Effective treatment of piriformis syndrome (pain in the butt)
The piriformis muscle (piriformis; “pear-shaped”) is a tiny muscle located deep in the buttocks, below the large gluteal muscles. This small muscle is the best known of a group of muscles known as the “hip rotator cuff” and is often the source of butt pain.
Piriformis syndrome is a miserable condition in which the piriformis muscle becomes too tight. It can be aggravated by bending over, lifting objects, sitting down, playing sports, or even driving (with your foot on the accelerator). Contrary to what your doctor may tell you, there are no drugs or surgery that are effective in treating piriformis syndrome. In over 20 years of practice, I have never seen a person whose Piriformis “release” surgery really worked.
WOMEN ARE MORE PRONE TO SUFFER PIRIFORMI SYNDROME THAN MEN
Piriformis syndrome is an extremely common condition and is much more likely to be found in women than men (12-15 times more often). Although I can only speculate as to the reason for this, I suspect it is a maternity issue. It probably also has to do with the naturally wider shape of a woman’s pelvis. Most likely, this explains why you find it much more often in women than in men, even in women who have not had children.
PIRIFORMIS SYNDROME CAUSES SCIATICA
Piriformis syndrome is a major cause of sciatica (leg pain, numbness, tingling, or weakness), hip pain, and buttock pain. Because sciatica is so frequently involved, it is often misdiagnosed as a herniated disc, herniated disc, or a chronic lower back or sacroiliac problem.
The sciatic nerve is the largest and longest nerve in the body, and at its largest point it is about the thickness of your thumb. The sciatic nerve originates in the lower back (lumbar spine region) and slopes toward the middle of the buttock. It then extends down the leg, passing under the piriformis muscle. Note that in up to half the population, the sciatic nerve travels through the piriformis muscle, passes over the piriformis muscle, or splits in two and passes directly around the piriformis muscle.
WHERE IS PIRIFORMIS PAIN SYNDROME FOUND?
The symptoms of piriformis syndrome usually begin as deep pain in what women like to refer to as the “hip” area. This pain will lie along an imaginary line running from the tip of the buttock cleft to the greater trochanter of the hipbone (the bony bump on the top and outer or side thigh).
CAUSES OF PIRIFORMIS SYNDROME
The people most predisposed to chronic contracture and microscopic scarring of the piriformis muscle are those who wear dirty or inappropriate footwear for their type of foot, those with poor mechanics of the spine or lower extremities, overweight, poor posture, excessive sitting, too much time on concrete, little activity (or sometimes too much exercise) and, of course, most importantly: the simple fact of being a woman.
Due to mechanical stresses causing chronic tightness/contracture, the piriformis muscle can shorten over time. This often results in microscopic scarring of the fascial sheaths that tightly surround the muscle itself. Piriformis syndrome is most commonly worse at rest (sitting or lying down) and is often (but not always) temporarily relieved by moderate activity (particularly walking or stretching).
EFFECTIVELY TREATING PIRIFORMIS SYNDROME
For years, I didn’t really understand why I had such good clinical results with so many cases of buttock/hip pain and sciatica, while other seemingly identical cases were largely unresponsive to chiropractic adjustments. Often these “problem” cases got fantastic short-term results from their adjustment, but these results never seemed to last more than a few days at most (and often no more than a few hours). It wasn’t until I started doing “TISSUE REMODELING” in 2001, that I began to understand what was going on.
Over the past decade I have come to realize that Piriformis Syndrome is literally an “epidemic” in the female part of our society (it’s the #1 Destroy Chronic Pain.com website by far – see the Patient Treatment Diary of our site); with the medical community largely baffled as to what it really is, or how to effectively treat it. Again, medications and surgery are not “effective” treatment for piriformis syndrome. Don’t assume that a “Piriformis Release Surgery” will solve your problems!
PIRIFORMIS SYNDROME AND MICROSCOPIC SCAR TISSUE
If you read my first article “Relation of Chronic Pain to Microscopic Scarring of Collagen-Based Elastic Connective Tissues,” you have at least a cursory understanding of scar tissue. Microscopic scar tissue is normal elastic tissue (think very well-groomed hair here) that has been disrupted from its organized structure. For various reasons, these connective tissues can break apart into a coiled, tangled ball of inflexible, hypersensitive microcartilage (think of a tangle of hair that can’t be combed). This type of microscopic scar tissue is usually not in the muscle itself, but rather in the fascia. Fascia is the thin, but very tough, yellowish-white membranes that cover muscles. In my neck of the Ozarks, deer hunters call these membranes, “Striffin.”
FASCIAL MEMBERSHIPS
Fascia is possibly the most pain sensitive tissue in the body! FASCIAL ADHESION will cause pain and dysfunction. Destroy fascial adhesions and destroy chronic pain!
Because most of these scar tissues are in the fascia and not in the muscle itself, they do not show up on MRI. In my opinion, microscopic scarring of the piriformis muscle is the most common cause of long-lasting, chronic sacroiliac or buttock pain (sacroiliac joints are bony protrusions that lie just above and lateral to the top of the buttock cleft). ). . It is also the most common cause of what for years I have referred to in the office as “butt based” sciatica.
THE FOOT / PIRIFORMIS CONNECTION
If you have arches that are too high or “dropped” arches, or if you have any type of abnormal biomechanics in your lower body; You will probably need arch supports (orthotics). We have some generic orthotics that will work for many people. However, some of you will need custom braces. Let me give you an example:
High arches can greatly contribute to piriformis syndrome. The higher the arch, the more it will be “pushed” toward the outside of your foot. To see what this does to the Piriformis Muscle; Stand up, put your hands on top of your buttocks in the piriformis area. Now, extend your weight to the outside of your feet. Notice how the piriformis muscle instantly tightens like a drum? This is what happens throughout the day if you have high arches. And there is only one company on the planet that I know of that specializes specifically in shoe inserts (orthotics) for people with high arches. “Xtreme Footwerks” by Shawn Eno in Idaho Springs, CO.
