scar tissue can also be very painful.  An August 2013 article on Livestrong called Does Muscle Scar Tissue Cause Pain During Exercise?

Think about it for a moment.  If Lance Armstrong’s Livestrong website is right (and why wouldn’t it be — his people pulled their information straight off my website), SCAR TISSUE (especially the microscopic kind) has the potential to be incredibly pain-sensitive when compared to normal, healthy, connective tissue.  This is not new information.  I heard it for the first time about 20 years ago at a WHIPLASH seminar taught by the venerable Dan Murphy, DC. 

Off the top of my head, I think he got the information from research being conducted at the University of Washington by the famed neurologist and acupuncturist, Dr. Chan Gunn.  According to the quote above, the, “stretching of scar tissue can also be very painful“.  I have likewise written about this fact (HERE).  When we combine these factors with something called PIRIFORMIS SYNDROME, there tends to arise a whole bunch of erroneous information.

Much of this has to do that despite the most current evidence saying that Piriformis Syndrome is America’s number one reason for SCIATICA (leg pain), we have huge numbers of websites and studies still touting outdated information from the past.  For instance, if you take a moment to look at the National Institute of Health’s (National Institute of Neurological Disorders and Stroke) article called, “Low Back Pain Fact Sheet“, they do not as much as once mention Piriformis Syndrome in their list of things that cause low back pain, even though they mention just about everything else. 

With Piriformis Syndrome, this seems to be pretty much par for the course. Take, for instance, a study that was published by Missouri’s own Washington University Medical School of Saint Louis 10 years ago in the July issue of the American Journal of Roentgenology (MRI of Piriformis Syndrome).  The abstract says…

Piriformis syndrome is a rare cause of lower back pain and sciatica secondary to sciatic nerve entrapment at the greater sciatic notch…  Although it has been known as a cause of lower back pain and sciatica since it was first described by Yeoman in 1928, piriformis syndrome is frequently misdiagnosed…  because of its rarity, nonspecific clinical symptoms, and absence of definite diagnostic tests.” 

Hmm. “Frequently misdiagnosed“.  I would have to agree. 

And although numerous studies have shown Piriformis Syndrome to be the cause of about 1-3% of all Sciatica (this study actually says 6%), the most recent information (HERE) says that it is closer to almost 7 times greater than this.  So; even though the Wash U study concludes that, “MRI can help to correctly diagnose piriformis syndrome and also to differentiate piriformis syndrome from other possible causes of lower lumbar pain and sciatica, such as lumbar disk herniation, lumbar stenosis,” and others, is this really true and accurate?  I say not (at least, not usually) and let me show you why.

In the first place, although the Washington University study mentions DISC HERNIATIONS and Lumbar Spinal Stenosis (another problem that along with PS, is not mentioned by the NIH article from the first paragraph) as problems that can mimic Piriformis Syndrome (HERE or HERE), we must proceed with caution because Disc Herniations can lead us down a slippery slope — a very SLIPPERY SLOPE.  This is because of the prevalence in the general population of something called “ASYMPTOMATIC DISC HERNIATIONS“. 

For those of you riding the MEDICAL MERRY-GO ROUND, it might also seem like a relief of sorts when the doctor finally tells you that they have found out what is causing your pain.  Usually a Herniated Disc.  The problem is, depending on whose study you choose to believe, anywhere from about 40% to almost 80% of the ‘pain free’ adult American population is walking around with Disc Herniations which are visible on MRI or CT SCANS —- even though there is no pain or overt symptoms present. 

As you might imagine, this can make it very difficult to ascertain whether or not your pain is coming from the disc or not. The second problem I see is that study after study after study tells us that MRI does a poor job of revealing the underlying cause of Pifriformis Syndrome (HERE).  And although there are a host of newer or advanced technologies being used to image the Piriformis Muscle (newer EMG, MRN, the latest Diagnostic Ultrasound technology), these are still considered to be “experimental” and are not covered by most insurances.  

This means that for the most part, unless the case is extreme / severe, the diagnosis is a clinical one.  In other words, the diagnosis is made by ruling other things out and knowing what to look for as far as Piriformis Syndrome is concerned.  My suggestions to you if you think you are dealing with a potential Disc Issue or a Piriformis Syndrome……

  • GET A HANDLE ON INFLAMMATION:  Although your problem may not be related to INFLAMMATION, it very well might be.  Inflammation might merely be a minor factor, or it could be causal.  Regardless, Inflammation is at the bottom of lots and lots of chronic pain and illness.  Click on the link to see what you should do about this problem.
  • LOSE THE EXCESS WEIGHT:  Extra weight, whether it’s a few extra pounds or outright OBESITY can present a significant problem as far as almost any health-related function is concerned.  For tips on WEIGHT LOSS, just click the links.
  • TRY CONSERVATIVE METHODS FIRST:  Before you even think about some sort of surgery (whether it’s a disc surgery or Piriformis Release Surgery), try conservative methods first.  These would include things like CHIROPRACTIC ADJUSTMENTS, SCAR TISSUE REMODELING, COLD LASER THERAPY or even SPINAL DECOMPRESSION THERAPY.  Just remember that Spinal Decompression Therapy is typically going to make Piriformis Syndrome worse.  These things might not work, but with the poor success rates of some of these surgeries, wouldn’t it make sense to find out?

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