Piriformis Syndrome: Quick Release from Back Pain

Piriformis syndrome is also called as back pain. It is caused by pinched muscles in your back. You can get rid of that pain by freeing up those muscles rather than having someone cutting into you. Here's how to free up your back muscles to get rid of your back pain:

Back: (do while sitting)

Place your left hand on your left leg next to your body. Place your right hand over your left shoulder, fingers over the back and the palm in the front and firmly pull down on them and hold. After 30 seconds slowly lower your body forward and to the outside of your left leg, keeping your left arm fairly straight as you do.

When you reach your lap remain there for another 10 seconds, release the pressure but rest there for another 30 seconds. Then reverse your hand positions and do your right side.

For best results relax your body first by taking a deep breath and exhaling then remain this relaxed.

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Piriformis Stretch for a Knee Replacement

Knee replacement is a very successful surgical technique that can alleviate knee pain and problems for many people. Stretching exercises, including piriformis stretches, are an important part of any rehabilitation program following knee replacement surgery because they keep your joints flexible and alleviate stiffness. These stretches are also useful if you suffer from piriformis syndrome, a condition that causes sciatic pain because of inflammation of the piriformis muscle. Consult your doctor or physical therapist before beginning a stretching program.

Supine Piriformis Stretch
Lie on the floor with your legs stretched straight out and your arms relaxed by your sides. Bend your right knee into your chest, holding the right shin with your hands. Bring the knee as close as you can into your chest without pain or strain. Hold the stretch for a few breaths. Repeat this stretch on the opposite leg.

Modified Standing Piriformis Stretch
For this stretch, you may need to hold on to a chair or table for support, especially if you do not feel steady in your knees. Do not perform this stretch if you doubt your ability to balance. Stand with your legs straight and your arms relaxed by your sides. Hold the chair with your right hand and bend your left knee, bringing it in to your stomach. Hold the left shin or knee, whichever is easier for you, with your left hand. Feel the stretch along the buttocks and the back of your thighs. Repeat on the opposite leg.

Thigh Cross
This stretch works on your piriformis muscle as well as your adductor muscles, located in your hips and thighs. Sit on a sturdy surface. Cross your left calf over your right thigh. Gently press down on the inner part of your left thigh with your right hand to help open up the hip joint. Bend forward from your hip joint, keeping you back straight and your head and neck in line with your spine. Bend only as far as you can without strain or pain. Place your hands on the arms of your chair or on your thighs for support. Hold the stretch for several breaths. Repeat on the opposite side.

Lying Twist
Lie on the floor with your legs straight. Relax your arms next to your body. Relax your jaw and facial muscles. Bend your right knee into your chest. Bring the knee across to the left side of your body, twisting your body from your rib cage area to bring the knee to rest on the floor. Use your hand to help the knee to the floor. If the stretch is too intense, bring your knee across your body only as far as is comfortable for you. Look over your right shoulder. Hold the stretch for a few seconds. Repeat on the opposite side.

Article source: Livestrong.com

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Piriformis Syndrome After Hiking

The piriformis muscle is a small muscle which sits deep in the buttocks over the sciatic nerve. It’s action is to rotate the hip out (external rotation) and extend the thigh back. When the piriformis is tight, is in spasm or on stretch, it irritates the sciatic nerve, which send pain down the back of the thigh or into the back.

When the foot pronates (rolls in), it causes the leg and knee to rotate in (internal rotation), which causes the hip to rotate in (internal rotation). This places tension on the piriformis muscle, which will then irritate the sciatic nerve. Those with tight hamstrings and tight calf muscles will have more pronation, which causes more internal rotation and stress on the piriformis muscle. The tight hamstrings also place abnormal forces on the pelvis, which increases the stress on the piriformis muscle as well.

HikingOn a hike yesterday, someone with piriformis syndrome was complaining of pain when walking uphill. The pain was in the center of the left buttock and was a deep burning pain which occurred with hill climbing and walking on uneven terrain. Both of these activities will increase the amount of pronation in the feet, increase the internal rotation at the hip, stress the piriformis and irritate the sciatic nerve. When I asked if he had placed his orthotics in his hiking boots, the answer was no. Rigid prefabricated orthotics or custom made orthotics can be very helpful for not only foot problems, but also for knee, hip and back problems because they control the amount of internal rotation at the leg, knee and hip.

