A Pain in the Butt

The Star (St. Lucia) - - HEALTH -

Pir­i­formis Syn­drome is a con­di­tion that mim­ics sci­at­ica: pain that ra­di­ates down the sci­atic nerve, usu­ally from the back through the but­tocks and down the leg. It nor­mally af­fects only one side of the body. Quite of­ten the symp­toms of sci­at­ica are caused by a prob­lem in the lum­bar spine, for ex­am­ple a her­ni­ated disc press­ing on the nerve, but an­other cause may be pir­i­formis syn­drome. The pir­i­formis is a small, sta­bil­is­ing mus­cle that sits in the but­tock area and lies just over the sci­atic nerve as it passes down through the but­tock and into the leg.

Usu­ally the main symp­toms are tin­gling and numb­ness in the but­tocks which, in se­vere cases, can travel down the back of the leg all the way to the foot, de­pend­ing on the amount of pres­sure ex­erted onto the nerve. It can be ex­ac­er­bated by driv­ing or sit­ting for long pe­ri­ods, run­ning and even climb­ing the stairs.

The first step to di­ag­no­sis is to rule out other con­di­tions such as arthritic changes in the spine or a her­ni­ated disc that ir­ri­tates the sci­atic nerve as it leaves the spine. In some cases there is ten­der­ness over the pir­i­formis mus­cle but in cases where the tin­gling and numb­ness are se­vere and other neu­ro­log­i­cal symp­toms are present, a health­care provider may sug­gest fur­ther tests, such as an MRI, to rule out se­ri­ous pathol­ogy.

The pir­i­formis is at work through­out the day, dur­ing ac­tiv­ity and at rest. Even turn­ing in bed causes the pir­i­formis to ac­ti­vate. As well as di­rect trauma to the mus­cle, such as a fall or be­ing hit, too much ac­tiv­ity (and some­times not enough) can also re­sult in in­jury to the pir­i­formis. Ac­tiv­i­ties such as run­ning or over-ex­er­cis­ing, lift­ing heavy objects, fre­quently go­ing up and down stairs and even long pe­ri­ods of sit­ting can trig­ger symp­toms. Peo­ple who like to sit for hours on end in front of the TV, or who drive a car over long dis­tances, are par­tic­u­larly at risk.

The fo­cus of treat­ment is to avoid ag­gra­vat­ing fac­tors and re­duce mus­cle spasm. Ice is usu­ally very ef­fec­tive at re­duc­ing pain and mus­cle spasm but in cases where ice is not help­ing, then a heat pack may help to re­lax the mus­cle. Quite of­ten pain may re­solve within a few days but where it lingers and ev­ery­day tasks are difficult, phys­io­ther­apy may help. Your phys­io­ther­a­pist will carry out a full as­sess­ment and phys­i­cal ex­am­i­na­tion to de­ter­mine if there are any other fac­tors which are slow­ing down re­cov­ery. They will an­a­lyse your move­ment, gait (walk­ing pat­tern), flex­i­bil­ity and power. Tight mus­cles can also be be­cause of weak­ness and al­tered move­ment pat­terns. Once a full as­sess­ment has been com­pleted, a treat­ment pro­gramme will be planned based on your prob­lems. Your pro­gramme may in­clude:

• Elec­trother­apy – An ef­fec­tive treat­ment for pain re­lief is a modal­ity known as Tran­scu­ta­neous Nerve Stim­u­la­tion (TENS). This in­volves ap­ply­ing elec­trodes to the skin and emit­ting a sig­nal that in­flu­ences the nerve sig­nals trans­mit­ted to the brain.

• Soft Tis­sue Mo­bil­i­sa­tion – Mas­sage to the pir­i­formis mus­cle and sur­round­ing soft tis­sues can help to re­lax the tis­sues.

• Stretch­ing – If the pir­i­formis mus­cle is tight there are cer­tain stretches that can help re­lieve the mus­cle spasm and tight­ness.

• Strength­en­ing Ex­er­cises – Strength­en­ing the mus­cles around the but­tock, lower back and legs will re­duce the load and will im­prove move­ment pat­terns and ef­fi­ciency of the mus­cles.

• Ice and/or heat – Both of these may help to re­duce pain. Ice is ef­fec­tive in re­duc­ing in­flam­ma­tion and heat pro­motes re­lax­ation to re­duce mus­cle spasm.

Preven­tion is al­ways bet­ter than cure so make sure you do not over­work or strain the mus­cles around the hip. Al­ways warm-up slowly be­fore ex­er­cise. When ex­er­cis­ing, en­sure that you have good pos­ture and are mov­ing cor­rectly. Weak mus­cles of­ten cause us to move in an awk­ward or un­nat­u­ral way which can put stress on the pir­i­formis mus­cle. If your work­out in­cludes run­ning up hills, en­sure that you have strong mus­cles in your legs and core. The best way to achieve these goals is to vary your train­ing rou­tine and al­ways in­clude stretch­ing and strength­en­ing in your weekly pro­gramme.

The ef­fects of Pir­i­formis Syn­drome may re­lieve over a few days but, when pain lingers, phys­io­ther­apy can help.

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