Anatomy in Action Series: Piriformis Syndrome

Compressive Syndromes There are several "tunnels" or "com­partments" in the body that, when misalignment of bones or spasm of associated muscles occur, can lead to compression of nearby structures, such as nerves or blood vessels. We see this in conditions such as thoracic outlet syndrome and carpal tunnel syndrome, which we will discuss in future articles. Piriformis syndrome is a condition with a similar concept. When this muscle tightens unnaturally or goes into spasm, a very significant structure can be af­fected and create debilitating pain and discomfort for the patient. Terminology Piriformis Muscle: The buttock region has several layers of muscle. Most of us have heard of gluteus maximus and gluteus medius. If you were to dissect those and lift them out of the way, you could then view some ofthe muscles of the deep gluteal region. These include the gluteus minimus, the gemellus muscles, the obturator muscles, and a small horizontally oriented muscle called the piriformis. The piriformis has attachments on the inferior lateral border ofthe sacral bone (triangular shaped bone at the base of the spine) and on the greater trochanter of the femur (bone of upper leg), as can be seen in the diagram. So why is this particular deep gluteal muscle so special? Sciatic Nerve: The sciatic nerve is the largest nerve in the body and the term "sciatica" refers to pain in that nerve. It is actually formed by nerve roots from L4 - S3 levels that bundle together to head down the leg and supply the lower extremity. In most people, this nerve lies right next to the piriformis muscle in the deep gluteal region. Thus, spasm of that muscle could potentially create pressure on the sciatic nerve. In a small percent­age of the population, the sciatic nerve actually runs through the muscle belly of the piriformis rather than running next to it. This is a very common anomaly, but for these folks a spasm of the muscle has a much greater chance of affecting the nerve. When compressed, the sciatic nerve can cause debilitating pain that goes part of the way or all of the way down the leg. It can also cause numbness, tin­gling, and muscle weakness in the lower extremity depending on the extent of the compression. What Causes Spasm? As with any muscle, one or more of a variety of mechanisms can cause spasm in the piriformis. These may include sprain/strain injuries from lifting, twisting, sports, or work accidents. It could also come from a subluxation of the low back, sacrum, pelvis, or femur. The DC may also analyze the patient's nutrition. An imbalance of calcium/magnesium is also often involved in muscle cramping. Management of Piriformis Syndrome Several conditions can cause pain in the sciatic nerve. Before making a diagnosis of piriformis syndrome, the DC must first rule out the possibility of a herniated disc or other underlying lesion that could be causing the symptoms. This will be accomplished through physical examination, orthopedic and neurological testing, and diagnostic imaging tools. Keep in mind that it is always great news for a patient to hear that they have piriformis syndrome instead of a disc herniation! When the DC creates a care plan for a patient with piriformis syndrome, he or she will address the issues of misaligned bones through chiropractic adjustments and will work to alleviate the muscle spasm. Those doctors who work with nutrition may also recommend a calcium/ magnesium supplement, and some may even recommend an herbal supplement such as St. John's wort, which helps promote muscle relaxation. From the prospective of physiotherapy, the DC may rec­ommend ultrasound or electric muscle stimulation on the overlying tissue. However, since the piriformis lies deep under other major muscles, it is sometimes hard to reach. Manual massage of the muscle is very effective and can be accomplished by the doctor or by a massage therapist. Piriformis stretching is also effective and is something patients can do at home or work after leaving the office. The muscle can be stretched lying down or sitting in a chair, and it has great benefit in keeping the muscle in a less "spasmed" state. Visit www.CCCAonline.com and click on the "Resources" tab on the left side of the page to watch a video that demonstrates this important stretch. Education Fosters Understanding An understanding of anatomy helps all health office em­ployees to better communicate with patients and provide care more safely. Online training programs in particular make high-quality training affordable and convenient, and canbetakenanytimeofday.Atwww.CCCAonline.com learn­ers can engage in a streamlined 24-hour training program, which meets or exceeds FCLB guidelines in every area of study, and fulfill the training requirement needed for the national examination! DCs will often pay for their employees to train. Full price forthis training is an affordable $339 for the entire 24-hour program. At www.CCCAonline.com, special discount pro­grams are available for COCSA state association members. Ask your state association for your specific discount code. Not a member? If you are receiving this article through The American Chiropractor magazine, you can still enjoy a discount. Use AMCHIRO as your discount code during the registration process to automatically receive a $15 discount off the regular price of the program. This is the program that gives back to the profession. Learners can expect text, images/schematics, dynamic video lectures, and robust customized experiential in­teractivities in a thorough 19-module program. Plus, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our web site or send us an e-mail at [email protected]. Laurie Mueller. DC served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate suhcoimnittee chair for 6 years; peer reviewed for the Research Agenda Conference, and wrote the informal role determination study that aided in the development ofFCLB's guidelines for chiropractic assistants. Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company. Impact Writing Solution and subsidiarywww.CCCAonline.com. She isaclinician, an educa­tor and an expert in online educational pedagogy. You can also contact me at drimielleronlinexvyahoo.com