Medicines for piriformis syndrome. How to treat piriformis syndrome? Herbal remedies for treatment

The piriformis muscle is located inside the pelvic cavity, passing under the gluteal muscle and over the sciatic nerve. Responsible for keeping the knee and foot turned forward when walking, takes part in abducting the hip outward. If the muscle is excited, it compresses the trunk of the sciatic nerve. There is pain in the buttock, which radiates to the groin area and to the leg. In addition, the sacral, gluteal, and genital nerves may be compressed. Blood supply is disrupted. The causes of pain in the piriformis muscle, as well as the symptoms of the pathology, can be different. It is important to consult a doctor in time, who will diagnose and prescribe treatment.

Why does pain occur in the piriformis muscle?

Spasm of the piriformis muscle can occur from its overstrain or inflammation. The primary causes are related to the impact on this muscle. These include:

• injuries in the buttocks;
• sprain or excessive tension as a result of prolonged stay in a monotonous uncomfortable position or during physical activity;
• inflammation of the piriformis muscle – myositis;
• injection if the needle touches a nerve root;
• severe hypothermia.

Secondary causes are associated with pathologies of the spine, sacral and pelvic organs: discogenic lumbosacral radiculitis, inflammatory and congestive processes of the pelvic organs, osteochondrosis in the lumbosacral region, gynecological diseases.

Experts identify secondary causes of the syndrome in more than 80% of patients.

How does pain syndrome manifest itself?

Signs of the syndrome may be:

• local: associated with spasm or inflammation of the brain itself;
• the result of compression of the sciatic nerve;
• the result of compression of arteries and vessels.

Local symptoms: nagging, aching pain in the buttock area, which spreads down the back of the thigh, lower leg and foot. The pain intensifies during long walking, when climbing stairs, after sitting or standing for a long time, when bending over and squatting. The manifestation of pain decreases in a lying position or sitting with legs apart. Other muscles pelvic floor also tense. Convulsions are possible.

In a state of complete relaxation of the gluteal region, you can feel the tight piriformis muscle. If you press on it, a sharp pain occurs (Bonnet-Bobrovnikova symptom). Tapping in the muscle area provokes pain on the back of the leg (Vilenkin's symptom).

When the sciatic nerve is pinched and the vessels in the infrapiriform space are compressed, the patient feels dull pain, which is accompanied by a feeling of stiffness, burning or tingling along the nerve. Intensification of these symptoms can be provoked by heat, stressful situations, and sudden changes in weather.

Compression of the vessels of the sciatic nerve and compression of the gluteal artery causes a sharp spasm of the vessels of the leg, and the person begins to limp. To continue movement, the patient needs to sit down or lie down. The skin on the leg turns pale, the fingers go numb.

Piriformis syndrome is almost always accompanied by mild sphincter disorders: discomfort during defecation and a short pause before urination begins.

Diagnostics

A neurologist diagnoses and treats GM syndrome. The doctor finds out from the patient the nature of the pain sensations and their changes depending on the position of the body, identifies possible reasons that led to the development of the syndrome: diagnosed diseases of the spine, sacrum and pelvis, injuries, conditions of overexertion, hypothermia.

After the conversation, the doctor conducts a medical examination: notes the features of gait, posture, and checks for pain in different body positions.

To determine the location of tissue compaction, assess sensitivity, muscle strength and the severity of reflexes, the doctor performs manual tests.

One of the methods to confirm the diagnosis of piriformis muscle syndrome is to inject an anesthetic solution directly into the muscle. This procedure is performed under X-ray guidance or computed tomography. If the pain disappears after the injection, a conclusion is drawn about the presence of the syndrome.

If it is suspected that the GM syndrome is concomitant with any disease, a radiographic examination is prescribed: radiography, magnetic resonance or computed tomography.

Treatment of piriformis syndrome

Treatment of SHM is conservative and comprehensive. Surgical methods are used in rare cases: for example, surgery is necessary if the syndrome is caused by an intervertebral hernia.

In the acute stage of the syndrome, you first need to relieve pain and spasm of the piriformis muscle.

Drug treatment

To block pain and relieve inflammation, the doctor prescribes anti-inflammatory non-steroidal drugs - NSAIDs. For severe pain, anti-inflammatory drugs are supplemented with analgesics.

Antispasmodics are prescribed to relieve muscle tension. If they do not help, the specialist prescribes a course of muscle relaxants.

