Piriformis syndrome or herniated disc – How can I tell the difference?
A herniated disc and Piriformis Syndrome cause very similar symptoms in the area of the sciatic nerve. Both trigger the typical nerve pain that can extend down to the tips of the toes. Usually, such symptoms are first suspected to be caused by a herniated disc.
This must be ruled out by means of imaging (e.g. MRI of the spinal column). If no cause is found that could explain the symptoms, the Piriformis muscle is usually the origin of the complaints. Specific tests can irritate the muscle and thus diagnose Piriformis Syndrome.
Piriformis Syndrome or ISG Blockage – How can I tell the difference?
Like Piriformis Syndrome, ISG blockage is often caused by a rapid uncontrolled movement in which the spine and hips must support the body. In an ISG blockage, the os sacrum (end of the spine) and the os ileum (part of the pelvic bones) become entangled with each other so that any movement of these bones against each other is painful. In most cases, the blockage triggers strong reactive tension in the lumbar spine. Therefore, in contrast to the Piriformis Syndrome, the lower back is usually more severely affected. More about this:
- How to recognize an ISG blockade – symptoms of an ISG blockade
Therapy measures
At the beginning of a treatment there is a pause of activities that further irritate the sciatic nerve due to activity of the piriformis muscle. In general, physiotherapy is also a good way of alleviating the symptoms of piriformis syndrome. Stretching maneuvers and other manual measures, which the patient can carry out independently, but also with the help of a physician and physiotherapist and is instructed to carry them out independently, can provide relief quite quickly, especially for older patients whose shortened holding muscles are the cause of the nerve irritation.In addition, pain and anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen or celecoxib may be used and, with physical restraint, can promote faster pain relief and a reduction in inflammatory nerve irritation.
However, despite their partial over-the-counter availability, they should be used with caution and according to medical advice due to their side effects. In addition, after finding out about the better effectiveness, the patient can relieve his or her complaints on the spot by moderate heat or cold. A local injection of a local anaesthetic and/or cortisone can, if it reaches the piriformis muscle and the adjacent sciatic nerve well, quickly reduce pain and have a positive effect on the local inflammation in the long term – until other methods can be additionally applied.
However, the success is strongly dependent on the skills of the doctor using the method and includes the risk of consequential damage to nerves and vessels. Surgery is rarely mentioned as a therapeutic method, but its risk is usually incompatible with the severity of the disease. However, in the case of the aforementioned positional anomalies of the sciatic nerve, an exceptional possibility should be considered.
Ultimately, the treatment and resolution of piriformis syndrome requires a lot of time and can take several weeks to months, which is why consistency and patience are important success criteria for both doctor and patient for a cure. Simple stretching exercises can often help prevent the development of Piriformis Syndrome. Furthermore, these stretching exercises can help to alleviate already existing complaints and positively influence the healing process.
In order to achieve a long-term effect, the stretching exercises should be integrated into every training session and performed regularly. In the following, three stretching exercises are described that can achieve rapid results in people with Piriformis Syndrome. Exercise 1 In this stretching exercise, the patient suffering from Piriformis Syndrome should first sit upright with one leg in front of the body.
This leg should be placed so that the knee joint has an angle of approximately 90 degrees. At the same time, the other leg should be stretched as far back as possible. During this stretching exercise it is especially important that the outside of the thigh always remains in direct contact with the floor.
Otherwise the stretching exercise becomes ineffective. Once this initial position has been reached, the patient must slowly bend the upper body forward. In the meantime, the hands may be placed on the floor for support.
A slight pull should be felt on the outside of the buttocks of the front leg. The intensity of this stretching exercise can be increased by letting the patient slowly move the upper body towards the foot. To achieve the greatest possible effect, the stretching exercise should be held for about 20 seconds and performed at least 2 to 3 times on each side.
Exercise 2 In this stretching exercise the patient must lie on his back and place his left leg on the floor at an angle. At the same time the right leg should be positioned so that the ankle joint is behind the left knee. As soon as this starting position can be held relaxed, the right foot must be pulled towards the hip.
Then the left leg should be pulled towards the body with both hands. If this stretching exercise is performed correctly, the patient will feel a stretch in the right buttock and in the area of the right hip. During this stretching exercise the intensity can be increased by pressing the right elbow slightly against the right knee.
This exercise must also be held for about 20 seconds and performed 2 to 3 times per side. Exercise 3 The patient must lie down on the floor at the side. The head can be laid on a cushion.
Then the upper leg must be bent at an angle of about 90 degrees while the lower leg remains stretched. At the same time, both arms should be stretched out in front of the body so that a 90 degree angle is formed between the arms and the torso. Once this basic position can be held in a relaxed position, the patient must rotate the upper arm in a straight axis to the other side.
The head should also be rotated during this movement. The best effect of this stretching exercise is achieved when the rotational movement is performed to such an extent that resistance to stretching is felt. This position should then be held for about 5 seconds.
Ideally the patient should repeat this stretching exercise 20 times per side. The exact cause of Piriformis Syndrome has not yet been conclusively clarified scientifically.However, a narrowing of the sciatic nerve is suspected when passing through the pelvis. This is where the piriformis muscle is located.
