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 MAY 22, 2002 A Pain in the Butt -- Piriformis Syndrome More than 2 million Americans suffer from a little known version of sciatica called piriformis syndrome that's often misdiagnosed and improperly treated. Most patients suffer pain for months or years before getting the proper diagnosis. People may be told that they have disk disease in the spine or gynecological problems, and undergo unnecessary and costly tests, including computerized imaging scans. The piriformis (meaning "pear-shaped") muscle is located deep in the buttock. At its widest, it attaches to the flat bone at the base of the spine just above the tail bone. It continues across the buttock and at its narrow point attaches to the head of the thighbone. Its main job is to rotate the hip when you turn your leg outward and up to the side. When the sciatic nerve, which passes under and through the piriformis muscle, becomes entrapped or inflamed, that causes piriformis syndrome. Pain in the upper buttock radiates down the thigh and sometimes to the lower leg, lower back, and groin. Common Causes The most common causes of piriformis problems are hours of prolonged sitting, such as working at a computer or driving long distances; activities that involve twisting or rotating the torso, such as serving a tennis ball; and trauma caused by a fall onto the buttock. Men who carry a fat wallet in their back pants pocket can also experience the syndrome, which can happen to almost anyone regardless of age, weight, sex, or physical fitness. Easy to Diagnose Once you know what to look for, the condition is easy to diagnose, either through a simple clinical exam or by using an electronic test that measures the speed of messages transmitted along the sciatic nerve. "If your pain becomes worse when you sit or press on the buttock, you may very well have piriformis syndrome," says Loren Fishman, MD, physical medicine and rehabilitation specialist at Columbia University in New York. He invented the test for piriformis syndrome "out of frustration with patients who didn't have herniated disks, but certainly had pain," Fishman says. Simple Stretches He also has developed a simple exercise program that stretches the piriformis muscle. Using his program, two-thirds of his patients feel 65% better within three months. First, he uses ultrasound to heat the muscle for 10 minutes and to stretch it slightly. Then, a physical therapist applies pressure to the muscle for 10 minutes using fingers, the heel of the hand, or the elbow. Home exercises may also help you stretch the piriformis muscle, but Fishman cautions against self-treatment until potential skeletal defects are ruled out. Patients often receive anti-inflammatory medication, and some receive injections directly into the muscle to relieve pain. For those who fail conservative treatment, surgery allows three-quarters of them to feel 65% better. Home Exercises 1. Sit with your right leg completely straight and left knee bent, left foot flat on the floor and next to the right knee. Put your right elbow on the outside part of the left knee and pull the right shoulder forward. Place your left hand on the floor behind your body so that your right chest is coming forward towards your left thigh and your left chest is going back toward the left arm. Rotate your torso around your spine to the left, pressing the outside of the left knee with the right arm. Hold this position for 15-60 seconds. Repeat on the other side to avoid back pain. If you have had back surgery, do not over-rotate your torso. 2. Lie on the right side of a bench or bed with both your right hip and knee flexed to 90 degrees. Bring your left leg forward over the edge of the bench or bed. Holding on with your left hand to avoid falling, bring your torso forward and to the left and dangle your left leg over the edge. Get a good pull on your right (underneath) buttock and thigh. Relax the muscles in the rectum and genitals. Repeat on the other side. This exercise is particularly useful for disabled people who sit a lot, but have limited means of exercising. |
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