When the patient is experiencing very severe pain in the piriformis muscle, a novocaine or lidocaine blockade is performed - the belly of the piriformis muscle is injected with an anesthetic solution.

At the recovery stage, if there are no contraindications, jars, mustard plasters or pepper plaster are placed on the lower back as a warming agent. There are patches that contain NSAIDs and anesthetics and act on the site of inflammation with small doses of medication for a long time. “Star” balm has a good warming effect.

Physiotherapy

Drug treatment should be combined with physiotherapy methods:

• electrophoresis: medicinal substances are administered to the patient through the skin using galvanic current;
• phonophoresis: introduction of active medicinal substances into the body using ultrasonic vibrations;
• Magnetic laser therapy: a combination of laser waves and magnetic field helps relieve swelling and inflammation, increases the body's defenses;
• UHF therapy: ultra-high frequency electromagnetic fields using special equipment penetrate into human tissues and organs and help reduce pain, inflammation, swelling, and stimulate blood circulation;
• amplipulse therapy: impact on parts of the body with sinusoidal simulated currents that promote analgesic, anti-inflammatory, absorbable, decongestant processes.

Massage and exercise therapy

In the early stages of the disease, therapeutic massage of the lumbar-gluteal region can be effective. The procedure must be carried out by a specialist.

Massage the piriformis muscle with a tennis ball

At home, a tennis ball can help relieve muscle spasms. Massage it into the painful area using slow and smooth circular movements.

In case of GM syndrome, it is necessary to perform a set of exercises physical therapy. Gently stretching the pinched muscle will help it relax and improve blood circulation in the area where the sciatic nerve is pinched. At each stage of treatment, the physiotherapist will select exercises individually, taking into account age, weight, and physical fitness.

Rules for doing the exercises:

• do not do gymnastics if you have sore knees and hip joints, after operations during which it is prohibited physical exercise, during pregnancy;
• perform the exercises slowly, smoothly, do not let the movements cause pain;
• breathe through your nose, calmly, without delay;
• exercise, if possible, 3 times a day, at least 5 times a week;
• Perform each exercise for 30 seconds and repeat three to five times;
• Before gymnastics, be sure to warm up for 10 minutes: this can be any movements in the hip joints and lower back in a standing, sitting, lying position that do not cause pain.

Several universal exercises that are aimed at stretching the piriformis muscle:

• Lying on your back, bend your knees, feet shoulder-width apart. Slowly bring your knees in and out.
• In the same position, bring your feet and knees together. Bend your knees to one side, then the other.
• Get on all fours. Move your sore leg to the side and straighten it carefully. Return your leg to the starting position. Repeat these movements with the other leg.
• Sit on a chair so that your thigh and shin form a 90° angle, and place your affected leg on your healthy knee. Slowly bend towards the leg on top. Repeat five to ten times, then switch legs.

When the condition improves, periodically sit for a few minutes with your legs crossed. Exercises can be performed for preventive purposes to strengthen the pelvic muscles.

Preventive measures

To avoid spasms, pinched nerves and pain in the piriformis muscle area, follow these preventative recommendations:

• Any disease is treated faster at the initial stage of development. Regularly undergo preventive medical examinations of the body.
• Take care of your spine: maintain a straight posture. Do not lift weights abruptly from an inclined position. Swimming strengthens the spine and back muscles well.
• If you play sports, warm up before exercise and stretch after exercise. Control your movements and do not overexert your muscles. Avoid exercise that causes pain.
• Don't get too cold.
• Avoid sitting or lying for long periods of time in positions that put unnecessary pressure on your buttocks. If your job is sedentary, take breaks with exercises to warm up your muscles: walk around, do a few bends.
• Treat your injuries promptly.

Prevention also includes following the rules healthy eating, sleep and rest patterns. Overwork and nervous tension negatively affect the functioning of all organs and systems.

The piriformis muscle belongs to the pelvic muscles and performs motor function. Under the influence of external irritants, it can be damaged, as a result of which human activity is disrupted and painful sensations arise in the buttocks, lower back and lower extremities.

From an anatomical point of view, the trunk of the sciatic nerve can have different positions. In most cases, it enters the gluteal region, located under the piriformis muscle, sometimes passing through it.

Spasm of the piriformis muscle leads to pinching of the sciatic nerve and blood vessels in the infrapiriformis space. The nerve can become pinched anywhere. The structure of the muscle changes, which leads to its dysfunction.

