Do you have piriformis syndrome, or is the pain due to something else.
If you have chronic pain in your hip, you may have been told it was piriformis syndrome. As defined by Wikipedia, “Piriformis syndrome is a controversial condition which is believed to result from compression of the sciatic nerve around the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg.[Often symptoms are worsened with sitting or running.”
A patient presented the other day who was a healthcare professional calling the pain piriformis syndrome. Her symptoms included chronic pain in the buttock and leg pain of three months duration that worsened while bowling. She treated it with constant stretching as recommended by a physical therapist friend which did not help, acupuncture which helped reduce the intensity of pain and massage which she believed aggravated the condition. Upon digging deeper for some more information, she mentioned that she had chronic pain in the shoulder blade years before the condition developed on the same side as her hip pain. Based on her history, it was suggested to her that the problem is likely the other side since treatment so far had failed to improve the condition. I also noted that when she sat speaking with me, her shoulders rolled in which is a common compensation to flat feet.
Our evaluation revealed that she had foot overpronation on the left side causing her foot to fall in and resulting in her right hip being markedly lower. I also noted that when standing, her pelvis was torqued, and ranges of motion in the hips were restricted, especially in rotation and lateral bending to the right. She needed to grab onto the table while performing a squat since she felt unstable and her neck rotation was restricted to the right, something she was unaware of. She looked very similar to this example on the left side while she was standing.
I explained that her problem was most likely developmental and present at the age of 6 however, she was unaware of it until recently. The shoulder blade pain was her warning of things to come.
It is quite common for people to have preexisting postural problems that they were unaware of because they were not causing discomfort. Patients are often surprised and at times refuse to believe it, even though it is an objective finding.
Piriformis syndrome or a body style and gait related issue?
Conventional approaches failed because they treated the pain, rather than the mechanism behind it. Conventional wisdom on piriformis syndrome suggests that the muscle will go into spasm and needs to be treated, however, if a more thorough evaluation of the person is performed, the provider will see a very different clinical picture which should alter treatment markedly.
The evaluation showed that she had an asymmetrical body style and that the myofascia which is the connective tissue that surrounded her core and her body musculature had simply adapted and tightened, worsening the condition, resulting in right hip strain. The tight core muscles also pulled her shoulders forward which was evident upon my initial consultation with her, and was likely the mechanism behind her chronic shoulder blade pain As I performed myofascial release to the fascia surrounding her abdominal muscles, she noticed the tension on her shoulders as she lifted her arms up. It was also noted that her left leg was tight but the typical compensation as discussed in the book Cheating Mother Nature, what you need to know to beat chronic pain was apparent since her right lateral leg fascia was tight restricting proper right ankle function and also straining the hip and the knee on the symptomatic side.
The symptoms surrounding what she was referring to as piriformis syndrome were in response to her body mechanics and the adaptive response causing tight myofascia, and the piriformis itself was not tight, however the gluteal muscles on that side were sore and tender.
She said that she had foot orthotics that she made for herself which is important as part of the treatment approach to improve her gait and level her hips. It was my suspicion that the orthotics either were not being worn or were under corrective, as she experienced some relief when her feet were taped in neutral and her squat mechanics improved markedly with just the tape on her feet alone, we well as her ability to move her neck.
Post treatment, she noticed she still had some discomfort in the right lower back but the right hip felt different. She also noticed she was able to squat better and that the ranges of motion had improved in her neck. A condition such as this requires a number of visits to improve overall mobility and to strengthen deconditioned areas.
Hip pain requires a holistic comprehensive approach to succeed.
- A chiropractor is most likely to take a comprehensive approach to the problem. The approach should include the following to get the best results including
- Myofascial release treatment
- Foot orthotics
- Manipulation of the spine and extremities
- Corrective exercises.
Seeing a chiropractor first has advantages since you may be able to see this one practitioner who will resolve the mechanism of pain, rather than try to treat the pain. To further understand body mechanics, it can be helpful to read the book Cheating Mother Nature, what you need to know to beat chronic pain, which is available on Amazon.com.