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. It's caused by jogging for miles, marathon sessions with the computer and with long commutes in a car. Sitting for long periods, vigorously over-exercising, or a combination of sitting and exercise are the most common causes. An accident or, occasionally, a congenital abnormality can also cause this problem.
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 can be extremely difficult to diagnose, partially because MRIs and X-Rays don't pick it up.
Symptoms
The prime symptom is a pain and tenderness lodged deep in the buttock. And that severe pain often runs down the leg, like an electric shock, an ache, pins and needles or another unpleasant feeling. The reason it feels as if there's a spasm in the buttock is because the piriformis muscle has knotted up and is actually in a spasm that can go on for days, months, and on occasion even years. The tight muscle may compress and irritate the sciatic nerve, causing the pain to travel along the course of the nerve. That's sciatica.
Diagnosis
Piriformis Syndrome was almost unknown 25 years ago, but as desperate patients came to my office in search of a cure because their doctors thought their problem was in their heads or in their spinal nerve roots, I developed diagnostic methods that distinguish this particular form of back pain from other causes. Electrodiagnosis is key to making the diagnosis. Using the EMG, I help the patient move the painful piriformis muscle against the sciatic nerve and then carefully determine whether that slows down the nerve's conduction. If so, well, we've got a diagnosis: piriformis syndrome.
Treatment
Thankfully almost all cases of piriformis syndrome can be treated without surgery. There are several options. First, there is exercise. Yoga provides many poses, chiefly twisting poses that can help by stretching the piriformis muscle, which often provides immediate relief. The Pigeon pose is another popular and effective way to lengthen the piriformis muscle. Gluteal stretches are also effective. They can be done standing, sitting or lying down.
An injection of a very small amount of steroid with a dentist-type quantity of Lidocaine is also an effective way to relax the muscle. After the injection, some sessions with a physical therapist can speed recovery.
Physical therapy, yoga and this small injection have cured 80 percent of the 7,500 patients I've seen with piriformis syndrome over the past 15 years. In particularly tough cases, I've used botulinum toxin, which does not improve the appearance of that particular cheek, but does relieve the pain more than 90 percent of the time. I've sent 120 of our failures to surgery, and followed them afterwards. The surgical success rate is also almost 80 percent.
Prevention
If you're a secretary or psychiatrist, a banker or a bus driver, then sit you must. My advice is to take breaks from sitting whenever you can. And while you are up and walking around, stretch a little. You can sit in your desk chair and do a modified gluteal stretch. If you drive long distances, a gel cushion will make a spasm less likely. When it comes to exercise, be moderate. Gradually increase your workout. Don't sit for hours and then go for a brisk mile-long jog that will increase the possibility of a muscle spasm.
Loren Fishman, MD: Alternative Therapies for Back Pain
New Harbinger: Are You Practicing Yoga or Yoga-Flavored Exercise?
Deepak Chopra: Weekly Health Tip: Watch Your Back!
WebMD Back Pain Health Center – Information and News About Back Pain
Back Pain Relief - 15 Remedies for Back Pain Relief
Back Pain Relief: Stretching to Relieve Back Pain
Lower Back Pain Symptoms, Diagnosis, Treatment and Prevention ...
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The symptoms are EXACTLY the same (crippling pain deep within one side of the buttock, kind of near the tail bone), however, I haven’t really experienced shooting pains down my legs. The pain is sometimes so unbearable, I can’t lie down or walk.
I’ve been to four different orthopedists, and they don’t tell me much but give me drugs. I’ve done physical therapy where they send electronic pulses to the muscles, but this does nothing for me.
Could what I have be PS or something else? I’m DYING to find out what’s wrong with me, so I can get rid of this pain
It's all gone now though because I have focused on back and core strengthening exercises.
I know I have a herniated L4/L5 disc, as it showed up very clearly on the MRI. I've been sore from right hip to right anterior tibial area, have a numb big toe and reduced motor control of the toe. But I wonder if it is from the herniated disc or piriformis syndrome. Last September, I felt a "pop" in my lumbar area when doing a situp, and had a sore back for 3 weeks. But the back pain went away, and when I was feeling better, I started dance lessons, lots of hopping and stomping on a concrete floor. In February I developed the butt pain and sciatica so bad I could barely walk or turn over in bed. My right sacroiliac joint is quite sore as well as my hip joint. So, I'm wondering if this other soreness could be part of the "syndrome"?
Also, because of the herniated disc, is it okay to do the twisting yoga postures?
I have validated a method of diagnosis that has high sensitivity and specificity.Stay tuned for more information about how problems like yours, with many different strands, can be diagnosed..
One of the causes of the issue is getting into car improperly. The correct way is to sit first, then swing the legs into the car so as not to put horizontal torsion on the piriformis. Its a difficult maneuver to remember at first - but so worth it.
I thank Dr.Fishman for talking about this syndrome and stretch for it.
One of the methods I use in my practice is working w/ the alignment of the pelvis and working w/ the muscle spindles and golgi tendons of the piriformis