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  • Piriformis syndrome/sciatica

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    Old 10-03-2015, 12:58 PM   #1
    Jonatan Meine
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    Piriformis syndrome/sciatica

    Hello, I've been suffering from a deep aching/burning pain at the back of my thighs for about one month now. The pain is usually more intense on my right thigh, but both hurt. The pain is heavily aggravated while sitting, thus forcing me to stand up from my chair or move around a little bit. However, if I stand or walk for prolonged periods of time, I also get similar symptoms in my feet (sole and heels). This leads me to think that my sciatic nerve is somehow pinched or irritated.

    I have had an MRI of my neck and lower back, which shows no signs of disc herniation or the like, which leads me to think that my sciatic-like pain is due to shortened/tight piriformis muscle and weak glute muscles in general (as I have been sitting for a long time). One very interesting thing to note, however, is that the thing that I personally think triggered these symptoms is my attempt at fixing my neck problems. Before my thighs/butt started to hurt, when I only had neck issues, I began to go jogging regularly. I stopped after about 2 weeks of jogging because I kind of felt that my body wasn't ready for such a big shift yet. Therefore, I started walking 2-4 miles everyday, which was fine at first until the symptoms in my leg started. My conclusion is therefore that my attempt at fixing my health issues triggered this leg pain.

    At the present moment the pain has progressed a little bit and changed its form; I now also have burning/tingling pain in my outer thighs when I lay in bed, which also makes it hard to sleep. I have been to the doctor and he sent me to a general physiotherapist who showed me some stretches for back and leg, and does some sort of massage to my legs and piriformis. Thus far this hasn't helped anything. I'm really worried and confused, should I continue walking regularly or should I try to rest for a few days? I also go swimming now, which relieves some of the pain, but only temporarily.

    On a side note I want to mention that I'm 19 years old, male and not overweight, nor do I think I suffer from diabetes (diabetic neuropathy) or some other more serious issue. Does anybody have any input on my problem?
    Thanks in advance

     
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    Old 10-04-2015, 10:36 AM   #2
    teteri66
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    Re: Piriformis syndrome/sciatica

    Welcome to the board. Did the lumbar MRI show any spinal stenosis or spondylolisthesis? What symptoms did you have that caused you to get a MRI of the cervical spine?

    When you have pain in both legs it indicates that there is some irritation in the central canal or something that is affecting both sciatic nerves such as a disc that has become damaged in the middle rather than on the left or right side.

    While the piriformis is often the culprit for sciatic nerve pain on one side, it is a bit unusual to have both piriformis muscles affected and pinching sciatic nerves descending into both left and right sides.

    There are a few things I can suggest for you to try that may help. Once the sciatic nerve becomes irritated, it is important that you do what you can to stop any activity or position that irritates it. I would try resting for a few days, icing several times a day to try to get any inflammation to go down. Limit sitting to 15-20 minutes. Then get up and walk for a few minutes. Sleep on your side or back with a pillow under your knees to preserve the natural curves of the spine. Drink lots of water and other fluids.

    I strongly suggest you do the following exercise several times per day. Lie on a firm surface like a carpeted floor, yoga mat, etc. on your back, knees bent with feet flat on floor. Place arms close to the body with palms facing up to the ceiling. Relax and breathe deeply and slowly from the belly...so you can see the belly going up and down. Do this for 2-5 minutes at a session. (Be sure pelvis is in a neutral position, not tipping forward or back.)

    This exercise helps to realign the spine, helps to unload the discs and the deep breathing in this position can help to reset the parasympathetic nervous system. If any muscles are guarding the injured area or overcompensating to protect injured area, this will help them to relax and let go.

    This is a great position to do even when there are no back injuries as it helps to keep the spine properly aligned and functioning appropriately.

    If you did irritate the sciatic nerves, it can take a good six weeks for recovery, so be patient and maybe just do very gentle walking for exercise...and not too far!

     
    Old 10-06-2015, 03:45 AM   #3
    kaleemphysio
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    Re: Piriformis syndrome/sciatica

    your physiotherapist will determine the cause of your pain.

    Once your diagnosis is established, treatment could involve any of the following:

    Pelvis and spine re-alignment techniques.
    Joint mobilisation to restore normal joint mobility, range of motion and function.
    Massage or electrotherapy to help decrease pain and spasm in your piriformis and increase blood flow plus soft tissue extensibility.
    Stretching program for muscle length and flexibility
    Acupuncture or Dry Needling to reduce muscle tightness around the buttock.
    Deep core stability and hip strengthening exercises to stabilise your hip, pelvis and spine.
    Foot orthotics or exercises, if indicated by your physiotherapist or podiatrist, to help restore foot and lower extremity alignment.

