Thursday, January 6, 2011

A better understanding of Piriformis Syndrome.

Book Excerpt (copyrighted)

Trigger points can mimic every symptom of degenerative disc disease. If your physician has ruled out degenerative disc disease, or you do not respond to the usual treatments for the disease, please consider the presence of untreated TrPs. Trigger points occurring in muscles—intervertebrals; quadratus lumborum; piriformis; or gluteus maximus, medius, and minimus—could be the culprit. © (Cooper and Miller, pg. 87)

The piriformis is a very small, deep muscle that extends from the side of the sacrum (lowest backbone, tailbone) to the top of the thighbone at the hip joint, passing over the sciatic nerve. When a short or tight piriformis is stretched, it can compress and irritate the sciatic nerve causing the pain of sciatica. Referred pain from the piriformis is felt in the sacrum, buttocks, and hip. A tight piriformis muscle can also put pressure on the pudendal nerve and cause pain in the groin, genitals, or rectum. In severe cases, piriformis syndrome could be responsible for buttock atrophy. The pain can cause altered gait and guarding, which can cause development of secondary musculoskeletal difficulties. Treatment of piriformis syndrome calls for releasing the entrapped sciatic nerve. I have found myofascial release and specific TrP treatments to be beneficial.(c) (Cooper and Miller, pg 103-104.)

Devin Starlanyl,  show cases 2010 research:

Aydemir K, Duman I, Tugcu I et al. 2010. Piriformis syndrome presenting with foot drop diagnosed with magnetic resonance imaging: a case report. J Musculoskel Pain. 18(3).261-264. Abstact at:

Comments from my mentor, friend and pioneer in understanding FM and the role of myofascial trigger points Devin Starlanyl.

“Piriformis syndrome can cause foot drop. Magnetic resonance imaging can help earlier diagnosis and treatment.” Piriformis syndrome is a description, not a diagnoses. The authors did not note that myofascial TrPs are the most common cause of this condition, and can cause foot drop as noted in Travell and Simons Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol II. Trigger points were not mentioned, although the authors noted the palpable mass that responded to steroid injection into the mass, resulting in resolution of the syndrome. It would have been interesting to see if the “mass” responded to TrP injection of local anesthetic. Steroids are undesirable and unhelpful in most TrP injections. DJS

I hope you found this information helpful.

Harmony and Hope, Celeste

Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper and Jeff Miller, Vermont: Healing Arts Press, 2010.

Fibromyalgia & Chronic Myofascial Pain: A Survival Manual, 2nd ed., by Devin J. Starlanyl, M.D., and Mary Ellen Copeland, M.S., M.A. Oakland, Calif.: New
Harbinger Publications, Inc., 2001.

Myofascial Pain and Dysfunction: The Trigger Point Manual by David Simons, Janet Travell, and Lois Simons, 2nd ed. Philadelphia: Lippincott Williams and Wilkins,


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dogkisses said...

Hi Celeste,

I had the MRI on my lower back. Also, I came back to this post and was surprised to read the second paragraph again, as it describes the exact location(s) of my pain.

I hope the new year brings a new treatment option for me. I want my body to work better and I would like to be on less medication as well. I want to write again and think.

I haven't sent my doctors any links yet. Paper work is rather overwhelming and I have my fair share.

Thanks for giving me this link.

Your blog is awesome! I can't believe it took me so long to start reading it.

Peace and Blessings,
Michelle (Rosa Blue).

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