Characteristic symptoms of inflammation

As a result of external influences on the piriformis muscle, various painful conditions may occur associated with the inflammatory process in the muscle itself, in the sciatic nerve, as well as damage to blood vessels and arteries.

This syndrome is characterized by a whole set of symptoms that can be divided into three groups:

Symptoms of inflammation of the piriformis muscle usually appear in combination. The pain radiates to neighboring areas, which causes difficulties in making a diagnosis.

Causes

Piriformis syndrome, like radicular syndrome, can be caused by various factors, among which the first place is taken by overload and hypothermia of the body.

In this case, the inflammatory process can occur due to the impact of an irritant on the organ itself or be the result of existing disorders in the body.

In medical science, it is customary to talk about two main groups of factors that provoke inflammation - primary and secondary causes.

Primary (vertebrogenic) causes

Among the primary causes that imply an impact on the organ itself, the following stand out:

• traumatic injuries in the lower back and buttocks;
• inflammatory process in muscle tissue (myositis);
• muscle strain;
• overexertion as a result of excessive cooling of the body or physical exertion.
• problems caused by spinal dysfunction.
• incorrectly given injection (injection).

Secondary (non-vertebrogenic) causes

Second-order factors do not directly affect the muscle itself, but lead to the occurrence of the syndrome:

• infections and inflammatory processes in the pelvic organs, causing reflex spasm (gynecological diseases);
• diseases associated with dysfunction of the musculoskeletal system.

Diagnostic methods

To diagnose the disease, you need to conduct an examination. Diagnosis of piriformis muscle syndrome includes a physical examination of the patient, as well as instrumental research methods.

First of all, they check the body’s reaction to various external stimuli:

• checking symptoms of Bonnet-Bobrovnikova, Vilenkin, Grossman;
• palpation of the sacroiliac region;
• transrectal examination, which involves palpation of an organ to determine the degree of its tension;
• exclusion technique: an anesthetic is injected into the muscle (its type depends on the individual intolerance of the human body, usually “Novocaine”); if the pain subsides, we can talk about suspected inflammation.

To clarify the diagnosis, a hardware technique is used:

• CT scan;
• X-ray of the lumbosacral region;
• if oncology is suspected - radioisotope study.

Treatment

Therapy for piriformis syndrome requires integrated approach. It is aimed at anesthetizing inflammation, as well as eliminating the very cause that caused it. Drug support is usually used. In some cases, surgical intervention is required. Physical therapy and massage, prescribed as additional methods, are important.

Drug therapy

To relieve pain, the patient is prescribed non-steroidal anti-inflammatory drugs and muscle relaxants (Ibuprofen, Diclofenac). It is necessary to alleviate the general condition of the body. If the muscle hurts severely, a blockade of the inflamed nerve is used, analgesics and antispasmodics are prescribed.

For vascular compression, drugs aimed at improving blood circulation are effective.

All medicines prescribed by a doctor after examining the patient and making an accurate diagnosis. It is important to read the instructions for contraindications and side effects. Many medications cannot be used by pregnant women, as well as people who have an individual intolerance to the components of the drugs.

Physiotherapy

Physical exercise helps to relax the muscle, relieve pain and restore motor activity of the injured limb. Exercise therapy methods are an excellent way to help cope with the disease.

For piriformis syndrome, a special set of exercises is used.

Gymnastics (stretching) has been developed that can be done independently.

For piriformis syndrome, massage is prescribed. It is carried out using a specially developed technique and has a therapeutic effect. Massage is especially effective in the early stages of the disease, when the pinched nerve needs to be unblocked.

Prognosis and prevention

To protect yourself from the unpleasant manifestations of the syndrome, you must follow a number of recommendations:

• Try not to get too cold. This negatively affects the functioning of the muscle.
• It is important to avoid excessive physical activity and carrying heavy objects.
• Infectious diseases should be treated promptly.
• You should consult a doctor at the slightest suspicion of a disorder of the musculoskeletal system.

Lack of proper treatment, ignoring drug therapy, using only remedies traditional medicine can aggravate the condition and lead to serious impairment of the motor function of the body.

The piriformis muscle is an internal pelvic muscle that connects the pelvic bones. When it becomes inflamed, there is compression of the blood vessels, pinching of the sciatic nerve, as well as the nerve endings of the sacral spine. Because of this, a person experiences severe pain in the buttocks, which can radiate to the thigh, lower leg, or groin. This phenomenon is called piriformis syndrome.

Piriformis syndrome affects people of all ages, men and women, young and old. It is useful to know about its symptoms and treatment for everyone who plays sports, does physical labor, or leads an active lifestyle.