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Physiotherapists Treat Piriformis Syndrome

Piriformis Syndrome

There are numerous treatments for piriformis syndrome but none are scientifically valid, particularly as accurate diagnosis is not clear. Physiotherapists concentrate on finding physical signs such as a tight piriformis, tight hip external rotators and adductors, weakness of the hip abductors, stiffness of the sacro-iliac joint and lumbar spine problems. The patient may walk with the hip externally rotated, have an apparent leg shortening and a shortened stride.

There may be tightness in the hip and piriformis muscles and in these cases the physiotherapist will start a programme of muscle stretches after warming up the hip muscles. Piriformis stretches are taught in lying, the hip positioned in 90 degrees, stretching the thigh over the other leg and pulling it with the other hand. The patient will need to follow a home exercise programme of muscle stretches, up to every few hours in cases of an acute nature. Stretching the piriformis may not be appropriate if the muscle is loose or stretched, in which case muscle strengthening and stretching of the opposing stiff areas is used.

Local manipulation is a common treatment directly over the most painful point in the buttock, which can be very tender indeed. Transverse or longitudinal mobilisations over the muscle is the technique used, maintaining the pressure steadily for up to 10 minutes initially. Treatment of the back and sacro-iliac joints is important to address any dysfunction which might contribute. Modifying posture and activity, muscle injections, mobilisations and stretching are commonly successful in reducing symptoms. In resistant cases surgery to the muscle or the tendon at the greater trochanter may be contemplated.

Piriformis Syndrome

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What Causes Piriformis Syndrome? (Piriformis Syndrome)

Piriformis Syndrome

Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors):

Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:

■ Exercising on hard surfaces, like concrete;
■ Exercising on uneven ground;
■ Beginning an exercise program after a long lay-off period;
■ Increasing exercise intensity or duration too quickly;
■ Exercising in worn out or ill fitting shoes; and
■ Sitting for long periods of time.

Biomechanical Inefficiencies:
The major biomechanical inefficiencies contributing to piriformis syndrome are faulty foot and body mechanics, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:

■ Poor running or walking mechanics;
■ Tight, stiff muscles in the lower back, hips and buttocks;
■ Running or walking with your toes pointed out.

Source: www.thestretchinghandbook.com

Piriformis Syndrome

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Back Pain Treatment - Self Care at Home (Piriformis Syndrome)

Piriformis Syndrome

General recommendations are to resume normal, or near normal, activity as soon as possible. Stretching or activities that place additional strain on the back are discouraged, however.

1) Sleeping with a pillow between the knees while lying on one side may increase comfort. Some doctors recommend lying on your back with a pillow under your knees.

2) No specific back exercises were found that improved pain or increased functional ability in people with acute back pain. Exercise, however, may be useful for people with chronic back pain to help them return to normal activities and work.

3) Most experts agree that prolonged bed rest is associated with a longer recovery period. Further, people on bed rest are more likely to develop depression, blood clots in the leg, and decreased muscle tone. Very few experts recommend more than a 48-hour period of decreased activity or bed rest. In other words, get up and get moving to the extent you can.

Piriformis Syndrome

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Back Pain Overview (Piriformis Syndrome)

Piriformis Syndrome

Back pain in the lower back or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Up to 50% will have more than one episode. Low back pain is not a specific disease. Rather, it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified.

• 

  Back Pain

  Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor's office or a hospital's emergency department.
• For 90% of people, even those with nerve root irritation, their symptoms will improve within 2 months, no matter what treatment is used-even if no treatment is given.
• Doctors usually refer to back pain as acute if it has been present for less than a month and chronic if it lasts for a longer period of time.

Article Source : www.emedicinehealth.com

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Massage Therapy and Bodywork for Piriformis Syndrome

Piriformis Syndrome

There are a number of causes for Piriformis Syndrome including direct blunt trauma to the buttocks, prolonged sitting while working or driving, Morton's foot, or S-I Joint instability. Frequent or prolonged running on canted surfaces and participation in sports requiring quick lateral movement such as tennis, skiing, and basketball may also overstress the piriformis muscle and lead to Piriformis Syndrome.

