In piriformis syndrome, the piriformis muscle compresses the sciatic nerve. Patients complain of severe pain symptoms that radiate from the buttocks into the legs. Treatment primarily involves massage and stretching exercises.
What is piriformis syndrome?
Piriformis syndrome is one of the so-called nerve compression syndromes. In these syndromes, a nerve is compressed, impairing its function. Another name for this type of syndrome is constriction syndrome. Piriformis syndrome refers to compression of the sciatic nerve, also known as the sciatic nerve. This is a peripheral nerve of the lower extremities that originates in the sacral plexus and contains fibers from spinal cord segments L4 through S3. The sciatic nerve is sometimes the strongest nerve in the human body. Compression of this nerve was first described in 1947. Robinson is considered to be the first describer. Up to the present time, the piriformis syndrome is a controversial topic in neurology. Different opinions exist, for example, regarding the definition, pathogenesis and therapy of the symptom complex. Because of the different opinions regarding the definition, the diagnostic procedure is sometimes not the same. Thus, statements about the epidemiology can hardly be made. However, speculation suggests that piriformis syndrome is a rather common syndrome that affects women far more frequently than men.
Causes
Piriformis syndrome can have several causes. Compression of the nerve is most likely at the bottlenecks that the cord must negotiate in its course. In the narrower definition, we speak of piriformis syndrome only when the sciatic nerve is compressed by the piriformis muscle. This muscle corresponds to a flat pyramidal to pear-shaped muscle of the skeletal musculature that belongs to the deep hip musculature. The muscle is innervated by the sacral plexus or the sciatic nerve. Pinching of the sciatic nerve under the muscle may be present, for example, after trauma. Sometimes the most common cause of nerve compression is trauma to the gluteal region. In some circumstances, violent movements can also lead to nerve compression. Other causes are chronically wrong body postures, so especially inform of prolonged and one-sided sitting. Depending on the cause, the piriformis syndrome either occurs suddenly, or builds up in its symptoms rather insidiously. In some cases, the syndrome has been causally associated with money bags in the back pocket, overexertion, or lifting heavy objects.
Symptoms, complaints, and signs
People with piriformis syndrome primarily suffer from pain symptoms, which can vary in severity from case to case. One of the main symptoms of nerve compression is considered to be severe pain symptoms in the buttock area. In most cases, patients describe radiating pain that may, for example, radiate over the dorsal portion of the thigh. In some cases, the pain radiates beyond the knee. The pain worsens with certain movements. These movements include, in particular, twisting movements, such as those performed when turning over in bed. Crossing their legs also often increases patients’ pain. Pain of some degree also persists regardless of movement or load. In addition, due to nerve compression, patients sometimes complain of sensory disturbances that primarily affect the legs. These sensory disturbances can range from numbness to tingling sensations of various kinds. In some cases, pain in the loins is also present.
Diagnosis and course of the disease
At first glance, piriformis syndrome resembles nerve root irritation of the sciatic nerve. A herniated disc can also cause similar symptoms. Therefore, the physician must make a differential diagnosis to exclude these two phenomena during the diagnostic process. Various tests are available for the diagnosis of piriformis syndrome. These include, for example, muscle testing. When the hip is extended, the compressing muscle acts as an external rotator. When the hip is flexed, on the other hand, it functions as an abductor.When these movements are performed by the patient against resistance, they characteristically provoke the pain of piriformis syndrome. In addition to this provocation test, a pain provoking stretch test is available as a diagnostic tool. The prognosis for patients with the syndrome depends on the cause.
Complications
In most cases, piriformis syndrome results in very severe and uncomfortable pain in the buttocks. It is not uncommon for this pain to spread to the back or other regions of the body. It occurs mainly when sitting or lying down and can significantly reduce the quality of life of the affected person. It may also be that the patient is no longer able to perform various activities without further ado. Paralysis or other sensory disturbances may also occur. In many cases, sporting activities are also no longer possible for the affected person. Furthermore, patients are often irritable and easily depressed. As a rule, the cause of the pain cannot be directly localized in piriformis syndrome. For this reason, a targeted treatment is also not possible. The pain and symptoms can be treated and limited with the help of therapies or massages. There are also no particular complications. Various stretching exercises can also eliminate the discomfort of the piriformis syndrome. In this regard, the syndrome does not usually affect the patient’s life expectancy.
When should you see a doctor?
