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What is Piriformis Syndrome?
Piriformis syndrome is a condition in which the piriformis muscle located in the buttock area has tension and stiffness, thereby pinning the sciatic nerve that runs between the piriformis muscles and arises sciatic symptoms due to sciatic nerve clasps in the buttocks.
Piriformis is a small muscle located deep inside the butt (behind the gluteus maximus muscle). It starts on the lower backbone and connects to the upper surface of the femur (femur). Runs diagonally, with sciatic nerve that runs vertically directly beneath it (though in some people the nerve can travel through the muscle).
Piriformis muscle function to help the hips rotate and rotate the lower leg and legs outward.
Causes of Piriformis Syndrome
The exact cause of Piriformis syndrome is unknown.
The alleged causes of Piriformis syndrome include:
– Piriformis muscle spasms, either due to irritation of the piriformis muscle itself, or irritation of nearby structures such as the sacroiliac or hip joint – Excessive tension of the piriformis muscle, as a reflex in response to injury or seizures
– Swelling of the piriformis muscle, due to injury or seizures
– Bleeding in the piriformis muscle area.
Any one or a combination of the above problems can affect the piriformis muscle, causing the butt pain and may affect adjacent sciatic nerves and cause pain, tingling, or numbness in the back of the thigh, calf, or leg (symptoms almost similar to sciatica or sciatica due to sciatic nerve clamps in the area of the spine).
Symptoms of Piriformis Syndrome
The most common symptoms, the patient describes acute buttock pain and sciatica pain as on the back of the thighs, calves and legs. This symptom is almost the same as the symptoms of sciatica (sciatica) caused by nerve clamps in the lumbar and sacral vertebrae for various causes.
The typical symptoms of Piriformis syndrome include:
– Rump and butt pain. This sign is typical for Piriformis syndrome.
– The pain is felt to the back of the thighs, calves and legs (such as sciatica)
– Pain will arise and increase as you walk up stairs or incline, after sitting long, walking or running and may feel better after lying down
– The range of hip joint motion is reduced, and the pain will be triggered by movements of the hips, thighs and lower legs that force the piriformis muscles to contract, such as bending the thigh forward with straight legs, rotating the hips
– In piriformis syndrome no neurological deficit occurs, this is different from sciatica pain caused by sciatic nerve root clamps in the lumbar and sacral vertebrae.
Diagnosis of Piriformis Syndrome
There are no special tests to diagnose Piriformis syndrome.
Diagnosis is established on the basis of symptoms, medical history, physical examination, and investigations that are needed to rule out other possible causes.
Physical examination includes examination of the hip and legs to trigger pain, because usually hip movement will trigger the onset of pain.
A medical history of symptoms, when they begin to arise, how they occur, gradually or after an injury, which position or activity exacerbates or improves symptoms, treatments and family history.
Diagnostic tests are intended to rule out other possible causes of sciatica symptoms, ie sciatica nerve clamps in the spinal area (in 3-4-5 lumbar sproids or 1 sacral vertebrae) due to HNP, degenerary disc disease, spondylolisthesis, etc.
Anesthetic injections with or without steroids are sometimes needed to help confirm whether piriformis muscle is the source of symptoms.
Treatment Piriformis Syndrome
Like sciatica or sciatica caused by nerve clamps in the spinal area, physical therapy and stretching of the piriformis muscle are the main focus and are urgently needed. But the training stage depends on the severity of the pain experienced. Generally it only takes conservative treatment (non surgical) to relieve neurological symptoms caused by sciatic nerve that is squeezed by piriformis muscle and prevents recurring tension from piriformis muscle. There are various treatment options in conservative care, namely:
1. Use of hot or cold compresses.
Hot or cold compresses in the sore area of the buttocks, can help relieve pain symptoms in the beginning. Use of 20 min compresses repeated as needed every 2-4 hours is helpful. The combination of cold compresses with gentle massage in the inflamed piriformis (buttocks) muscle area is also highly recommended. But be careful in the use of hot or cold compresses, so as not to injure the skin and massage should be done gently to avoid further piriformsi muscle inflammation. Consult more about this method to your doctor.
2. Pain relief pain medication.
Over-the-counter pain medicines are sometimes effective for mild symptoms, while in severe cases, pain relievers and muscle relaxants are prescribed by doctors, whose use should be cautious given the side effects.
3. Pain relief injections
For severe pelvic pain from piriformis syndrome, injections may be part of the treatment. Local anesthesia and corticosteroids are sometimes injected directly into the piriformis muscle to help the muscles relax and reduce seizures and pain. The purpose of the injection is usually to reduce acute pain and prepare the patient for physical exercise.
4. Physical exercise.
A number of stretching exercises for piriformis, hamstrings and pelvic extensors can help reduce pain symptoms along the sciatic nerve and help patients to move back. A competent doctor will teach some of these exercises.
5. Physical Therapy.
The combination of physical exercise and physical therapy, will greatly help reduce the symptoms of pain that arise. Use of such devices as ultrasound, laser, TENS, infra red is often necessary, as it is useful for reducing or relieving the symptoms of sciatic pain, reducing inflammation, increasing blood supply and nutrients to the area and for repairing damaged tissue. The application of electrical stimulation to the butt area with transcutaneous electrical nerve stimulation (TENS) units can help to block pain and reduce muscle spasms associated with piriformis syndrome.