Periformice syndrome....Advise please

[Guest ctMTBer]

Anyone else here suffers from this?

Anyone had the injection done in Cape Town area?

 

I have struggled with this for 2 years now and stretching and physio does help, but whenever I give it a bit of a workover or go aero (as much as I can ) on the bike I get this pain in the "ass"

Sometimes it grabs the Sciatic nerve and I get the hamstring pain and some ITB pain....but the moment it relaxes the Hammy and ITB pain is GONE...So I am sure it is not ITB.

 

I read that they can do an injection, and I really want to give it a go.

[Escapee..]

What kind of injection?

 

I know that you can get a steroid injection, but thats usually for SI joint issues

Edited October 30, 2012 by Escapee..

[Guest ctMTBer]

I read that they can inject either local anaesthetic or Botox to paralyze the muscle....and that then stops it from rubbing on the nerve

[curah]

Firstly, are you sure that it is a Piriformis Syndrome?

 

Piriformis Syndrome is caused by the Piriformis muscle being in spasm and catches/traps the Sciatic nerve.

It usually starts with a dull pain that runs down the back of the leg, hamstring and also calve muscle.

It can feel like a dull pain or lack of sensation when it is just starting.

It develops to feel like as though your Hamstring or calf muscle gets weaker with increased exercise.

I have not up to date seen a Piriformis entrapment that primary causes ITB pain.

 

Piriformis Syndrome is caused by weakness or muscle inbalance of your Gluts.

If the Gluteus Medius is weak( a primary stabilizer of the hip) the hip rotators (incl Piriformis) go into spasm to compensate for it.

This muscle spasm is what causes the entrapment.

 

Physio needs to obviously loosen the spasm and tissue that can cause it, but you will need to do rehab exercises to strengthen the muscle.

Good core stability also plays a big role.

Part of your treatment should be neural stretches to help the nerve release through the muscle.

 

The ITB is also affected by weak Gluteus Medius. there are three muscle implanting on the ITB and if the front muscle is stronger, it pulls the ITB more on the front portion of the band and causes ITB syndrome. ITB is treated by loosen the ITB and in this case I advise to use that foam roller in the gym a lot and strengthen the Gluteus Medius.

 

To avoid the nerve trapping during the day, rather sit on a pillow underneath your Hamstring almost keeping you buttocks slightly suspended in the air. The will take some pressure of the muscle and less pressure on the sciatic nerve.

 

I would recoomend seeing a physio specializing in sport injuries and with either SPT1 or OMT1 qualification.

she might give you good strengthen exercises.

Otherwise consult a biokineticis for exercises as well.

 

However, you will need to exclude your back. The position that you are experiencing pain can be causes by a bulging disc in your back. It will start with buttocks pain and radiate pain down the leg.

A good physio will need to 1st exclude your back as the cause before only treating the Piriformis syndrome.

Ever done a X-Ray for your back?

Also, if your pelvis is asymmetrical it causes an imbalance in the gluteal muscles and will also affect muscles up and down.

 

Cortisone will only release the inflammation on the nerve and might release the muscle, but in my opinion will be short lived...

 

In a very small group of the population, the Sciatic nerve actually splits in two during development phase, before you are born, and can actually run through the Piriformis muscle. In these cases it is usually operated on.

 

1. Consult Good physio

2. Do X-Ray for back as well and test for disc

3. See othopeadic surgeon

[Wet Ears]

_{Curah are you a physio?}

[curah]

Yes

[Guest ctMTBer]

Firstly, are you sure that it is a Piriformis Syndrome?

 

Piriformis Syndrome is caused by the Piriformis muscle being in spasm and catches/traps the Sciatic nerve.

It usually starts with a dull pain that runs down the back of the leg, hamstring and also calve muscle.

It can feel like a dull pain or lack of sensation when it is just starting.

It develops to feel like as though your Hamstring or calf muscle gets weaker with increased exercise.

I have not up to date seen a Piriformis entrapment that primary causes ITB pain.

 

Piriformis Syndrome is caused by weakness or muscle inbalance of your Gluts.

If the Gluteus Medius is weak( a primary stabilizer of the hip) the hip rotators (incl Piriformis) go into spasm to compensate for it.

This muscle spasm is what causes the entrapment.

 

 

This is excatly what I experience

 

In the last MRI they notice that my Sciatic nerve run through the Periformice....

 

Had a disctectomy done years ago and I am 100% sure that it is NOT trapped in my back.

 

Been doning the neural "flossing" and it help until the next morning when the periformice grabs again.

[Andymann]

+100 to curah - I had exactly the same, and was told by various people I needed injections, operations, no running, no cycling etc, etc Went on for almost a year of Physio, Acupuncture, posture correction, sciatic stretching, flossing sitting on a ball, blah blah blah - at which point I had lost most of the sensation on the outside of my calf and foot. Eventually found a really good biokinetikist who helped me with a 6 week run of pure core exercises and proper stretching. By the third week I knew we had pinpointed the problem, and by week 6 I had zero pain, a core and hip flexor muscles I didnt think existed and my time over a 10km run had reduced by 4mins.....

[curah]

This is excatly what I experience

 

In the last MRI they notice that my Sciatic nerve run through the Periformice....

 

Had a disctectomy done years ago and I am 100% sure that it is NOT trapped in my back.

 

Been doning the neural "flossing" and it help until the next morning when the periformice grabs again.

 

Have you consulted an orthopedic surgeon specializing in Hip Problems?

Between him and possibly a neurosurgeon can release it.

[Guest ctMTBer]

Have you consulted an orthopedic surgeon specializing in Hip Problems?

Between him and possibly a neurosurgeon can release it.

 

I dont want to waste time and money going to the surgeon again....I want to just go straight to someone who can do the injection and then I can do the streatches again etc. But at the moment I can not do much

[curah]

I dont want to waste time and money going to the surgeon again....I want to just go straight to someone who can do the injection and then I can do the streatches again etc. But at the moment I can not do much

 

i would get the operation done so it releases. Will take you off cycling for a while, but at least a more permanent solution.

Usually best to have it injected under sonar ensuring that they don't prick/pierce the nerve during infiltration.

Again, consult an orthopedic surgeon specializing in hips, he can refer you for injection with the sonographer and have your details on record when you do decide to do further intervention measures

[Guest ctMTBer]

i would get the operation done so it releases. Will take you off cycling for a while, but at least a more permanent solution.

Usually best to have it injected under sonar ensuring that they don't prick/pierce the nerve during infiltration.

Again, consult an orthopedic surgeon specializing in hips, he can refer you for injection with the sonographer and have your details on record when you do decide to do further intervention measures

 

Thanks very much for the info. I heard once that the periformice gives blood to the ball in the hip joint....and cutting it can cause the ball to die.....?

[curah]

No, and they only release the nerve inside the muscle.They don't cut the muscle off.

Speak to your surgeon to explain as well.

[Guest ctMTBer]

No, and they only release the nerve inside the muscle.They don't cut the muscle off.

Speak to your surgeon to explain as well.

 

Thanks very much now to find the right surgeon. I had a neuro surgeon do the disctectomy last time....i will go see him again