Piriformis syndrome is a combination of pain in the gluteal region. The pain does not necessarily have a localized character, it can be given to the genital area and even to the lower leg, so that it creates the feeling that it hurts somewhere below.
Almost any person has repeatedly heard such a phrase as "inflammation (neuropathy) of the sciatic nerve." Let's figure out what the seat is and what nerves there can become inflamed.
About problem
Sciatic nerve neuropathy is a very common problem. As we noted above in the definition, in fact, this is a severe pain in the pelvic region, which can occur absolutely out of the blue suddenly and will only progress over time. Any physical activity, even the most insignificant, in which tension is created in the buttocks, contributes to the intensification of the pain syndrome. In addition to everything, pain has an effect on the region of the lower extremities, which, in turn, prevents a person from moving normally at all.
What is accompanied by?
All of the above pain symptoms may be accompanied by a feeling of fatigue, a burning sensation or tingling in the pelvic-gluteal region.
This is due to the fact that as a result of a violation of the correct functioning of the sciatic nerve and the vessels surrounding it, too much pressure is created, which, in turn, leads to disruption of the circulation of nutrients in the body. If the piriformis muscle experiences a long-term displacement, this leads to the occurrence of the above complex of severe pain syndromes. This is piriformis syndrome.
Some anatomical facts
The piriformis muscle is the muscle of the internal pelvic section. It is a muscular system connecting the bones of the ileo-sacral joint. This muscle in the human body is represented by the shape of a triangle, and, in fact, resembles the shape of a pear, hence the name. It is connected to the pelvic bones using tendons.
The piriformis muscle is located beneath the gluteus maximus, which is the largest in the human body. Next to the piriformis muscle is a ligament that connects the sacral processes, or rather, their ends. Between the piriformis muscle and the ligament in the sciatic foramen are the blood vessels that supply the muscles and nerves that we are talking about inflammation. So, if suddenly, for some reason, which we consider in more detail below, the inflammatory process begins in the piriformis muscle, then the lumen of this very sciatic opening may narrow significantly. It is easy to guess that, thus, the walls of the lumen begin to put pressure on the nerve itself. This is ischemia (neuropathy) of the sciatic nerve. In philistine language, a nerve is pinched, which leads to unbearable pain.
Symptoms and treatment of piriformis syndrome are interconnected.
Since the role of the piriformis muscle is to hold the bones of the pelvic section, any functional disturbances lead to overvoltage. Pain during overstrain of this particular muscle is the strongest. It is for this reason that this pain and inflammatory syndrome is distinguished into a separate diagnosis, which is called piriformis syndrome.
Causes of occurrence
As we noted above, piriformis syndrome often occurs absolutely suddenly, it would seem, out of the blue. The causes of this syndrome can be completely elementary household factors. Or can these factors have a rather complex nature of origin. Piriformis syndrome can cause even excessive physical activity. It leads to muscle overload.
We summarize the anatomical prerequisites for the development of piriformis syndrome:
- an inflamed muscle pinches a nerve in the sciatic opening itself;
- pinching of the sciatic nerve occurs, which passes through the piriformis muscle;
- nerve processes of the sacral spine experience compression.
The following causes of this syndrome can be distinguished:
- malnutrition;
- improper and excessive physical activity;
- fatigue and stressful situations of a chronic nature;
- hypothermia;
- long static loads;
- stretching;
- various injuries in this area;
- osteochondrosis of the sacral and lumbar;
- tumor processes of any nature leading to anatomical deformations;
- incorrect intramuscular injection.
Classification
In medical practice, it is customary to classify piriformis syndrome into primary and secondary.
- Primary inflammation is caused by the causes that we have listed above.
- Secondary inflammation occurs when the inflammatory process passes from the area of the joint of the ilium and sacrum, or the pelvic organs to the piriformis muscle. In other words, the initial inflammation did not begin with the piriformis muscle, but elsewhere.
Symptoms of the disease
We have already noted above that piriformis syndrome is always accompanied by a pronounced pain syndrome, which cannot be overlooked. The disease does not have a latent form of the course. Symptoms are represented by signs of a local inflammatory process, ischemic signs of the sciatic nerve (pinching), as well as atrophic, arising due to compression of the vessels of the nerve and lower buttock artery.
Piriformis syndrome radicular syndrome is accompanied very often.
Signs of local inflammatory processes
- Sharp pains in the pelvic region, which tend to aggravate while standing, as well as when walking and when trying to move the hip inward, for example, when trying to put your foot on your foot. When breeding legs in a horizontal position, the pain becomes noticeably less.
- Pain is variable. They are dull, aching, and can be shooting. Exacerbations of the pain syndrome provoke weather changes or a prolonged warm position, for example, under a blanket during a night's sleep. What other symptoms of piriformis syndrome are there?
- We noted above that the infringement of the sciatic nerve is irradiating in nature. The whole thigh surface, the gluteal region may hurt, and the pain can even spread up to the toes. This is because the sciatic nerve is one of the largest nerve formations in the human body, and it is it that innervates the entire region of the pelvis and lower extremities.
- The area of the nerve passage is also characterized by a complex of pain syndromes: tingling, numbness.
- The tactile sensitivity of the pelvis and lower extremities is reduced. The patient may not even feel injections or contact with the hot.
- The pain syndrome can even spread to the internal organs, for example, difficulties with urination may appear.
- The appearance of severe lameness is the result of squeezing the vessel. The skin in this area becomes pale due to impaired blood supply.
Treating piriformis syndrome at home can be very effective. About it further.
Symptoms of sciatic nerve ischemia
- The nature of the pain is oppressive. You may experience a feeling of chills, burning, or a feeling as if the affected area is wooden.
