KIM’S KORNER: A Pain in the Butt

[dropcap]P[/dropcap]iriformis Syndrome is a condition that mimics sciatica: pain that radiates down the sciatic nerve, usually from the back through the buttocks and down the leg. It normally affects only one side of the body. Quite often the symptoms of sciatica are caused by a problem in the lumbar spine, for example a herniated disc pressing on the nerve, but another cause may be piriformis syndrome. The piriformis is a small, stabilising muscle that sits in the buttock area and lies just over the sciatic nerve as it passes down through the buttock and into the leg.

Usually the main symptoms are tingling and numbness in the buttocks which, in severe cases, can travel down the back of the leg all the way to the foot, depending on the amount of pressure exerted onto the nerve. It can be exacerbated by driving or sitting for long periods, running and even climbing the stairs.

The first step to diagnosis is to rule out other conditions such as arthritic changes in the spine or a herniated disc that irritates the sciatic nerve as it leaves the spine. In some cases there is tenderness over the piriformis muscle but in cases where the tingling and numbness are severe and other neurological symptoms are present, a healthcare provider may suggest further tests, such as an MRI, to rule out serious pathology.

The piriformis is at work throughout the day, during activity and at rest. Even turning in bed causes the piriformis to activate. As well as direct trauma to the muscle, such as a fall or being hit, too much activity (and sometimes not enough) can also result in injury to the piriformis. Activities such as running or over-exercising, lifting heavy objects, frequently going up and down stairs and even long periods of sitting can trigger symptoms. People who like to sit for hours on end in front of the TV, or who drive a car over long distances, are particularly at risk.

The focus of treatment is to avoid aggravating factors and reduce muscle spasm. Ice is usually very effective at reducing pain and muscle spasm but in cases where ice is not helping, then a heat pack may help to relax the muscle. Quite often pain may resolve within a few days but where it lingers and everyday tasks are difficult, physiotherapy may help. Your physiotherapist will carry out a full assessment and physical examination to determine if there are any other factors which are slowing down recovery. They will analyse your movement, gait (walking pattern), flexibility and power. Tight muscles can also be because of weakness and altered movement patterns. Once a full assessment has been completed, a treatment programme will be planned based on your problems. Your programme may include:

• Electrotherapy – An effective treatment for pain relief is a modality known as Transcutaneous Nerve Stimulation (TENS). This involves applying electrodes to the skin and emitting a signal that influences the nerve signals transmitted to the brain.

• Soft Tissue Mobilisation – Massage to the piriformis muscle and surrounding soft tissues can help to relax the tissues.

• Stretching – If the piriformis muscle is tight there are certain stretches that can help relieve the muscle spasm and tightness.

• Strengthening Exercises – Strengthening the muscles around the buttock, lower back and legs will reduce the load and will improve movement patterns and efficiency of the muscles.

• Ice and/or heat – Both of these may help to reduce pain. Ice is effective in reducing inflammation and heat promotes relaxation to reduce muscle spasm.

Prevention is always better than cure so make sure you do not overwork or strain the muscles around the hip. Always warm-up slowly before exercise. When exercising, ensure that you have good posture and are moving correctly. Weak muscles often cause us to move in an awkward or unnatural way which can put stress on the piriformis muscle. If your workout includes running up hills, ensure that you have strong muscles in your legs and core. The best way to achieve these goals is to vary your training routine and always include stretching and strengthening in your weekly programme.