Reasons for the development of the syndrome

The causes of inflammation of the piriformis muscle can be different. As a rule, the following factors play a negative role:

• Overwork of the piriformis muscle, excessive physical activity;
• Hypothermia of the body;
• Constant stress, overwork;
• Finding the body in an awkward position;
• Lack of microelements in the pelvic bones (due to unbalanced nutrition or metabolic disorders);
• Pelvic injury, sprain or hematoma;
• Tumor in the roots of the spinal cord;
• Incorrectly given injection;
• Advanced stage of osteochondrosis of the sacral or lumbar spine.

Characteristic symptoms

The syndrome never occurs hidden. He announces himself immediately, giving the patient no rest.

The main symptom is a sharp pain in the pelvic area, which subsides when sitting or lying down when spreading the legs, and intensifies when crossing legs or standing up. The nature of the pain is dull, aching, sometimes shooting, jerking. A characteristic weather dependence appears: when the weather changes, the pain intensifies. Often an increase in pain occurs in a warm room at night.

If the sciatic nerve is pinched, the pain can spread to the buttocks, inner thighs and even the entire leg, down to the toes. Lameness, numbness, and loss of sensation appear.

Inflammation of the muscle can spread to the pelvic organs, in particular the bladder, which is manifested by tingling and local pain, and difficulty urinating.

The muscle and nerve tissues in the pelvic area lack blood supply. With ischemia of the sciatic nerve, pressing pain occurs with chills, burning, and a feeling of severe numbness. Warmth, changes in weather, stressful situations, and feeling the lower leg cause increased pain.

Compression of blood vessels, including the inferior gluteal artery, causes pale skin, spasms, and lameness. In a quiet position, the pain usually goes away. It is difficult for the patient to walk; he needs to relax the limb (sit or lie down) so that he can then get up and move around.

You cannot let the disease take its course. In addition to a lot of unpleasant sensations, it can cause complications. You should seek medical help.

Diagnostic methods

Pain in the pelvic area is caused by many other diseases: hernias of the lower parts of the spine, inflammatory processes in the pelvis, osteochondrosis, arthritis of localization adjacent to the pelvis. Therefore, to make a diagnosis, it is important to differentiate pathologies by highlighting the real cause of pain.

The first involves manual examination of the patient in various body positions. The doctor will ask you to cross your legs, spread them under resistance, and bend your leg in a lying position. In difficult cases, a rectal or vaginal examination is used, the purpose of which is to palpate the piriformis muscle. The criterion for determining the disease is the tension of the inflamed muscle.

One of the frequently used diagnostic methods is the novocaine test. An injection of a drug from a number of novocaines is injected into the piriformis muscle. With piriformis syndrome, the pain will disappear or be significantly reduced.

The piriformis muscle is covered by the bulky muscles of the buttocks, so studying it using hardware methods is difficult and not very informative. Some exception is the echographic diagnosis of the sciatic nerve. Sonography is done on both sides to compare the results. On the affected side, there is increased blood flow and thickening of the nervous tissue. MRI and CT are also performed for diagnostic purposes, but their data are more relevant to the diagnosis of tumors. It is important to check whether there are tumors in the pelvic area. If there is a suspicion of pinching of the nerve endings of the lumbar or sacral regions, an MRI is done with a contrast agent injected into the buttock muscle.

Treatment of this pathology is long-term, it is carried out comprehensively in several directions at once.

Medication

A 10-day course of anti-inflammatory non-steroidal drugs is the basis of therapeutic treatment. They can be prescribed in the form of tablets or intramuscular injections (2 injections every 6 hours daily). Ketan drugs and other medications in this group have proven themselves well.

In case of severe pain, analgesics, antispasmodics, and muscle relaxants are prescribed. The disease that became the root cause of the syndrome is being treated.

Since the syndrome tends to worsen seasonally, courses of treatment are repeated several times and carried out twice a year.

Blockade

To relieve tension and spasm of the piriformis muscle, novocaine blockade is used. 10 ml of novocaine (dose for an adult) is injected using a syringe to a depth of 6-8 cm into the space between the piriformis muscle and the sacral root.

Surgical

The surgical method is used only in the most severe cases. This is usually a complication in the form of foot paresis. It occurs due to the strong pressure of the altered piriformis muscle on the nerve. The essence of the operation is to excise the piriformis muscle and release the sciatic nerve.

