What Is The Piriformis Muscle
Piriformis syndrome is an incredibly common condition that is predominately caused by excessive sitting, says Eugene Charles, DC, Diplomate of applied kinesiology and author of Journey to Healing: The Art and Science of Applied Kinesiology.
Sitting puts undue stress on the pelvis, and this, along with other reasons, led the famed Mayo Clinic to regard sitting as the new smoking.
The strain on the sacroiliac joints in the pelvis cause the piriformis muscles to tighten in a vain attempt to stabilize the pelvis.
This tightening can put pressure on the largest nerves in your body, the sciatic nerves, which lie directly under, and on some occasions through, the piriformis muscle.
This tightening of the piriformis muscle can lead to sciatica pain and tingling in the butt, hip and down the leg.
When I was a personal trainer, the butt muscles I commonly talked about with my clients were the gluteus maximus and the gluteus minimus.
Fitness instructors often speak of the glutes, as these are the force production muscles that give our butts their shape .
The piriformis muscle is also located in the butt, except that its close enough to the sciatic nerve that it can end up compressing it.
Back of the leg and butt. The piriformis muscle is indicated in red.
When something presses upon the sciatic nerve, it can cause pain, tingling or numbness at any point along this nerves path .
How Can Physical Therapy Help
Physical therapists are experts at diagnosing and treating pain anywhere in the body. At Origin, our PTs specialize in the female body and can help you at any stage of life, including during pregnancy, postpartum, and menopause. Theyâll start by listening to your symptoms and concerns and examining how you move and experience pain â so they can make an accurate diagnosis.
If you are found to have sciatica, treatment typically involves manual therapy techniques to the glutes and low back to loosen up the tissues. It also includes exercises to improve core, glute, pelvic girdle, and pelvic floor strength, as well as stretches and mobility exercises for the hips and sciatic nerve. Pregnant or postpartum? Your PT will help you adjust movements that contribute to pre or postnatal sciatic pain, including how to get up off the couch and roll in and out of bed.
When it comes to chronic nerve pain, youâll need to be patient and pace yourself. Nerves take time to heal and progress can be quickly lost if you do too much too soon or move in a way that re-aggravates the sciatic nerve. Your PT will teach you how to increase activity incrementally, so that you continue to heal.
What Causes Hip Pain
Pain may arise from structures that are within the hip joint or from structures surrounding the hip.
The hip joint is a potential space. This means that normally there is a minimal amount of fluid inside the joint to allow the femoral head to glide in the socket of the acetabulum. Any illness or injury that causes inflammation will cause this space to fill with fluid or blood, stretching the hip capsule lining and resulting in pain.
Articular cartilage lines the femoral head and the acetabulum, allowing the bones to move within the joint with less friction. Also, the socket area of the acetabulum is covered with tough cartilage called the labrum. Just like any other joint cartilage, these areas can wear away or tear and become the source of pain. There are thick bands of tissue that surround the hip joint, forming a capsule. These help maintain the hip joint stability, especially with movement, keeping the femoral head firmly in the acetabulum.
Movement at the hip joint is possible because of the muscles and tendons that surround the hip and that attach across the hip joint, allowing the leg to move in different directions. Aside from controlling movement, these muscles also act together to maintain joint stability. There are large bursas that surround areas of the hip and allow the muscles and tendons to glide more easily over bony prominences. Any of these structures can become inflamed.
Picture of the Anatomy of the Hip
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Main Causes Of Hip Pain
There are so many different potential causes of hip pain, including injuries, arthritis, inflammation, pinched nerves , and even cancer.
When serious, hip pain is often a symptom of something else, like sciatica, arthritis, or bone cancer. Minor hip pain is usually caused by injury, such as:
- Labral tears
You may also just be experiencing discomfort because of how youre sitting every day, often causing low back pain in addition to hip and sciatic nerve pain. If you work in an office, or you work from home, you likely have to sit in an office chair for at least eight hours every day.
This can cause a lot of discomfort to the lower back, hips, and buttocks. While you wont have an injury such as a sprain or a fracture, you can still experience pain.
Does Arthritis Cause Sciatica Or Vice Versa
In some instances, arthritis can cause sciatica. If you have osteoarthritis in your spine, for example, the cartilage in that area degenerates over time. As that happens the sciatic nerve can become irritated. Many older adults with OA also develop bone spurs, tiny, jagged edges of bone that can press on the sciatic nerve.
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Testing For Piriformis Syndrome
Because piriformis syndrome symptoms mimic those of sciatica, your medical provider will perform specific tests to determine whether your symptoms are discogenic or caused by an impingement of the sciatic nerve by the piriformis muscle.
Your provider should examine your low back, hip, pelvis and sacroiliac joint and check your gait, posture and leg length. Theyll also test your reflexes, which should be normal if you have piriformis syndrome.
Your provider will manipulate your leg to check for piriformis syndrome.
