Suggested Subtitle: #PiriformisSyndrome is a rare neuromuscular condition impacting about 6% of low #BackPain patients.
The piriformis muscle is located in one’s buttocks, near the hip joint, and is important because it helps to stabilize that joint when one walks. The piriformis muscle starts at the lower spine and connects to the top of each femur bone. The muscle assists in rotating the hip and turning the leg and foot outward. One’s sciatic nerve passes under the piriformis muscle; a small percentage of the population may have the sciatic nerve running through the muscle. When a person is experiencing Piriformis Syndrome they will likely experience chronic and intense pain mimicking sciatica, as the muscle is compressing the sciatic nerve.
Piriformis Syndrome is hard to diagnose because it is not something that will show up on scans such as MRIs, CT scans, or X-rays.
There is no definitive medical test that indicates Piriformis Syndrome. Additionally, because it isn’t very common, many doctors simply aren’t looking for it. In March of 2015, Hal David Martin, Manoj Reddy, and Juan Go ́mez-Hoyos proposed that Deep Gluteal Syndrome is a more appropriate terminology for the condition, as there are many structures capable of causing sciatic nerve entrapment in the gluteal space and the piriformis muscle is just one.
Suggested Header No. 1: How is Piriformis Syndrome Diagnosed?
It can be difficult to diagnose Piriformis Syndrome because it cannot be found through traditional tests such as MRI and CT scans. Much of the diagnostic process for Piriformis Syndrome involves ruling out other potential causes of the pain, such as lumbar spine irregularities or injuries. The diagnostic process depends on a review of the patient’s medical history, knowledge of spinal health and abnormalities, and patient reports of pain and other symptoms.
Treatment and diagnoses in Western Medicine, for any medical condition or disease, are based largely on objective measures such as bloodwork, labs, and traditional diagnostic imaging and physical examination(s.) Pain, however, is subjective, and every patient will experience pain differently. Therefore, treatment of pain depends on medical personnel viewing the patient as a credible reporter of their own pain. This can put the patient at odds or in conflict with the caregivers who are charged with their treatment.
Many patients experiencing Piriformis Syndrome will benefit from nonoperative treatment such as physical therapy, anti-inflammatory medications, and local steroidal injections. However, there is a small subset of patients for whom nonoperative measures will not be successful, and the patient will require a surgical decompression of the sciatic nerve. There are instances where a patient who receives surgical decompression develops scar tissue around the sciatic nerve; scar tissue can contribute to continued symptoms, and in such cases, the scar tissue may also need to be removed surgically.
Suggested Header No. 2: Piriformis Syndrome and Lumbar Spine Pain
It has been nearly one year since I began experiencing debilitating lower back and leg and foot pain that I now know to be Piriformis Syndrome.
In a period of 7.5 months, I saw five physicians and specialists. I started with my general practitioner, was referred to a total of three orthopedic surgical specialists, then came a pain management specialist and anesthesiologist, and in the midst of it all, one emergency physician who saw me for a total of nine minutes. I was charged over $900 in copays for the privilege of that nine minutes.
I was told repeatedly that the symptoms I was describing and the pain levels I was claiming to experience were not justifiable. My MRI scans and X-rays showed moderate #DegenerativeDiscDisease, four bulging/herniated discs in my lumbar spine, and #Osteoarthritis in my spinal column but no one could see what was happening in my gluteus muscles. I was told time and again that I simply couldn’t be experiencing things like numbness in my left leg and #ChronicPain reaching a 10 on a 1-10 pain scale. I couldn’t find any relief for the pain, not spinal injections or a myriad of medications, and I was in just as much pain laying down as I was sitting up or standing.
Finally, after nearly 8 months, I was referred to a pain intervention specialist at a local hospital’s neurology clinic who listened and believed me. After a set of sacroiliac joint injections failed to provide relief, and in consideration of my health history and other symptoms such as numbness and tingling in my left leg and foot, I was diagnosed with Piriformis Syndrome. After working with my pain interventionist for two months we had a diagnosis that hadn’t been reached in the previous months by five physicians and specialists. I believe the key difference in treatment was that my newest doctor trusted me to be an accurate reporter of my own pain and symptoms where the others had not.
I have had three sets of local steroidal injections into my piriformis muscle, to date. I’ve received a great amount of relief from these injections, enough so that I am able to walk unassisted, drive myself to various appointments and treatment centers, and participate in water aerobics and muscle training sessions as part of my continued rehabilitation. However, after twelve months, I am still unable to work outside of the home or even to work full time from home. My pain interventionist and I have a wonderful relationship and communicate quite well. He openly admitted to me in April of this year that he’s just not sure what to do for me, long-term. That’s what it is like to have a rare medical condition.
My physician and I had hoped that because I had such success with my first round of steroidal injections that physical therapy and continued rehab would resolve my pain, at least mostly. However, the longest period of relief I have experienced is about six weeks, the shortest just two or three weeks. Due to high out-of-pocket costs and increased risk of infection and scar tissue, local injections are not a suitable long-term solution. I am currently awaiting an appointment with an orthopedic/hip specialist and surgeon at Vanderbilt Hospital in Nashville, Tennessee. The goal of the appointment is an assessment of whether or not a Piriformis Release or Decompression Procedure may be the right next step for me.
Suggested Heading No. 3: Living with Piriformis Syndrome
I encourage anyone experiencing chronic pain and symptoms such as I have described here to explore the possibility of a Piriformis Syndrome or Deep Gluteal Syndrome diagnosis with your physician. If you experience that your doctor(s) simply won’t listen to you, know that you are not alone, especially if you are a woman.
A legal study conducted by Diane E. Hoffman and Anita J. Tarzian, “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” found that women are more likely to suffer from Chronic Pain syndromes and diseases associated with pain than men and that, contrary to popular assumptions, women are more sensitive to pain than men. The study also reported that, statistically, women’s reports of pain are taken much less seriously than complaints from men. Finally, the study found that women are more likely to have their pain discounted by medical professionals as ’emotional,’ or ‘psychogenic.’
It is interesting to note that Dr. Axe: Food is Medicine reports that women are six times more likely to have Piriformis Syndrome than men. Other risk factors include but are not limited to: being overweight/obese, a history of sciatic nerve pain, bulging discs, or other spinal problems, and having an anatomical abnormality in the piriformis muscle such as was referenced in the opening paragraph of this article.
We, as patients, are our own best advocates. If you feel that your physician is not treating you well, not hearing you in regard to your pain and other symptoms, request a referral to another physician; do it again and again until you find the right one. We all deserve the best quality of life afforded to us and just because we don’t fit into any particular medical checkbox doesn’t mean we aren’t experiencing real symptoms and legitimately debilitating pain.