In the early stages of the disease, therapeutic massage can be effective. The session begins with kneading the paravertebral area with a transition to the lumbosacral region. The buttock on the sore side is warmed up, then the back of the leg. The session lasts 15-20 minutes. Massage should be performed under the supervision of a physician. A course of 12 procedures is recommended, repeated every month.

Physiotherapy

Physiotherapeutic procedures are useful and effective as additional methods of treatment. Typically, doctors send patients for therapy using low current devices:

• Treatment with dynamic currents;
• Phonophoresis;
• Amplipulse;
• Vacuum massage.

A laser treatment method has also appeared, but it is not yet very widespread.

Reflex methods

Reflexology includes several treatment methods that have come down to us from ancient times and are successfully used for muscle diseases:

• Acupressure massage of active points of the body;
• Blockade;
• Laser treatment of points;
• Warming up (cauterization) of the points;
• Point-linear massaging;
• Treatment through points on the auricle.

Whether this or that method is suitable for a particular patient can only be decided by a practitioner. The choice of technique may differ depending on the stage of the disease, the general condition of the body, and existing diseases.

The basis of reflexology is the ancient Eastern teaching about active points on the body through which energy circulates.

Physiotherapy

Exercise therapy helps the patient fight the disease, giving the opportunity to alternate muscle relaxation with light loads. Exercises relieve tension and spasms. With the help of regularly performed gymnastics, it is possible to strengthen muscles and also avoid their atrophy. To avoid excessive stress, it is better to hold off on other workouts, visits gym until recovery.

The following set of exercises is performed strictly in the order listed. You can do exercises 1 to 3 times a day.

1. Lie on your back, bend your knees, bring your knees together and spread them several times. Then shine the light on your knees again until they touch. Push one knee with the other for several seconds: first the left with the right, then vice versa.
2. Lie on your stomach with your shoulders pressed to the floor. Straighten one leg, bend the other at the knee. Using the palm of the hand opposite to the bent leg, press the knee to the floor through the other leg. You need to hold this position for as long as possible, at least 30 seconds. The same thing is repeated with the change of legs.
3. Lie on your back. Bend your knees and keep them suspended. Place the sore leg on top of the healthy one (as in the “lotus” position, only lying down). Grasp the thigh of the supporting leg with your hands and pull it towards you. The exercise helps stretch the piriformis muscle, making it less prone to spasms.
4. Performed with an assistant. Sit on the mat with your feet wide apart, knees bent and brought together. Leaning on the couch with one hand, stretch the other forward and begin to rise. When the elbow is fully straightened, the assistant takes the patient by the free hand and puts him on his feet (the knees open).
5. For this exercise you need an expander or a tight stretch cord (tape). Attach one end of the expander to any stationary object (support), and place the other on the foot on the sore side. Then stand sideways to the support and with effort, overcoming the resistance of the expander, move your leg to the side as far as possible without bending it at the knee. Slowly return the leg to its place, holding back the compression force of the expander.

Traditional methods

• Compress of black radish and horseradish.

Grind a small black radish tuber and horseradish root in a blender. Add 1 tbsp. l. vinegar and salt. Leave it in a dark place for a week, then apply it to the sore spot for 20 minutes through several layers of gauze.

• Rubbing with alcohol tinctures with pepper.

Mix triple cologne with tinctures of hawthorn, valerian and hot pepper, as well as 10 crushed aspirin tablets. Leave for a week in a dark place. Rub the sore spot. Then wrap it in a plastic bag or compressor paper, and wrap a warm scarf or scarf on top.

Beeswax compress. Lubricate the sore spot with burdock oil, then apply molten(heated in a water bath) beeswax in several layers. Keep until the wax cools. For convenience, wax can be applied with a brush.

The main advice from experts is not to get too cold, not to overload the lumbar spine, undergo regular medical examinations, try to maintain healthy image life, eat right.

Possible complications

In advanced cases, piriformis syndrome is life-threatening, not to mention the pain syndrome that torments the patient. This is an inflammatory process in the body, and like any inflammation, it is fraught with complications. The disease is prolonged and weakens the immune system of the entire body. Pain can spread to the entire limb, causing muscle paresis, as well as to the pelvic floor area. Piriformis syndrome can cause inflammation of the pelvic organs and disrupt the function of the rectum and urinary system.