Massage Therapy

There are many ways that massage therapy and bodywork can be used to treat Piriformis Syndrome. The massage therapist will employ a number of techniques to relieve the condition. For example the massage therapist may use Neuromuscular Therapy or Trigger Point Therapy to eliminate myofascial trigger points in the piriformis muscle. The massage therapist could also use Myofascial Release techniques or Deep Tissue Massage techniques to release adhesions between the piriformis muscle and surrounding tissues while also using Muscle Energy Techniques to gently lengthen the piriformis muscle. Piriformis Syndrome also responds well to positional release therapies such as Ortho-Bionomy which work with the body's nervous system to release muscles and improve joint movement in the area. In addition to working on the piriformis muscle it may be necessary to provide therapy for other muscles near piriformis and even to muscles opposing piriformis to improve muscular balance. Comprehensive treatment with massage and bodywork, in conjunction with a home program of stretching and exercise, usually helps to completely resolve Piriformis Syndrome.

Piriformis Syndrome

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Piriformis Stretch (Piriformis Syndrome)

Piriformis Syndrome

If you are seeking a good stretch for the deep muscles in the outer hip and gluteus region including the piriformis, perform the following stretch with each of your workouts either at the beginning (the active version) in your warm-up or at the end (the static version) as part of a relaxing cool down. This stretch is particularly helpful for hikers, mountaineers, climbers, runners and skiers.


To stretch your right hip, start in quadruped position on hands and knees. Bring your right ankle in to rest directly behind the bend in your left knee, keeping right angles to both knees. Move your right hand off farther to the right and hold onto the right foot with your left hand so you can add more resistance to the stretch. Simultaneously shift both hips and shoulders smoothly to the right until you feel a stretch in the outer part of your right hip and down the outer portion of the thigh. Avoid lateral flexion or rotation of the pelvis or trunk. Reverse and repeat for left hip. To include in an active warm-up, perform rhythmically, shifting hips right and left and holding for a second or two in the stretched position 8-10 times. For a static stretch as part of a cool down, hold end position for 20-30 seconds before repeating on the other side.

Piriformis Syndrome

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Piriformis Muscle (Piriformis Syndrome)

Piriformis Syndrome

The piriformis muscle begins inside the pelvis. It connects to the sacrum, the triangular-shaped bone that sits between the pelvic bones at the base of the spine. The connection of the sacrum to the pelvis bones forms the sacroiliac joint. There is one sacroiliac joint on the left and one on the right of the low back. The other end of the piriformis muscle connects to the greater trochanter, the bump of bone on the top side of your hip.

The piriformis muscle is one of the external rotators of the hip and leg. This means that as the muscle works, it helps to turn the foot and leg outward. Problems in the piriformis muscle can cause problems with the sciatic nerve. This is because the sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis. The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica.

Piriformis Syndrome

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Treatment and Prevention of Piriformis Syndrome (Piriformis Syndrome)

Piriformis Syndrome

Treatment of Piriformis Syndrome

The RICER regimen should be implemented for at least the first 48 to 72 hours after injury.

After diagnosis, treatment will be started and an ice pack or ice massage may help reduce inflammation.

Rest is usually recommended and, at least, a two or three week break from all sports or activities that cause pain.

Anti-inflammatory medications like ibuprophen and naproxen are helpful in treating the pain and inflammation caused by the nerve irritation.

Corticosteroid injections with an anesthetic medication may be injected into the piriformis muscle.

Oral cortisone may also be prescribed to reduce the sciatic nerve inflammation.

Heat Packs ease muscle spasms and reduce the inflammation.

TENS is helpful and, sometimes, a low voltage current to the area is combined with a cold application.

Ultra-sound Treatments provide deep heating and are ideal preparation for deep massage.

Deep massage and specialized soft tissue mobilization may be useful.

Custom foot orthotics can help with both treatment and prevention. Gait correction can reduce the use of the piriformis muscle, allowing the muscle to relax and begin to heal.

A Botox injection may be used which actually paralyzes the piriformis muscle, causing it to relax, taking pressure off the sciatic nerve. Both types A and B botulinum toxin have been used.

The injection is done using either Ultra-sound or a CAT 9 (computerized axial tomography) for guidance. Both toxins are effective and pain relief usually lasts for more than 3 months.

During this time, a stretching program may be started which may correct the problem.

Prevention of Piriformis Syndrome

The more you can do to prevent this syndrome, the better off you will be. The most important things to remember are:

A thorough and correct warm-up to prepare the muscles and tendons for activity. Without a warm-up, muscles are stiff and there is reduced blood flow to the hip area, making it more injury-prone.

Let muscles rest and recover after any strenuous activity.

Strengthening and conditioning the muscles of the hips, buttocks, lower back will help prevent this disorder.

