Muscular disorder is often mistaken for sciatica or a herniated disc, leaving patients with unresolved pain
CHICAGO, Aug. 30, 2017 – Patients with pain, tingling or numbness in the backside and down the leg are most commonly diagnosed with sciatica or a herniated disc, but osteopathic physicians say piriformis syndrome may be behind the suffering.
While relatively common among marathon runners and other athletes, only about 200,000 cases are diagnosed each year. Researchers say piriformis syndrome is often overlooked in clinical settings because it can masquerade as other conditions that have similar symptoms.
"Effective treatment requires identification of the true musculoskeletal culprit," said Clifford Stark, DO, medical director at Sports Medicine at Chelsea in New York City. "On an MRI, I may see a herniated or bulging disc but the physical exam tells me the disc isn't causing the problem."
While there is no definitive test for piriformis syndrome, diagnosis involves a discussion of the patient's symptoms and daily activities. To identify the source of the disorder, an osteopathic physician will manipulate the body to determine whether the pain is caused by irritation of the sciatic nerve due to a contracted or tender piriformis muscle, herniated disc, or another issue.
"In the case of piriformis syndrome, it's important to understand that imaging can be misleading. In my opinion, it's far more beneficial to try the frontline treatments, including physical therapy, and reserve scans for patients who don't improve," said Dr. Stark.
The piriformis plays a crucial role
The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint, positioned in very close association with the sciatic nerve. It stabilizes the hip area and is critical to lower body movement.
"While many patients may not be familiar with the piriformis, it's an important muscle for biomechanics and function," said Dr. Stark. "It plays a crucial role in gait and balance."
The sciatic nerve—where shooting leg or back pains often originate—is a long, relatively thick nerve in the body that passes alongside or in some cases through the piriformis muscle. A healthy piriformis can protect the sciatic nerve, whereas a spasm of the piriformis muscle can cause excruciating pain when it compresses and irritates the nearby sciatic nerve.
Treating the musculoskeletal culprit
Treatments for piriformis syndrome include stretching, manipulation, anti-inflammatory drugs, and in rare cases, surgery.
Physical therapy can help reduce sciatic nerve compression caused by piriformis syndrome. Additionally, osteopathic manipulative treatment has been used to help relieve pain, increase range of motion, and restore overall function. Rest, ice, and heat may also help alleviate symptoms.
Some health care providers may recommend anti-inflammatory medications or muscle relaxants as a non-invasive treatment. Injections with a corticosteroid or anesthetic may follow, though Dr. Stark prefers to reserve this approach for those who do not respond to or cannot tolerate the other therapies.
About the American Osteopathic Association
The American Osteopathic Association (AOA) represents more than 129,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools. Visit DoctorsThatDO.org to learn more.