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Piriformis Syndrome: A Pain In The...Back

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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.


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