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  • Sciatica or Piriformis Syndrome?

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    Old 04-01-2014, 09:12 AM   #1
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    Sciatica or Piriformis Syndrome?

    Let me start by explaining that I have a right knee in serious need of replacement and I have been limping on it a lot over the past month or so. About three weeks ago, I started with a pain in my lower right buttock. It felt like a tight muscle. Over the past three weeks, it has gotten progressively worse and quite painful. It grabs each time I take a step or shift my weight on that side. I have gone from walking independently to using a cane and limping very badly. With each step, the pain grabs in the right buttock and I feel like I could easily fall. Initially sitting was a relief. Now it's becoming painful at times to sit on it or to shift positions when sitting. I saw the PA at my PCP's office twice now and she continues to call it Sciatica. But a PT friend suggested that it sounds more like Piriformis Syndrome. I have no pain in my back or my leg. It stays largely to that one area of the buttock, which makes me think she could be right. I was prescribed a course of prednisone and a muscle relaxer, neither of which helped. She's now referring me to a pain management clinic for injections.

    Has anyone had similar symptoms or can you shed some light on what I might be dealing with? Before someone starts injecting me for sciatica, I would like to have an actual exam and an attempt at a proper diagnosis. What specialty makes that diagnosis? Orthopedics? Neurology? And wouldn't they first try stretching, ultra sound, etc.? Would appreciate anyone's input. Thanks!

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    Old 04-02-2014, 07:59 AM   #2
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    Re: Sciatica or Piriformis Syndrome?

    It's hard to say what it could be. It certainly could be either one but I would not undertake the injections lightly! You need an MRI to rule out spine issues. How can a pain DR inject you if they don't know where the pain is being generated from?

    Get yourself to a Spine clinic. Ortho or Neuro.

    There are several members on here with more experience than I have so I hope they chime in but my suggestion is get a diagnosis before any type of treatment!!!

    Good luck!

    Old 04-02-2014, 11:53 AM   #3
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    Re: Sciatica or Piriformis Syndrome?

    When there is an issue that causes a change in gait, it has an effect on the entire spine and every body part that is connected to the movement. You will have a difficult time getting the pain in your hip/buttocks to resolve as long as you are having issues with your knee.

    I would be curious to know for how long you have had the knee problem and whether you are sure it is actually the knee or whether it could be related to a lower lumbar spine issue. I assume a knee specialist has told you in detail what is wrong and what has caused it.

    In terms of sciatica or piriformis syndrome, in a way you are talking about the same thing. Sciatica is really just a term for a collection of symptoms that relate to some type of inflammation of or injury to the sciatic nerve. It is also used for a nerve pain that radiates down the back of the leg, which usually has its origin in spinal stenosis or a lumbar disc issue. People, including medical personal, use it loosely to describe when someone has pain in the buttocks and running down the back of the leg. It does not describe a specific ailment.

    What you are describing sounds like a problem with the piriformis muscle, particularly when you mention being unable to sit for long, and, having no pain in the leg. The piriformis is a muscle in the buttocks that attaches near the sacrum and runs over to its attachment by the "hip." When it is pulled taut due to strain, inflammation, etc. it can have an effect on the sciatic nerve, which runs directly underneath the piriformis. In a few people, the sciatic nerve actually runs through the piriformis.

    It can be difficult to diagnose as the symptoms mimic those of a herniated lumbar disc or some other lumbar issues...and it can be very difficult to treat.

    I have had years of experience with both and can tell you that there are a number of very helpful articles about "piriformis syndrome" on the internet. Look for ones from a university or a large medical center, or from the NIH. Those sources will provide factual information and not be wanting to sell you a miracle cure for your pain.

    There are specific stretches you can perform to kind of tell whether the pain is coming from the piriformis. Since it involves getting into a kind of weird position, I suggest you look for piriformis stretches online, as it is too hard for me to describe. Ideally you could go to a physical therapist to see if it is the piriformis muscle. They could work with it using deep tissue massage, ultra-sound, e-stim, etc. Sometimes dry needling or acupuncture will help too.

    I would also recommend getting a "far-infrared" heating pad. The wave lengths penetrate farther into the tissue whereas the usual heating pad really only warms up the surface. They are more expensive, but most people who have them cannot live without them!!

    If the doctor is talking about injecting a steroid into the piriformis muscle, that might help with your pain, at least temporarily. But if they are referring to giving you a series of epidural steroid injections into the spine, I would suggest you do not agree to that. In this day and age, medical practioners tend to offer these very casually, without paying much attention to the potential consequences to the patient. It may turn out that you will need this treatment, but you will not know this unless you have a MRI and are given an accurate diagnosis by a spine specialist. This can be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon who limit their practice to neck and back issues.

    But before going forward with all that, do some reading online. You can do just about as much for piriformis syndrome on your own. I'm afraid that until you can get your structural alignment straightened out, the pain from your knee causing your body to compensate and to change your gait, you will have a difficult time getting rid of some of these other issues.

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