     
    Old 10-07-2015, 02:29 AM   #4
    Jonatan Meine
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    Re: Piriformis syndrome/sciatica

    [QUOTE=teteri66;5386167]Welcome to the board. Did the lumbar MRI show any spinal stenosis or spondylolisthesis? What symptoms did you have that caused you to get a MRI of the cervical spine?

    When you have pain in both legs it indicates that there is some irritation in the central canal or something that is affecting both sciatic nerves such as a disc that has become damaged in the middle rather than on the left or right side.

    While the piriformis is often the culprit for sciatic nerve pain on one side, it is a bit unusual to have both piriformis muscles affected and pinching sciatic nerves descending into both left and right sides.

    There are a few things I can suggest for you to try that may help. Once the sciatic nerve becomes irritated, it is important that you do what you can to stop any activity or position that irritates it. I would try resting for a few days, icing several times a day to try to get any inflammation to go down. Limit sitting to 15-20 minutes. Then get up and walk for a few minutes. Sleep on your side or back with a pillow under your knees to preserve the natural curves of the spine. Drink lots of water and other fluids.

    I strongly suggest you do the following exercise several times per day. Lie on a firm surface like a carpeted floor, yoga mat, etc. on your back, knees bent with feet flat on floor. Place arms close to the body with palms facing up to the ceiling. Relax and breathe deeply and slowly from the belly...so you can see the belly going up and down. Do this for 2-5 minutes at a session. (Be sure pelvis is in a neutral position, not tipping forward or back.)

    This exercise helps to realign the spine, helps to unload the discs and the deep breathing in this position can help to reset the parasympathetic nervous system. If any muscles are guarding the injured area or overcompensating to protect injured area, this will help them to relax and let go.

    This is a great position to do even when there are no back injuries as it helps to keep the spine properly aligned and functioning appropriately.

    If you did irritate the sciatic nerves, it can take a good six weeks for recovery, so be patient and maybe just do very gentle walking for exercise...and not too far![/QUOTE]
    Thanks for the quick answer, well all I got as an answer from the MRI was that everything was fine and there was nothing to worry about. Yesterday I visited a neurologist who, based on my symptoms, pointed towards piriformis syndrome. He said that it still could be piriformis syndrome in spite of the bilateral symptoms. He also did some sort of nerve-conduction test in which electrodes were placed at different places on my legs and electrical shocks were sent through them. The results were also nothing abnormal, but he did mention that the signal to or from my L5 was not 100%, but then argumented that this was common, as it is hard to measure that area. I really don't know what to do anymore. I might want to see an orthopedic, who maybe can point out anatomical asymmetries.

     
    Old 10-07-2015, 07:53 AM   #5
    teteri66
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    Re: Piriformis syndrome/sciatica

    Sciatic pain can also be caused by sacroiliac joint issues or dysfunction which does not show up on MRI.

    Another possibility is a structural misalignment, which can be caused by something as simple as a foot pronation or other foot problems. This can throw alignment off and effects can be felt all the way up the spine. For example, foot pronation causes the leg to rotate inward, which affects the hips and the tipping of the pelvis.

    The piriformis runs from the SI joint over to an attachment on the top of the femor near the hip. The sciatic nerve runs underneath the muscle, but in a small percentage of the population the sciatic nerve runs through the muscle. Any swelling or tautness in the muscle can result in pressure on the sciatic nerve. Also, inflammation of the SI joint can cause the same issues with the piriformis muscle. It can cause sciatic nerve pain, and it can also cause "hip" pain when walking....(among other symptoms.)

    Another possibility is a spondylolisthesis of either L4-5 or L5-S1 which can go undetected on MRI. A flexion/extension x-ray is the best test to diagnose this problem where one vertebra slips over the top of the adjacent vertebra. This causes or can cause some instability in that area of the spinal column.

    If you could find a hands on practioner who does body work and manual therapy, they are often better at evaluating muscular issues like piriformis syndrome.

     
    Old 10-07-2015, 07:56 AM   #6
    teteri66
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    Re: Piriformis syndrome/sciatica

    I should add that if the piriformis is found to be the cause of sciatic pain, it can take a long time to go away.

     
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