Piriformis syndrome is a compression of the sciatic nerve, which is characterized by severe pain, tingling and numbness in the buttocks, thighs and entire limb. Pain sensations spread along the branching of the sciatic nerve. This pathology is characterized by significant pain, but is not life-threatening and requires surgical treatment in rare cases. It is not difficult to relieve pain using medications and physiotherapeutic methods of treatment. It is more important to recognize the cause that causes this syndrome.

What is piriformis syndrome?

Piriformis syndrome is a fairly common tunnel neuropathy characterized by severe pain in the buttocks that spreads as the sciatic nerve passes. Thus, the pain may radiate to the groin, thighs and ankles. The main manifestations are caused by compression of the sciatic nerve, as well as the vessels surrounding it.

The piriformis muscle has the shape of an isosceles triangle, which originates in the lower part of the spine and closes with the upper part femur. Excessive contraction of the piriformis muscle causes its increase in volume (thickening) in the abdominal area, which leads to a significant narrowing of the infrapiriformis. The vessels and nerves located there are significantly compressed, which provokes pain. In this case, the main pressure falls on the trunk of the sciatic nerve. Since the sciatic nerve passes through the thickness of the muscle belly, its compression is quite significant.

The function of this muscle is to abduct the hips, as well as rotate them outward (that is, turn the feet and legs). The main function of the piriformis muscle is to provide the initial stage of movements when walking and running, when a person is just trying to take a step.

Tunnel neuropathy also occurs when injections are performed unsuccessfully, when the nerve roots are injured. In this case, tension in this muscle develops, which causes compression of the sciatic nerve and blood vessels.

This pathology is common in patients suffering from discogenic radiculitis. The reflex tension arising in the muscle provokes the development of neurotrophic phenomena, which are caused by irritation of the sacral and lumbar roots.

If the piriformis muscle is inflamed and irritated, then the sciatic nerve also undergoes inflammatory metamorphoses. Most often, athletes, namely athletes and runners, encounter this pathology. Painful sensations appear sharply and acutely, but the pathology develops slowly. Usually, after stretching, the pain does not stop, but only intensifies.

Causes of piriformis syndrome

It is well known that this syndrome occurs as a result of excessive stress on the pelvic organs, which results in compression of nerve fibers and blood vessels. The causes may be primary or secondary.

Primary causes occur in the following cases:

• significant stress on the muscles;
• colds and hypothermia;
• prolonged stay in an uncomfortable and monotonous position;
• muscle tension;
• unsuccessful injection into the piriformis muscle area;
• injuries of the sacrum and lower back;
• spinal injuries.

Secondary causes are caused by various pathologies, and the syndrome develops against their background. Most often this is associated with diseases of the lumbosacral region and spine.

Secondary causes develop as a result of the following ailments:

• sacroiliitis;
• lumbar stenosis;
• gynecological diseases;
• osteochondrosis;
• spinal tumors;
• lumbar dorsopathy;
• myositis ossificans.

Symptoms of tunnel neuropathy

The main symptom of the syndrome is persistent and untreatable pain. As a rule, it is combined with other clinical symptoms. In this case, this syndrome begins together with lumbodynia (lumbar pain), which after 15 days transforms into sciatica (inflammation of the sciatic nerve).

Piriformis syndrome includes the following syndromes:

• local symptoms that are caused directly by contraction of the piriformis muscle;
• neuropathic, which are caused by sciatica (compression and inflammation of the sciatic nerve);
• vascular manifestations, which are provoked by compression of the vessels passing in the infrapiriform canal.

An overly contracting muscle causes permanent pulling, aching pain in the buttocks. So, even easy walking, trying to squat and cross your legs increases pain and discomfort. A decrease in pain is observed when the legs are spread to the side. However, it is still not possible to completely eliminate pain and discomfort.

In addition, such painful sensations are complemented by lumbodynia and sciatica, as well as paresis of the foot and leg. In severe cases, it is even possible to develop “horsefoot” or “dangling” foot.

Intermittent claudication is caused not only by compression of the arteries, but also by their spasm. In addition, both large and medium-sized and small arteries are involved in the pathological process. There is also pallor of the skin on the leg and coldness of the toes.

Specific symptoms are possible - dysfunction of the rectum and urethra, which appears as a result of secondary contractions of the pelvic muscles. This is associated with unpleasant sensations during defecation, pauses before urination and discomfort in the genitals during sexual intercourse.

Diagnostics

Diagnosis of the disease is somewhat difficult, since the pain syndrome appears at the time of certain movements. The main diagnosis is based on palpation of the spinal region. In this way, it is possible to determine the area where muscle tightening is observed.