Keep muscles and tendons supple and flexible through a structured stretching routine.

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The solution to Piriformis Syndrome (Piriformis Syndrome)

Piriformis Syndrome

The first thing you need to do when you have Piriformis Syndrome is "think" I know it hard to do when you have pain and stress is building but you have to identify those activities that are putting your self at rick. Those activities that are repetitive and over developing some muscle groups and do not address others.

In some cases you will have to stop exercising or at least stop doing the same exercises everyday, one example is if you treadmill everyday try walking backwards on it, go slow and hold on but changing the activity will stop the over development and help minimize the imbalances.

The action plan you come up with will need to have a whole body assessment phase looking for muscle imbalance and postural dysfunctions as the base of your recovery you should not even start or even try to do a single stretch or exercise before you get assessed, that is why I not giving you a single activity to try. Sorry...

To list some other good treatments for Piriformis Syndrome, you can try Trigger Point therapy if you have Piriformis Syndrome, you have Trigger Points in your Piriformis and other muscles there is no way that you can not, they go hand in hand. Stress reduction, drinking more water, inversion therapy, some seating devices work great at minimizing the pressure on the nerve...

What it boils down to is education coupled with action towards the root causes, not just addressing the symptoms of your pain, there is a huge difference and the results will show in the level of frustration you have not to mention the quicker the relief you will get.

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How to Stretch the Piriformis Muscle (Piriformis Syndrome)

Piriformis Syndrome

Simple Piriformis Muscle Stretch Options

Sitting Cross-Legged. One of the easiest ways to keep your hips open and stretch your piriformis muscle is by sitting cross-legged on the floor for several minutes a day.
Piriformis Chair Stretch. Another easy way to stretch out the piriformis, especially if you have a desk job, is to cross one leg over the other with your ankle resting on the knee of the opposite leg. Gently press down on the inside of the knee and slowly lean forward until you feel a mild stretch in the hips.
Floor Piriformis Stretch. A more intense stretch can be performed while laying on your back on the floor. Cross the right leg over the left, with the right ankle resting on the left knee. Slowly lift the left foot off the floor and toward you while you apply gentle pressure to the inside of the right knee. Hold 20 to 30 seconds, and repeat on the other side.

Advanced Piriformis Stretch - Pigeon Pose

This stretch, pictured above, is a more advanced piriformis and hip stretch, in which you use your whole body weight to stretch the piriformis, the IT band and other hip rotators. Use caution as you get in to and out of this pose.

• Start in a push-up position on your hand and toes.
• Slide your right knee forward toward your right hand. Angle your knee, so the outer ankle is touching the floor (see picture).
• Slide your left leg back as far as comfortable.
• Keep your hips square to the floor.
• You should feel a deep stretch in your right glutes (buttock), hip and the outer thigh.
• You can either stay up on your hands or fold forward and let your forearms rest on the floor in front of you or fully extend your arm in front of you.
• Breathe slowly and deeply from your belly. Hold the stretch 30 seconds to 60 seconds and release. Repeat on the other leg.

Piriformis Syndrome

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Piriformis Syndrome - Symptoms and Signs, Diagnosis and Treatment

Piriformis Syndrome

Piriformis Syndrome is compression of the sciatic nerve by the piriformis muscle, causing pain.

The piriformis muscle extends from the pelvic surface of the sacrum to the upper border of the greater trochanter of the femur. During running or sitting, this muscle can compress the sciatic nerve at the site where it emerges from under the piriformis to pass over the hip rotator muscles.

Symptoms and Signs

Symptoms of Piriformis Syndrome

A chronic nagging ache, pain, tingling, or numbness starts in the buttocks and can extend along the course of the sciatic nerve, down the entire back of the thigh and calf, and sometimes into the foot. Pain is usually chronic and worsens when the piriformis is pressed against the sciatic nerve (eg, while sitting on a toilet, a car seat, or a narrow bicycle seat or while running). Unlike piriformis pain, lumbar disk compression of the sciatic nerve (sciatica—see Neck and Back Pain: Sciatica) is usually associated with low back pain, in addition to sciatic pain down the lower extremity.

