Piriformis Syndrome

  • Piriformis syndrome is a common diagnosis for pain in the buttock. It is often attributed to issues related to the sciatic nerve but that’s not really the cause. In more than 80% of cases it has to do with some kind of trauma or repetitive motion not an anatomical difference of the piriformis muscle and sciatic nerve.
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Brief overview of the episode:

Piriformis syndrome is the literal pain in your butt. Other symptoms include low back pain, numbness, difficulty walking, pain with sitting/squatting/standing/bowel movements and tenderness. Sometimes this is called deep gluteal syndrome, extra-spinal sciatica or wallet neuritis.

The reason that the piriformis muscle is so famous is because it can have a unique arrangement with the sciatic nerve. There are 6 other muscles in this area that can also play a role and that is why primary piriformis syndrome makes up less than 15% of cases.

Secondary pirifomris syndrome is by far more common. This is usually due to some kind of trauma, muscle holding, gait patterns or other issue further down or up the kinetic chain. That will then present as pain in the buttocks.

Women are affected 6x more than men. This seems to be due to an increased q angle as this impacts the relationship between the quadratus femoris and the OS Coxae.

Most people you experience piriformis syndrome will get better with short-term activity modification and exercises. Surgery is not often recommended even in cases of primary piriformis syndrome.

Other episodes you might enjoy:  

Lumbar Strain: Episode 123

Lateral Shift: Episode 106

Sciatica: Episode 34

Lumbar Strain

(Weight Lifters Back)

  • Lumbar strain also known as weight lifters back, low back pain, pulled back, my back went out, strained back and lumbago is a really common issues. It is likely that everyone will deal with this at some point in their lives.
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Lumbar strain is one of the most common reasons someone will go to their primary care physician or the emergency room. It occurs as a result of trauma, overuse, sports, slips and falls. Sometimes called weight lifters back, lumbago, back strain, pulled back and is a result of a muscle, tendon or ligament injury of the low back.

The most common muscles injured are the quadratus lumborum, multifidus, gluteus medius, gluteus max and piriformis. These are muscles of the low back and the buttocks/hip. Symptoms will included low back pain, spasming and being sore to the touch.

Most people will have some reduction in symptoms with walking, short duration stretching and ice/heat/NSAIDS. In most cases it is not necessary to see a physician or have imaging done. Symptoms will improve in 1-4 weeks and should fully resolve in less than 8 weeks.

Low back pain is most often a result of some activity and usually you know what caused your pain. There is high likely hood that you pain will improve with gentle movement and activity and there is not a serious underlying pathology.

Other episodes you might enjoy:  

Lateral Shift: Episode 106

Core/Abdominal Wall: Episode 35

Low Back Pain: Episode14

 

Radicular Pain: Episode 22

  • Radicular pain occurs when a nerve root is irritated. It is most common in the lumbar spine and is often referred to as sciatica. Radicular pain does also occur in the cervical spine with symptoms being felt in the arm and hands.
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Today we are reviewing Late July Mild Green Mojo Tortilla Chips compliments of Pattie Skiles and we are going to cover radicular pain. Ridiculous pain. That’s radicular pain. That’s what I said. Oh, you jokester. Haha, radicular pain.

 

Radicular pain is more common from the lumbar spine. It tends to be called sciatica at that point. That is the most common one you will hear of. That’s one of those terms, sciatica. It’s kind of like hip pointer. It’s not very definitive is it. It dose not really mean much. No.

 

You also have radicular pain cervically. Which is not as common, thankfully, but does occur. It does not have a cool name like sciatica. You can call it brachiaca. I guess. yeah you could. Compression of the bracial plexus. Then you are almost talking about thoracic outlet syndrome. We will talk about that at a later date.

 

Radicular pain typically is caused by some irritation on the nerve root. That can be a disk herniation, a bone spur, potentially following a more traumatic injury a fracture, ligament strain or tear. Often you might see a facet joint issues. But the biggest cause is inflammation.

 

In other words; radiculopathy or radicular pain is a symptom, not a diagnosis. So it is a symptom, typically where inflammation sites by the nerve root and causes irritation on that. Inflammation by itself is nothing more than an irritant. So when it sits there and irritated that nerve you get symptoms along the distribution of that nerve or group of nerves.

 

If you have nerve root irritation the pathway is not necessarily predictable like sciatica. So if you have pinching or inflammation along on nerve root anywhere along the lumbar spine. It will refer along the distribution pattern of that nerve. You can have pain in the groin, pain in your big toe, pain on the inside of your thigh. But ridiculer pain can come also if you have distal compression of the sciatic nerve. Then it will follow the distribution of the sciatic nerve, which is along the back of your thigh and into your calf.

 

The biggest one to remember there is the piriformis muscle and piriformis syndrome.

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