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Most people have heard of sciatica and the diagnosis (or frequently self-diagnosis) of sciatica is too often made based on just one symptom: radiating leg pain. There is however, a condition similar to sciatica that also causes leg pain, yet it is markedly different.
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Anatomically, sciatic nerve, the largest and thickest nerve of the human body, emerges from the spinal cord in the lumbar (low back) portion of the spine and runs down through the buttocks and the back of the thigh; above the back of the knee it divides into the tibial and the common peroneal nerve, both of which serve the lower leg and foot.
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Sciatic nerve may get irritated at two main locations: at the root and further down its path. If the damage to the nerve occurs at its root, such as in rupture of a portion of an intervertebral disk – a condition called disc herniation – into the spinal canal, this may result in true sciatica. True sciatica is described as pain along the sciatic nerve, which runs from the lower back down the leg, below the knee and into the foot. It may be accompanied by numbness and tingling sensations anywhere along the path of the sciatic nerve.
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A sciatica-like condition, called piriformis syndrome, may result if sciatic nerve, as it passes over, under, or through the piriformis muscle of the buttock on the way down the leg, becomes entrapped or pinched, causing pain in the affected buttock and thigh, or occasionally groin. This condition is not considered a true sciatica, and is sometimes called pseudo-sciatica.
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In majority of cases, piriformis syndrome is the result of entrapment and irritation of the sciatic nerve by a very tight or spasmed piriformis muscle. Depending on the individual’s anatomy, the sciatic nerve can be compressed as it passes between the piriformis muscle and the bone of the sciatic notch or, in 15% of the cases, through the muscle itself. Irritation of the nerve is more likely to occur if there is an abnormality of the piriformis, such as hypertrophy (enlargement of the muscle), inflammation, scarring, or spasm. These conditions can result from overuse, trauma to the area, or even prolonged sitting. In athletes, piriformis syndrome can also be seen following activities that cause repetitive hip rotation and extension, such as running and climbing.
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Piriformis syndrome most commonly leads to dull aching pain in the buttock, with or without radiation to the back of the thigh; the pain seldom radiates below the knee. The symptoms tend to worsen with prolonged sitting or lying on the back and improve with standing and walking.
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In some cases, you may not need medical treatment. Your provider may recommend the following self-care tips to help relieve pain.
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- Try ice and heat. Use an ice pack for 15 to 20 minutes every few hours. Wrap the ice pack in a towel to protect your skin. Alternate the cold pack with a heating pad on low setting. Don’t use a heating pad for longer than 20 minutes at a time.
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- Warm up and stretch before exercising. Then gradually increase the intensity of your activity.
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- Follow your provider’s instructions for doing special stretches. Stretches and exercises can relax and strengthen the piriformis muscle.
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Get medical help immediately if:
- You have sudden severe pain in your lower back or legs, along with muscle weakness or numbness
- You have difficulty controlling your foot and find yourself tripping over it when you walk
- You can’t control your bowels or bladder
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The following supplements may be useful in the treatment of piriformis syndrome:
Magnesium – essential for the regulation of muscular contraction, blood pressure, insulin metabolism, cardiac excitability, vasomotor tone, nerve transmission and neuromuscular conduction. Imbalances in magnesium, usually involving low magnesium or hypomagnesemia, could result in neuromuscular, cardiac or nervous disorders.
B-complex – B vitamins play a vital role in maintaining good health and well-being. As the building blocks of a healthy body, B vitamins have a direct impact on your energy levels, brain function, and cell metabolism. They’re essential in DNA repair and cell division, neurological function and amino acid metabolism.
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Prevention
There is no reliable way to prevent piriformis syndrome. For people who have had this or other back problems, standard recommendations include home exercises and stretching, a heel-lift (if the legs are of different lengths), not carrying a wallet in the back pocket, avoiding prolonged sitting, and getting treatment for other contributing conditions (such as spinal arthritis or foot problems). If triggered by vigorous exercise, reducing exercise intensity or changing activities (for example, from running to swimming) can prevent future episodes.
Treatment
While medications, such as pain relievers, muscle relaxants, and anti-inflammatory drugs may be recommended, the mainstay of treatment for piriformis syndrome is physical therapy, exercise, and stretching. Specific treatments may include:
- adjustments in gait
- improved mobility of sacroiliac joints
- stretching to relieve tight piriformis muscles and those surrounding the hip
- strengthening of the hip abductors (muscles that move the hips outward from the body)
- application of heat
- acupuncture.
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