The following positive tests are also indispensable diagnostic methods:

1. Freiberg test (appearance of pain when rotating the hip inward).
2. Beatty test (pain when trying to raise the knee while lying on the other side).
3. Pace test (pain during hip flexion and internal rotation).
4. Mirkin test (slow bending forward without bending the knees);
5. Bonnet-Bobrovnikova test (internal rotation of the hip).
6. Grossman test (spasm of the buttocks during effleurage).
7. The occurrence of pain along the distribution of the sciatic nerve.

In addition, the following instrumental diagnostic methods are used:

• electromyography (EMG);
• computed tomograph (CT);
• magnetic resonance imaging (MRI);
• radiography.

How to treat piriformis syndrome

Treatment is carried out in two directions:

• medicinal;
• non-medicinal.

Drug treatment

To relieve pain and relieve inflammation of both the sciatic nerve and the piriformis muscle, the following drugs are used:

• nonsteroidal anti-inflammatory drugs NSAIDs (diclofenac, movalis, indomethacin)
• muscle relaxants;
• drugs that improve blood microcirculation;
• analgesics.
• to relax muscles and relieve spasms, in this case antispasmodics are prescribed, these drugs stop pathological muscle contractions, usually these are drugs based on drotaverine.

In case of severe pain syndrome, a therapeutic blockade is performed. In this case, the belly of the piriformis muscle itself is injected with an anesthetic. During blockades as medicinal products glucocorticosteroid drugs are prescribed, usually with a two-stage action, which have a quick and long-lasting effect. Their introduction significantly reduces pain, inflammation and swelling of the muscle itself and the sheath of the sciatic nerve.

Compresses with anesthetics, dimexide and corticosteroids are effective. They are applied to the lumbar region in the area of ​​the pinched sciatic nerve.

An important part of complex treatment are:

• physiotherapeutic procedures;
• massage;
• manual therapy;
• reflexology with acupuncture;
• vacuum and laser acupuncture.

Physical therapy performed by an experienced instructor is designed to relax the piriformis muscle. It perfectly complements treatment and prevents the use of high doses of analgesics.

After the acute period, it is necessary to identify the cause of the pathology and carry out conservative treatment. Without such measures, treatment becomes meaningless, and attacks of sciatica will constantly recur.

Physiotherapeutic treatment

For severe pain, drug therapy is combined with physiotherapy. The most effective physiotherapeutic methods are:

• vacuum therapy;
• laser puncture;
• acupuncture.

Properly performed acupuncture has excellent therapeutic effects. By activating biologically active points, spasms are eliminated, blood circulation and tissue nutrition are improved. Physiotherapy with laser is completely safe, eliminates swelling and pain, promotes rapid tissue restoration and improves motor activity.

Massage

Along with medicines and physiotherapy good action provides massage to the lumbar buttock area. It is better to start massage at an early stage of the disease. It begins with kneading the spinal area with a gradual transition to the lower back and buttocks. You need to know that massage does not lead to a good effect in all cases, so it should be performed under the careful attention of the attending physician. The massage begins with working out the buttock on the sore side, then massaging the back surface of the lower limb. The course of massage should be up to 20 sessions, and after a month it can be repeated again.

Physiotherapy

An excellent addition to basic therapy is physical therapy exercises. Gymnastic exercises must be carried out for a long time, so you will have to stock up on willpower and patience. There is one mandatory condition regarding the exercises that will be given below: they must be performed in a strictly presented sequence.

So, the following exercises are effective:

1. Lie on your back, bend your knees, then bring your knees together and spread them apart. When the knees touch, they need a certain push. The movement should last about 20 seconds.
2. Lie on your back, press your shoulders to the floor. Then bend one leg at the knee and straighten the other. The movements are performed alternately. Press the palm opposite the bent leg to the floor. You need to stay in this position for a few seconds. Then repeat with the other leg.
3. Lying on your back, bend your knees and hold them in the air (in weight). Cross the affected leg over the healthy one, much like in the lotus position. Then, with both hands, grab the thigh of your supporting leg and pull it towards you. In this case, the muscle tissue is stretched, it becomes elastic and plastic, and spasms are eliminated.
4. The patient will need an assistant for this exercise. Sit on a hard surface, spread your feet wide, bend your knees and try to connect them. You need to lean on the floor with one hand, stretch the other forward and try to rise. If the elbow is fully straightened, the assistant takes his free hand and helps the patient fully straighten the torso. At the same time, the knees are separated.
5. The exercise is performed with an expander. In a standing position, one end is tied to a strong support, and the second is passed through the foot on the injured side. You need to stand sideways to the support and, overcoming the obstacle through the resistance of the elastic band, move the limb to the side as far as possible. The leg returns to its original place slowly, receiving load on the other limb.
6. In a lying position, place your feet on the floor, bend them at the knees, bringing your feet and knees together. Gently and slowly tilt your joined knees to one side or the other.
7. Get on all fours, bend the injured limb at the knee, move it to the side, then carefully straighten it, again getting on all fours. Repeat the steps with the other limb.
8. Sit on a chair so that your legs are at 90 degrees compared to your torso. Then place the injured limb on the healthy one. Slowly bend forward towards your knees, keeping your back straight.

