Lumbar Hernia or Piriformis Syndrome?

Sciatica is pain that starts in the buttocks and spreads through the leg. The most common cause is inflammation or compression of the nerve roots in the lower back. Lumbar hernia or lumbar calcification problems can damage the nerve roots and cause sciatic pain. Piriformis syndrome is another condition that can cause sciatic pain.

The piriformis is a muscle that starts from the front of the rump (sacrum) bone between the two pelvis bones and extends to the thigh (femur) bone. The piriformis muscle helps rotate the hip. When the hip is straight, it rotates and when the hip is bent, it makes an outward movement. The sciatic nerve can run alongside or through the muscle. In piriformis muscle spasm, the sciatic nerve can be compressed and cause complaints. This is called piriformis syndrome.

Piriformis Syndrome Symptoms

The main symptom of piriformis syndrome is sciatic pain. There may be symptoms such as numbness and tingling sensation that starts from the buttocks and spreads along the back of the leg, tenderness in the thigh muscles, inability to sit comfortably, the discomfort increases as the sitting time increases, and the pain in the buttock and leg worsens with movement. As the problem worsens, activities such as sitting at a computer, driving a car, or doing household chores, even for a short time, may be restricted.

What Causes Piriformis Syndrome?

The piriformis muscle is active throughout the day. It works constantly when walking, turning the hips, changing the weight from side to side while sitting. The muscle becomes vulnerable to injury by over-exercising or, on the contrary, being inactive for a long time. Sitting for a long time, running, climbing stairs, carrying heavy objects, and excessive exercise for the leg muscles can lead to piriformis syndrome.

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The piriformis muscle can also be damaged by sudden rotation of the hip, falling, direct impact during sports, traffic accident or sharp-piercing injuries.

How Is It Diagnosed?

You should see a physical therapist for complaints of pain or numbness in the buttocks and legs that persist for more than a few weeks. After listening to your complaints, the doctor will ask about the risk factors, possible initiating causes and the nature of the pain. A physical examination is then performed. In the examination, waist and hip movements are checked, muscle strength, sensation and reflexes are evaluated. With some special actions, it is checked whether the complaints have increased. Computed tomography or MRI (MR) imaging may be required to examine other possible causes such as herniated disc or lumbar calcification. Ultrasound imaging of the piriformis muscle can aid in diagnosis.

There is no specific test for the diagnosis of piriformis syndrome. Medical history and physical examination are the basis for diagnosis. If other possible causes such as herniated disc or narrowing of the waist canal are not detected by imaging methods, the diagnosis of piriformis syndrome comes to the fore. A person can also have both herniated disc and piriformis syndrome. In this case, diagnosis becomes difficult.

Piriformis Syndrome Treatment

Mild problems may not require specific treatment. Rest and avoiding activities that increase pain may be sufficient. Alternately applying cold and hot to the buttocks can reduce complaints. You can try to heat it for 15 minutes with an ice tray wrapped in a thin cloth, then for 15 minutes with a covered hot water bag, every 2-3 hours, for a few days. Simple pain relievers can also be used.

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If results cannot be obtained with these simple methods, physical therapy can be performed. TENS, deep heating treatments and exercises are applied in physical therapy. Exercises should be done to increase the flexibility and strength of the piriformis muscle.

One of the exercises you can do yourself for piriformis syndrome is this: Lie on your back with your knees bent at approximately 90 degrees. Lift your left ankle and place it on your right knee. Then gently pull your right knee towards your chest and hold it there for 5 seconds. Return to the starting position and repeat for the other side.

If the complaints do not benefit from physical therapy, local anesthetic and corticosteroid injections (injections) can be performed to reduce muscle inflammation. Botulinum toxin A injection, which has muscle relaxant properties, is also one of the options.

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