Other signs of piriformis syndrome include:
When testing for pain or weakness in specific positions, your provider will conduct each test until you experience symptoms or for up to 60 seconds, whichever comes first.
In addition to a physical exam, you might also need imaging to rule out other causes for your symptoms. Your doctor may order X-rays, an MRI, or a CT scan. In addition, injections into the piriformis muscle may be used to confirm the diagnosis, while simultaneously helping with treatment.
Once you pin down the source of your pain, you can move forward with treatment, which typically consists of NSAIDs and physical therapy. Although you might be inclined to rest, wait, and see what happens, the sooner you find the root of your issues, the sooner you can get back to pain-free living.
Piriformis syndrome or sciatica? Get a proper diagnosis find a spine specialist near you who can help.
Treating Acute And Chronic Sciatica
You might have acute sciatica symptoms that go away on their own with exercises like walking and stretching. Alternating between applying hot and cold packs to the painful area can also help alleviate your discomfort.
Chronic sciatic nerve pain that doesnt respond to at-home solutions may require a more customized treatment plan. Depending on your needs, that could mean regular physical therapy with prescribed exercises, steroid injections, or chiropractic adjustments.
At Steel City Spine and Orthopedic Center, we take a conservative, natural approach to alleviating sciatica so you dont become dependant on prescription medications that mask symptoms yet dont resolve the root cause of the problem.
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Should I Rest If I Have Sciatica
Some rest and change in your activities and activity level may be needed. However, too much rest, bed rest, and physical inactivity can make your pain worse and slow the healing process. Its important to maintain as much activity as possible to keep muscles flexible and strong.
Before beginning your own exercise program, see your healthcare provider or spine specialist first to get a proper diagnosis. This healthcare professional will refer you to the proper physical therapist or other trained exercise or body mechanics specialist to devise an exercise and muscle strengthening program thats best for you.
Sacroiliac Joints Sacral Fractures May Replicate Sciatica
The sacroiliac joints connect the spine to the pelvis. There are two SI joints, one on either side of sacrum. While these two joints are relatively immobile, they are subjected to tremendous force during routine, daily activities. Examples of SI joint pathology that can mimic spine-related sciatica include:
Sacroiliitis: Inflammation of the SI joints. The pain begins slowly with no obvious inciting event. It localizes to the buttocks and can cause radiating pain down the back of the thigh. This is thought to be due to either irritation of the sciatic nerve by the inflammatory molecules present in the SI joint or pain that is perceived to be in a location other than the location of the pain generator. Pain due to sacroiliitis tends to improve with light walking.
Sacral Insufficiency Fracture : A fracture of the sacrum that occurs in people with weakened bone after a minor injury or without trauma. Risk factors include advanced age, osteoporosis, chronic steroid use, rheumatoid arthritis, and vitamin D deficiency. Pain usually localizes to the low back and radiates to the buttocks and/or groin and is made worse with activity.
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Common Sciatica Cause #: Spinal Tumors
Spinal tumors are abnormal growths that are either benign or malignant . Cancerous tumors are usually metastatic, which means they have spread to the spine from cancer that had formed somewhere else in the body. Benign growths in the spine that can compress the sciatic nerve include:
- Aneurysmal bone cysts . ABCs are not tumorsas the name dictates but cysts that are filled with blood that tend to expand quickly.
- Giant cell tumors . GCTs are aggressive bone tumors that usually attack bones that are close to a joint, a potentially big problem for the spine with its 364 joints.
- Osteoid osteomas. These tumors are found in bone, tend to be small, and do not grow larger once formed. However, they can cause new, unintended bone to form in the affected area or osteoid bone to form around the tumor itself.
When a spinal tumor develops in the lumbar region, there is a risk for sciatica to develop as a result of nerve compression. Fortunately, spinal tumors are rare. If your sciatic nerve pain fails to improve with medication, physical therapy, or injections, suggest an MRI scan to your pain management expert or surgeon. It can rule out an intraspinalmeaning within the spinal canal or columncause of your pain, says Dr. Subach.
Why Does Sciatica Cause Hip Pain
Many lower back problems that present as hip pain are caused by a herniated disc. Herniated discs typically occur from simple wear and tear due to aging and are common in patients between 30 and 50 years old.
When a disc herniates, the gel-like center of the disc protrudes into or through the discs outer lining. This herniated disc will sometimes press directly on the nerves in your spinal column, producing pain called sciatica.
Some other symptoms that often accompany hip pain from sciatica include:
- Pain that feels similar to a bad leg cramp
- Pain that is sharp
- Pain that heightens when you move, sneeze or cough
- Weakness, numbness or a tingling sensation down your leg
OrthoIndy spine surgeon, Dr. Kevin ONeill, explains why a patient might feel hip pain from sciatica, even though its a condition of the spine.
Most commonly, sciatic nerve pain runs down the back of the thigh and into the calf and foot, but it can also run down the front of the thigh, Dr. ONeill says.