How long does it take for rehabilitation?

Such timing is usually individual, but with timely and adequate treatment, the symptoms of the pathology can be eliminated quite quickly, especially if you follow all the doctor’s recommendations and advice. As a rule, full recovery occurs from two weeks to a month. In addition to special exercises during the recovery period, you can swim, use exercise equipment and ride a bike. Before engaging in any activity, you should consult your doctor for a recommendation.

Piriformis syndrome is a rare diagnosis in medical history. Few people know where this deeply hidden muscle is located, what function it performs and what role it plays in inflammation of the sciatic nerve. But in practice, more than half of patients with lumbosacral radiculitis with persistent pain radiating to the leg along the sciatic nerve, which is not relieved by conventional anti-inflammatory therapy, suffer from this particular pathology. But for some reason, both doctors and patients prefer all kinds of “osteochondrosis”, “lumboischialgia” and “radiculitis” - diagnoses that reflect not the causes or mechanisms of the disease, but only the general picture. Indeed, “lower back pain” is much clearer than some kind of fruit-apple syndrome.

Piriformis muscle (shocked by the humor or imaginative thinking of ancient anatomists! Where did they see the pear?) is located deep in the gluteal muscle mass, and can only be palpated in the presence of severe pain. It originates from the sacrum and attaches to the greater trochanter of the femur. At first glance, nothing special, but the piriformis muscle almost completely fills the large sciatic foramen of the pelvis - the Thermopylae passage for vessels and nerves (including the sciatic) to lower limbs. Normally, even during the period of tension of the piriformis muscle in the greater sciatic foramen, the upper and lower fissures remain free, where the neurovascular bundles pass. But the picture changes dramatically if prolonged pathological contraction of the piriformis muscle begins to compress the sciatic nerve and gluteal arteries.

Piriformis syndrome. Clinical picture.

Clinical manifestations of piriformis syndrome are manifested primarily by symptoms of inflammation or entrapment of the sciatic nerve:

1. Drawing cerebral pain in the buttock and along the back of the thigh, aggravated by running, walking, squats.
2. Feeling of chilliness, decreased sensitivity of the lower leg and foot, feeling of stiffness in the leg. Or a manifestation of hypersensitivity - crawling, a burning sensation below the level of the knee joint.
3. Weakness and atrophy of the muscles of the leg and foot
4. Trophic skin disorders of the lower legs

Local symptoms include pain in the hip joint, sacroiliac joint, and pain on palpation of the piriformis muscle itself.

When the arteries passing through the greater sciatic foramen are compressed, vascular disorders develop. The skin on the back of the leg becomes pale and dry, microcirculation disturbances and signs of ischemia of the leg tissue appear.

Diagnosis and treatment of piriformis syndrome

Diagnosis of the disease is carried out on the basis of a characteristic clinical picture, anamnesis, identification of manual tests and specific symptoms. An important diagnostic technique is blockade of the piriformis muscle with novocaine or lidocaine. And in some cases, even its single use is enough for a complete cure. In general, with piriformis syndrome, pain relief is the first and main treatment measure. And after the pain is relieved, you can safely continue further therapy. In the presence of severe inflammation of the sciatic nerve - non-steroidal anti-inflammatory drugs, in case of microcirculation disorders - drugs that improve blood circulation and tissue trophism, in case of polyneuropathy - B vitamins, magnesium preparations.

Prevention and rehabilitation

Therapeutic exercise is the most important means of preventing piriformis syndrome and rehabilitation after pinching of the sciatic nerve. The main exercise is:

And if you combine different options for hip abduction along with twisting (rotational) movements in lumbar region spine, then the sciatic nerves together with the piriformis muscles will thank you very much and will never bother you.