- The extinction of the Achilles ligament reflex is observed, as well as a decrease in skin sensitivity.
- Pain sensations are concentrated mainly in the area of innervation of the tibia - large and small. Palpation of the ankle muscles, as well as walking, lead to a noticeable increase in pain.
- As in the case of local symptoms, unpleasant symptoms of sciatic nerve ischemia are provoked by changes in weather conditions, as well as prolonged exposure to heat.
Symptoms of squeezing the inferior artery and vessels
- Similarly to the previous symptoms, an upright position provokes increased pain: vasospasms and severe lameness appear. In a horizontal and seated position, the pain subsides.
- As a result of impaired blood supply, severe pallor of the skin in the buttocks and limbs is observed.
Diagnostic Methods
Diagnostic methods of the inflammatory processes of the piriformis muscle are aimed at differentiation with other diseases with a similar set of symptoms. For example, arthritis, osteochondrosis, intervertebral hernias, as well as a number of other diseases of the pelvic area that have similar symptoms.
In the diagnosis of piriformis syndrome, the right and left rarely resort to hardware-instrumental methods, since there are no criteria that would clearly determine the degree of pathology. In addition, there are no clearly defined norms for the ratios of the muscular-vascular and nerve plexuses in the gluteal region. The reasons for the impossibility of developing such standards are associated with anatomical features that do not allow devices to visualize this area.
Which are the most affordable?
We list the available diagnostic methods:
1. Manual inspection allows you to identify some characteristic manifestations:
- Difficulty in adopting a foot-to-foot position;
- legs spreading through resistance causes severe colic and fatigue of legs and trembling;
- Bonnet syndrome;
- conducting motor tests with provocation reveals a shortening of muscle fibers;
- symptom according to the method of Vilenkin;
- Grossman symptom
- the most complex cases may require a vaginal or rectal examination.
2. The most important diagnostic criterion is the use of novocaine blockade: an injection in the piriformis muscle of the drug of the novocaine group. After the injection, a noticeable weakening or disappearance of all pain syndromes is observed. Carrying out the above manual examinations after novocaine blockade also does not reveal any pain syndromes.
3. The use of computed tomography and magnetic resonance imaging methods is shown in cases where it is necessary to exclude or confirm the presence of neoplasms that create pressure on the pelvic area. MRI is also used to clarify a detailed picture of the degree of damage to muscle fibers in the acute period of the disease. MRI images clearly visualize areas of swelling, atrophic lesions, and infiltration.
MRI can be used for differential diagnosis of piriformis syndrome with other diseases with similar symptoms, for example, intervertebral hernia.
Treatment
Usually, the treatment is complex:
Drug treatment involves:
- Taking anti-inflammatory drugs of the non-steroid group. Examples are diclofenac-based drugs: Voltaren, Meloxicam, Dicloberl, Ketanov. Drugs are prescribed for intramuscular injection or oral administration. The course of treatment is determined by the doctor.
- To relieve pain, antispasmodics and painkillers are used: Baralgin, Tempalgin, Sedalgin and other drugs that remove muscle cramps and reduce pressure on the nerve and blood vessels, as well as the well-known No-Shpa, which is prescribed intramuscularly.
- In the case of complications of inflammation in the form of bone deformation, muscle relaxants are used. In such cases, the above antispasmodics can not cope with analgesia. Muscle relaxants relieve muscle tone, thereby releasing impaired blood vessels and nerves. An example is most often Midokalm.
Massage. Together with exercises for muscle stretching, it helps to relieve painful tone, and also improves vascular trophism, accelerates the metabolism of myofibrils. Piriformis massage can be carried out in the form of self-massage, rectal massage, as well as in the form of stretching exercises. How to treat piriformis syndrome, not everyone knows.
Manual therapy. It is an alternative method of alternative medicine. Recently, it has become an increasingly popular method of treating diseases of the spine and muscles. Manual therapy is carried out by an osteopathic doctor, the choice of which must be approached very, very carefully.
Physiotherapeutic treatment of piriformis syndrome. The most popular physiotherapeutic procedures with a good warming effect are: electrophoresis, phonophoresis, amplipulse and UHF.
Reflexology. This group of methods also relates to alternative methods of treatment of many diseases. It combines the methods of ancient Eastern medicine and the modern practice of treating muscular-inflammatory diseases. In general, reflexology is a unifying concept for a number of techniques: acupuncture, blockade, work with active points, massaging of a point-linear nature, laser and pulse therapy, etc.
LFK (Therapeutic exercise). There are a number of therapeutic exercises for piriformis syndrome that help to cope with pain symptoms and help normalize the general condition of the body during the inflammatory process of the muscle. They should not cause pain.
Wearing special corrective clothing and shoes: orthopedic insoles, special underlay for buttocks, etc.
Recently, a combination of both medical methods of treatment for the removal of acute pain syndromes and physical therapy and general health practices with preventive purposes is considered popular and effective.
Piriformis Syndrome - Home Treatment
Various folk rubbing agents have high efficiency:
- Amanita tincture. For its preparation, fresh mushrooms are needed, they are washed and stacked in a jar. To the top, everything is filled with vodka. Insisted week. Compresses are also used for one week.
- Horse chestnut tincture. In 0.5 l of wine alcohol, 50 g of horse chestnut is soaked. The gauze is soaked and applied at night. Continue for ten days.
- Turpentine (1 tbsp. L.) And protein. Everything is mixed, applied to the tissue and applied to the sore spot. Change the bandage twice a day.
- Horseradish ointment - the root is rubbed, 2 tbsp. l root mixed with 1 tbsp. l honey. It is applied on cheesecloth and applied for four hours.
We examined the symptoms and treatment of piriformis syndrome.