When this is the case, it can be confused with pain coming from the hip joint. Classically, pain from a hip joint problem is felt in the buttock and wrapping around to the groin, but can feel like it runs down the thigh.
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What Are Causes Of Traumatic Hip Pain
Falls are the most common reason that elderly people break a hip. The fracture is due to a combination of two effects of aging, osteoporosis , and a loss of balance. These two risk factors are the potential cause of many falls. Occasionally, the bone may spontaneously break due to osteoporosis and become the cause of the fall.
Bones may also weaken because of other diseases that have affected the hipbones. A pathologic hip fracture describes this situation, and osteoporosis is but one cause. Other potential causes of bone weakening are cancer within the bones, benign tumors and cysts, Paget’s disease, and inherited diseases of bone.
When health care professionals talk about a hip fracture, they really mean a fracture of the proximal or upper part of the femur. Fractures of the acetabulum are less common and usually are due to major trauma like a motor-vehicle collision or a fall down a flight of stairs.
The precise location of the fracture is important, because it guides the decision of the orthopedic surgeon as to which type of operation is needed to repair the injury.
Picture of the Location of Most Hip Fractures
Other structures should be mentioned as a cause of hip pain because they become inflamed.
When Is Surgery Considered
Spinal surgery is usually not recommended unless you have not improved with other treatment methods such as stretching and medication, your pain is worsening, you have severe weakness in the muscles in your lower extremities or you have lost bladder or bowel control.
How soon surgery would be considered depends on the cause of your sciatica. Surgery is typically considered within a year of ongoing symptoms. Pain that is severe and unrelenting and is preventing you from standing or working and youve been admitted to a hospital would require more aggressive treatment and a shorter timeline to surgery. Loss of bladder or bowel control could require emergency surgery if determined to be cauda equine syndrome.
The goal of spinal surgery for sciatic pain is to remove the pressure on the nerves that are being pinched and to make sure the spine is stable.
Surgical options to relieve sciatica include:
Microdiscectomy: This is a minimally invasive procedure used to remove fragments of a herniated disk that are pressing on a nerve.
- Laminectomy: In this procedure, the lamina that is causing pressure on the sciatic nerve is removed.
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How To Identify It:
Hip arthritis usually presents as pain in the groin but can sometimes cause pain on the side of the hip and leg, as is often the way with sciatica. When this condition causes pain on the side of the leg, it can mimic sciatica symptoms in the hip.
The pain will normally be worse with movement and fine at rest, with early mornings and getting going from a resting position being the worst times. Along with pain, you may notice restricted movement in the hip, particularly with rotation.
A demonstration of rotation of the hip is shown below. If this exercise gives you pain, you may have hip osteoarthritis:
A simple X-ray will likely show the extent of the changes in the hip and can be useful in diagnosis.
How Sciatica Is Treated
At-home treatment for sciatica consists of over-the-counter anti-inflammatories, icing and/or applying heat to the afflicted area, and some patience. For many people, that is enough to help them heal within a few weeks.
If your pain is bad enough that youve sought professional help, however, you likely need extra help. Treatment options for sciatica include:
This is the most common and generally most effective treatment for sciatica, says Dr. Huffstutter. The main goal is to take pressure off the sciatic nerve by strengthening and stretching the surrounding muscles. Physical therapy can be invaluable its really hard to learn how to do the right exercise without it, he says.
Epidural steroid injections
Physical therapy is very helpful, but sometimes the pain is too severe, and the patient feels they cant do it, says Dr. Barsoum. In that case, the first step might be to inject inflammation-reducing medication directly into the epidural space that surrounds the nerves in the spine.
Your doctor might suggest using anti-inflammatories, muscle relaxants, or even a narcotic medication if the pain is very severe. These drugs can make you feel a lot better and give your body a chance to heal.
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Causes Of Sciatica Pain
What are the Causes of Sciatica Pain? Sciatica pain is caused by inflamed nerves from nerves being pinched, bulging discs and inflamed muscles that cause severe sciatica pain. Most medical doctors find it hard to treat and patients rarely get relief using these methods. Natural sciata pain treatment can give you lasting and permanent sciatica pain relief without harmful surgeries or prescription medications with side-effects more dangerous than your sciatica.
Sciatica Pain is first noticed in the lumbar spine and then the pain will tend to radiate out to your buttocks and run down the back of your legs on one side of your body. This is a mild aching type pain that may progresses to a sharp or burning feeling that causes excruciating and radiating pain. It is important to use a natural sciatica pain treatment as soon as you can as it can lead to nerve degeneration and fused spinal discs.
You may feel like you’ve been struck by a thunderbolt of lightning. I’ve known people who have used conventional medicine to treat their sciatica pain and after many surgeries and bottles of harmful and ineffective prescription medications they are still no better off, and some have even spent away their nest egg looking for relief.