Since there is no self-healing in piriformis syndrome, this disease must be examined and treated by a doctor in any case. Only medical treatment can limit the pain. The doctor should be consulted in piriformis syndrome when there is severe pain in the area of the buttocks. The pain may occur sporadically and without any particular reason, making the life of the affected person difficult and reducing the quality of life. Especially at night, there may be severe pain and difficulty sleeping. The doctor should also be consulted if the pain spreads to the thighs. Furthermore, a visit to a doctor is necessary in piriformis syndrome if the affected person suffers from disorders of sensitivity or various insensations. Piriformis syndrome can be treated by an orthopedic surgeon or by a sports medicine physician. Whether a complete recovery will occur cannot generally be predicted. However, the patient’s life expectancy is not negatively affected by the disease.
Treatment and therapy
Therapy for piriformis syndrome aims to free the compressed nerve. This release occurs as early as possible to prevent permanent damage to the nerve. The therapy corresponds to a causal therapy. The cause of the pain symptoms is to be eliminated by the individual therapy steps. As a rule, no invasive therapies are initially used to decompress the sciatic nerve. Rather, the treatment is composed of conservative steps. These conservative treatment steps include, for example, targeted massages designed to relieve tension in the piriformis muscle and thus free the nerve from its compressed position. In addition to massages, a so-called trigger point treatment can take place. This treatment also resolves myofascial trigger points in the sense of localized muscle stiffness of the skeletal muscles. In combination with these treatments, movement therapy, which consists mainly of stretching exercises, usually takes place in the context of piriformis syndrome. Stretching the muscle can return the compressed nerve to its physiological position. For their pain, patients are usually given analgesic medications. If the nerve cannot be released from compression in the long term by conservative therapy steps, surgery may be performed under certain circumstances. However, such interventions almost never occur.
Outlook and prognosis
Because piriformis syndrome is a hereditary condition, there is no complete cure, so most patients depend on lifelong therapy to limit or alleviate symptoms. The further course is strongly dependent on the severity and also on the type of pain, so that a general course cannot be predicted.However, piriformis syndrome cannot heal itself, so a visit to the doctor is always necessary for this disease. However, the sooner a doctor is consulted, the better the further course of the disease. If the syndrome is not treated, those affected suffer from severe pain that can affect the entire body. Since it is primarily the legs that are affected, there are significant limitations in the everyday life of the affected person. Often, the symptoms of piriformis syndrome can be alleviated and limited by massages and physiotherapy measures. Stretching exercises can also be helpful. The syndrome is very rarely treated by surgery and does not limit the life expectancy of the affected person. The syndrome can also be prevented by proper posture and regular stretching of the affected parts.
Prevention
Piriformis syndrome can be prevented, at least in moderation, by postural training and regular stretching of the piriformis muscle.
Aftercare
Because piriformis syndrome is a genetic disease, patients have very few or very limited follow-up care measures available to them. First and foremost, a physician should be contacted at the first signs and symptoms of the disease to ensure early diagnosis and subsequent treatment. As a rule, self-healing cannot occur in piriformis syndrome, so the affected person is always dependent on medical examination and treatment for this disease. Most patients depend on the measures of physiotherapy or physiotherapy for this disease. Some of the exercises from these therapies can also be performed in the patient’s own home, which often speeds up the treatment. At the same time, care and support from the patient’s own family in everyday life is often necessary. This can also prevent depression or other psychological upsets. Similarly, sufferers should avoid strenuous exertion to avoid putting unnecessary strain on the muscles. In general, a healthy lifestyle with a healthy diet has a positive effect on the further course of this disease. As a rule, piriformis syndrome does not reduce the life expectancy of the affected person.
What you can do yourself
This syndrome varies in severity and, accordingly, can lead to varying degrees of pain and impaired movement. Depending on the severity of the symptoms, the doctor will prescribe massages to relieve tension and tightness, which should improve the symptoms. Stretching exercises also help to relieve the bottleneck in the area of the sciatic nerve. Patients can have their physiotherapist show them the appropriate exercises. There are also many stretching exercises in yoga that alleviate piriformis syndrome, such as “the pigeon.” Those who do not want to combat the pain exclusively with medication can also rub the painful areas. This can involve the use of various ointments or gels that contain diclofenac or ibuprofen. There are also ointments that have homeopathic remedies mixed in and have also proven effective for piriformis syndrome. These include, for example, ointments with Schüssler salts or with mixtures of medicinal plants. Pain gels have the advantage of pleasantly cooling the painful areas. However, if they are used frequently, they dry out the skin. Ointments, on the other hand, provide additional care for the skin and are therefore more recommended for continuous use. All these classic treatment measures take time to take effect. Piriformis syndrome, however, only rarely requires surgical treatment. Patience and the necessary compliance therefore pay off for the patient.
