Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle. When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.
Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year olds and affects women more often than men.
Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.
Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day. The home stretching exercises described in this handout are an important part of your recovery.
Here is a brief description of the treatments we may use to help manage your problem.
Your chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any “restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints.
We may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed.
Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft-tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility.
Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.
Fallen arches and faulty foot mechanics are common problems that can perpetuate your condition. Our office will carefully evaluate your feet and consider the need for a change in shoe style, arch supports or even custom orthotics.
After this initial course of treatment we will reassess your progress. We will determine the need for any additional care after your reassessment.
Your mattress and the position you sleep in may affect your condition.
- Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
- Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
- Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.
In & Out of Bed
Here are a couple of tips to help you get in and out of bed more comfortably:
- To lie down: Sit on the edge of the bed, pull your arms to your sides and tilt your body into the bed, maintaining the bend of your knees at 45 degrees. Finally, bring your feet into in a lying position or roll onto your back.
- To get up: From a side-lying position with your knees bent, push your body upright into a sitting position, swinging your legs over the edge of the bed as you rise.
Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:
- Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
- Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
- Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
- Use a lumber roll for lower back support.
- Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
- Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
- Periodically, perform the “Brugger relief position” -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.
To minimize strain from wearing a backpack, observe the following guidelines:
- Backpacks should never weight more than 5-10% of a child’s body weight.
- Shoulder straps should be padded, appropriately adjusted, and worn over both shoulders.
- Purchase a backpack with an internal frame to distribute the load evenly.
- Wheeled backpacks are optimal.
The acronym RICE can help you remember what to do after a new injury:
- Rest – Limit stress to the injured area for at least the first 48 hours.
- Ice – Apply for 10-15 minutes. Break for 30 minutes. Reapply. (Alternatives to the ice pack include Ziploc bags filled with ice, or a bag of frozen vegetables.)
- Compression – Wrap the injured area with an elastic ACE bandage if possible.
- Elevation – Elevate the injured area to limit swelling.
Here are some tips to help you lift safely:
- Avoid lifting or flexing before you’ve had the chance to warm up your muscles (especially when you first awaken or after sitting or stooping for a period of time).
- Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
- To lift, stand close directly facing object with your feet shoulder width apart.
- Squat down by bending with your knees, not your back. Imagine a fluorescent light tube strapped to your head and hips when bending. Don’t “break” the tube with improper movements. Tuck your chin to help keep your spine aligned.
- Slowly lift by thrusting your hips forward while straightening your legs.
- Keep the object close to your body, within your powerzone” between your hips and chest. Do not twist your body, if you must turn while carrying an object, reposition your feet, not your torso.
An alternative lifting technique for smaller objects is the golfers lift. Swing one leg directly behind you. Keep your back straight while your body leans forward. Placing one hand on your thigh or a sturdy object may help.
To avoid extra stress on your spine while standing:
- Avoid high-heeled shoes or boots
- Use a footrest measuring 10% of your height
- To decrease stress on your back and feet consider leaning on a tall chair.
- If excessive standing can’t be avoided, consider shock-absorbent shoes or an anti-fatigue mat.
- When transitioning from a sitting workstation to a standing desk, begin gradually by standing 20 minutes per hour and not necessarily in a continuous period. Add an extra 10 minutes per hour each day as long as there is no prolonged stiffness or discomfort.
Improperly supported feet can affect the alignment of all of the structures above. To improve your overall comfort:
- Choose shoes with good arch support.
- Avoid going barefoot or wearing shoes that lack support (i.e. flip-flops). The following brands of sandals provide better than average arch support: Naot, Fit Flops, Orthoheels, Abeo, Vionic and Yellow box.
- Avoid high-heeled shoes or boots (keep heels to a maximum of 1½ inches, especially if you are going to be doing a lot of walking).
- “Cross-trainer” athletic shoes tend to provide the best all around support and shock absorption for daily activities.
- Patients with fallen arches should consider adding arch supports or orthotics.
- Repair or replace shoes with worn soles or heels.
Running shoes need to be replaced every 250 miles. There are three basic options:
- Motion Control Shoes – Designed for people with low or no arches, these shoes are for runners who strike the ground on the outer edge of their foot. Avoid overly stiff shoes as these decrease you perception of ground strike and lead to new injuries.
- Stability or Neutral Shoes – Designed for people with normal or average arches and running mechanics. The shoe contains some cushioning to absorb shock and prevent injuries and some rigidity to avoid pronation.
- Cushioned Shoes – Designed for people with high arched feet. Their footprint will typically leave a thin band along the foot’s edge. As they run weight is distributed from heel strike to the outer edge of the foot and small toes that bear the brunt of “lift off.” This shoe is more flexible and absorbs the shock created by the lack or rotation (under-pronation) created by their running style.
Entering & Exiting a Vehicle
Entering and exiting your vehicle is a potential risky activity for low back pain sufferers. Follow these tips to limit problems:
- To enter the vehicle, open the door and stand with your back to the seat, legs close to the side of the vehicle. For larger vehicles, you may wish to begin by standing on the running board. Place your hands on the door and door frame to keep your movements slow and controlled then slowly lower your body into the vehicle.
- Tuck your head into the vehicle. Keep your knees close to each other, as though they have been taped together, brace your abdomen as though you are about to be punched in the stomach and pivot your body as a whole without twisting or bending at the waist. You may grasp the steering wheel with your right hand to help you pivot.
- Use a lumbar roll or other support to help maintain good posture. Position the roll slightly above your belt to support the “small of your back”. Adjust your seat so that your knees are slightly lower than your hips. Try to avoid prolonged car rides- take frequent breaks.
- Before exiting, create adequate space by pushing your vehicle seat back as far as possible and move the steering wheel up and out of the way. To exit, first scoot slightly to the door side edge of your seat, then keep your knees together and pivot with the same cautions that you used to enter the vehicle. When your feet are shoulder width apart and firmly on the ground or running board, grasp the door and door frame, lean forward, but be sure not to bend your back, as you tighten your abdominal muscles. Slowly thrust your hips forward to stand up.