Diagnosis

Diagnosis is by physical examination. Pain with forceful internal rotation of the flexed thigh (Freiberg's maneuver), abduction of the affected leg while sitting (Pace's maneuver), raising of the knee several centimeters off the table while lying on a table on the side of the unaffected leg (Beatty's maneuver), or pressure into the buttocks where the sciatic nerve crosses the piriformis muscle while the patient slowly bends to the floor (Mirkin test) is diagnostic. Imaging is not useful except to rule out other causes of sciatic compression. Differentiation from a lumbar disk disorder is sometimes difficult, and referral to a specialist may be needed.

Treatment

The patient should temporarily stop running, bicycling, or doing any activity that elicits pain. A patient whose pain is aggravated by sitting should stand up immediately or, if unable to do so, change positions to raise the painful area from the seat. Specific stretching exercises for the posterior hip and piriformis can be beneficial. Surgery is rarely warranted. A carefully directed corticosteroid injection near the site where the piriformis muscle crosses the sciatic nerve often helps.

Piriformis Syndrome

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Conservative Care For Piriformis Syndrome (Piriformis Syndrome)

Piriformis Syndrome

The piriformis muscle and the sciatic nerve
The piriformis muscle is a small muscle located in the buttocks that rotates the hip. It runs horizontally, and the sciatic nerve runs vertically directly beneath the muscle. The muscle can become tight and place pressure on the sciatic nerve, resulting in leg pain which may be difficult to distinguish from a radiculopathy (nerve pinching in the spine), which is also commonly called sciatica.

The patient’s spinal imaging studies will not show any nerve pinching, and on physical exam, motion of the patient's hip will generate the pain.

Conservative care for Piriformis Syndrome

Treatment for Piriformis Syndrome typically consists of:

• Physical therapy that includes manual release (deep massage), along with hip range of motion exercises can help piriformis sydrome.
• For severe cases of piriformis sydrome, the muscle may be injected with lidocaine to decrease spasm and help the patient make progress in physical therapy.

Piriformis Syndrome

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Mystery or A Pain In The Behind (Piriformis Syndrome)

Piriformis Syndrome

Piriformis Syndrome is difficult to diagnose and resistant to therapy. The existence of Piriformis Syndrome has been doubted for years, but with the power of the Internet the reality of this syndrome has finally reached a tipping point. Previously, it was not even considered as a diagnosis, in others it was quickly ruled out. In others the symptoms are ascribed to "sciatica" or some other cause, even if the Piriformis Syndrome is considered as a possible cause. Often the patient has considered the possibility before the physicians, trainers, therapists and others have.

“...The existence of Piriformis Syndrome has been doubted for years. But with the power of the Internet the reality of it has finally reached a tipping point...”
Piriformis Syndrome may overlap with a variety of other problems including what McCrory et. al. have called a "deep buttock" syndrome. This includes pain in the buttock region, possibly pain in the hamstrings, occasionally pain in the back of the leg that is difficult to locate.

Piriformis Syndrome in the Behind

These symptoms of the piriformis muscle dysfunction may be caused by other clinical entities that include gluteus medius dysfunction, herniated or bulging disks, "sciatica", pelvic stress fractures and other musculoskeletal problems in this area. Scant information is available on the piriformis syndrome in lay publications, and only a little more in scientific publications. The functioning of the muscle has not been clearly defined and examined in the literature. The location of the muscle does not allow for surface EMG (electromyographical) study. It is quite difficult, if not impossible to place a deep electrode in the muscle for study purposes also.

The anatomical position of the muscle leads one to conclude that it functions in some ways similar to that of the gluteus medius. The major portion of origin of the Piriformis Syndrome is the anterior lateral portion of the sacrum and the insertion is on the upper portion of the femur.

Piriformis Syndrome

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What is Piriformis Syndrome? (Piriformis Syndrome)

Piriformis Syndrome

The piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called "sciatica", often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats. The piriformis muscle assists in abducting and laterally rotating the thigh. In other words, while balancing on the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling. This is the action of the right piriformis muscle.

Stretching the muscle often duplicates the pain. To do the piriformis stretch, lie on your back, and flex the right hip and knee. Now, while grasping the right knee with your left hand, pull the knee towards your left shoulder. This adducts and flexes the hip. In this position, grasp just above the right ankle with the right hand, and rotate the ankle outwards. This applies internal rotation to the hip and completes the stretch. Another way to do this stretch is to stand on your left foot and place the right foot on a chair, such that the right knee and hip are flexed at about 90 degrees. Now, using the right hand, press the right knee across towards the left side of the body while keeping the ball of the right foot on the same spot on the chair.

Piriformis Syndrome

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