If it is shortened, thickened or tense, it presses on the sciatic nerve and provokes an irritation. Physiotherapy therefore aims at stretching and relaxing the piriformis muscle. The movement of the affected leg in physiotherapy is also important, as the exercises can alleviate the pain in the leg.
Since the cause of Piriformis Syndrome is usually a hardening of the Piriformis muscle, self-massage with a tennis ball can alleviate the symptoms. The tension in the muscle causes various painful points, which are also called trigger points. By massaging these trigger points, a relaxation of the piriformis muscle can be triggered.
Since the piriformis muscle is hidden under the gluteal muscles, a hard massage ball is needed for the massage. Even a tennis ball is hard enough to reach the muscle. The self-massage is performed as follows: You lie with your back on a hard surface and place the tennis ball under the aching buttock.
The body weight is now shifted to the ball. By slightly changing the position, the trigger points can be found. Then massage these trigger points with small rolling movements.
The fascial roller is just as suitable as a tennis ball to massage trigger points of the piriformis muscle. To do this, lie with your back on a hard surface and place the fascia roller under your buttocks. Afterwards, the body weight is transferred to the roll.
Once you have found a trigger point, stay on the painful point for a few seconds. The point can be additionally massaged by moving it slightly back and forth. By this self-massage of the piriformis muscle tensions can be released.
Heat is a frequently used therapeutic tool to release muscular tension. Since piriformis syndrome is often caused by muscle tension and hardening, the application of heat can provide relief. However, the piriformis muscle is a small muscle that is well hidden in the pelvis.
Seen from the outside, it also lies under the gluteal muscles. It is therefore not easy to reach this muscle with a heat pad. However, a heat pad that is placed on the buttocks can penetrate the piriformis muscle with the heat.
Complaints caused by the piriformis syndrome do not always require extensive therapy. In mild cases, acupuncture can help to effectively relieve the symptoms. The term “acupuncture” refers to a branch of traditional Chinese medicine.
This doctrine assumes that the body’s vital energy circulates along defined pathways and has a controlling influence on all bodily functions. The local stimulation of different acupuncture points can therefore have a positive influence on the organism. These acupuncture points are stimulated by inserting fine needles into the skin surface.
In the field of medicine, acupuncture has been enjoying increasing enthusiasm for years. This treatment method is also said to be particularly promising for patients suffering from Piriformis Syndrome. In pronounced cases of illness, acupuncture can be additionally supported by local heat applications (so-called moxibustion).
In this method, special acupuncture points are heated via the needle or directly with glowing moxa herb (synonym: mugwort). After the first acupuncture session, most of the affected patients already describe a significant pain relief as well as an improvement in mobility. Taping can provide acute relief for patients with piriformis syndrome.
The advantage of taping for muscular and/or nervous complaints in the area of the sciatic nerve is the fact that the treated region is only partially immobilized by the tape bandage. In this way, mobility is not completely restricted, but only overloading is prevented. For this reason, taping is also referred to as a so-called “functional bandage”.
The effect of taping is based on the fact that the strips of plaster stuck on the skin transfer the forces acting on the body region to the skin and in this way support deeper lying structures (for example muscles or the capsule-ligament apparatus of a joint). In addition, the taping and the resulting compression of the treated body region effectively prevents swelling.This topic might also be of interest to you:
- Tape bandage
Osteopathy is a special field of alternative medicine. Through the various treatment methods of osteopathy, a variety of diseases and ailments can be effectively treated.
One of the basic assumptions of osteopathy is the opinion that the body is a functional unit and is basically capable of self-regulation. The healing of various diseases is therefore only possible by promoting the body’s self-healing powers. In patients suffering from Piriformis Syndrome, the so-called fascial techniques in particular are often said to lead to effective relief of the symptoms.
This treatment method from the field of osteopathy includes special connective tissue massages, which are supposed to help relieve tension in the musculature. It is basically a manual stimulation therapy, which mainly targets the connective tissue under the skin. The effect of this treatment method from the field of osteopathy is mediated by activating various muscle reflex arches during the massage.
In this way, the normal muscle tone, which is often disturbed in the presence of Piriformis syndrome, can be restored. In addition, tensions that lie directly in the connective tissue can be effectively relieved in this way. Patients affected by Piriformis Syndrome usually report that they have experienced significant relief after only a few applications.
Besides trigger point treatment, stretching exercises and massages, drug-based pain therapy plays an important role in the treatment of piriformis syndrome. First and foremost, pain-relieving (analgesic) and anti-inflammatory (antiphlogistic) drugs such as Diclofenac, Ibuprofen and Coxibe (for example Celecoxib) are used. They belong to the drug group of NSAIDs (non-steroidal anti-inflammatory drugs).
In combination with physical protection, they can lead to freedom from pain quite quickly. Although they can be sold over the counter, NSAIDs should be taken with caution, as excessive or long-term use can lead to stomach problems, among other things. If the effect of these drugs is insufficient, local injection of a local anaesthetic, possibly in combination with cortisone, can help.
This can achieve a reduction in pain or even freedom from pain for weeks or even months. A prerequisite for this, however, is good accessibility of the piriformis muscle. Likewise, the success of the injection is strongly dependent on the skills of the doctor performing the injection.
