Introduction
Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, run, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs — in short, in almost every motion of the hips and legs.
The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm of the piriformis muscle.
Signs & symptoms
Pain, tingling, or numbness in the buttocks.
Severe pain extending down the length of the sciatic nerve (called sciatica).
Tenderness of the muscles in the buttocks.
Difficulty in sitting comfortably.
Pain can be triggered when the piriformis muscle compresses the sciatic nerve, such as while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time.
Causes
Compression or contraction of piriformis muscle on sciatic nerve, which may happen due to trauma or a nearby growth or mass
Pathophysiology
Piriformis syndrome is most often caused by micro or macrotrauma to the buttocks, leading to inflammation of soft tissue, muscle spasm, or both, with resulting nerve compression. Microtrauma may result from overuse of the piriformis muscle, such as in long-distance walking or running or by direct compression. Involvement of the superior gluteal nerve usually is not seen in cases of piriformis syndrome. This nerve leaves the sciatic nerve trunk and passes through the canal above the piriformis muscle. Blunt injury may cause hematoma formation and subsequent scarring between the sciatic nerve and short external rotators. Nerve injury can occur with prolonged pressure on the nerve or vasa nervorum.
Diagnosis
There is no definitive test for piriformis syndrome. In many cases, case history, revealing a trauma to the area, repetitive, vigorous activity such as long-distance running, or prolonged sitting will be enough. Diagnosis of piriformis syndrome is made by physical examination of nervous & locomotor systems.
Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.
Treatments
Avoid positions that trigger pain.
Rest, ice, and heat pack may help relieve symptoms.
Exercises and stretches help reduce sciatic nerve compression.
Osteopathic manipulative treatment helps relieve pain and increase range of motion.
Anti-inflammatory medications, muscle relaxants, or injections with a corticosteroid.
Iontophoresis – which uses a mild electric current, and
Botox injections
Surgery may be recommended as a last resort.
Prognosis
The prognosis is good in most of the patients with piriformis syndrome. Once symptoms are managed, normal activities can be resumed. In some cases, a regular exercise routine is advised to avoid recurrence.
Complications
Complications are usually due to surgery done for piriformis syndrome. They include:
- Nerve injury
- Sciatic nerve injury is the most common
- Infection
- Bleeding
Disease & Ayurveda
Khallwi/grdhrasi
Nidana
Dhaatukshaya (degeneration of tissues)
Aavarana (obstruction to channels in the body)
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors Vaata gets vitiated and gets lodged in the lower limbs, especially nerves & muscles, causing the signs & symptoms.
Lakshana
Severe pain in the lower limb
Difficulty to raise the lower limb
Divisions
Not mentioned
Prognosis
Saadhya when the disease is new
Krichrasadhya when the disease is chronic
Chikithsa
Samana
Lepana with soolaharadravyas
Parisheka with warm soolahara-sothahara dravyas
Upanaha with Vaataharadravyas
Sirodhara, kateevasti, kateepichu with Vaatahara taila(once there is no aama)
Sodhana
Sneha (Abhyanga)
Sweda (Potalisweda)
Vasti
Virechana
Raktamokshana
Daahakarma
Commonly used medicines
Maharasnadi kashayam
Sahacharadi kashayam
Rasnerandadi kashayam
Dasamoolarasnadi Kashayam
Yogarajaguggulu
Balaatailam
Guggulutiktakaghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Medical professionals suggest the following to ease pain & other disturbances in the legs:
- Stop the activity that caused the pain.
- Stretch and massage the muscle.
- Hold the leg in the stretched position until the pain is relieved.
- Apply heat to muscles that are tight or tense.
- Use cold packs on tender muscles.
Diet
- To be avoided
Drink enough liquids. Ensure enough hydration.
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause obstruction in channels
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid sedentary lifestyle. Be active.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga
Vigorous exercises are not allowed in painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Salabhasana
vajrasana
Bhujangasana
exercises for leg pain
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/books/NBK448172/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
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