In this issue, I�d like to discuss piriformis syndrome, one of the more interesting
conditions caused by spasm of a specific muscle. This syndrome is intriguing, not only
from a functional standpoint, but also from an anatomical perspective. The piriformis
muscle can cause pain when in spasm, like any other muscle. Things get complicated by
its relationship to the sciatic nerve, which runs close to�or even through�the piriformis
muscle and can be irritated or entrapped by muscle spasm.
Is it a herniated disc or piriformis syndrome?
Sciatic nerve entrapment can mimic lumbar disc herniation, complete with motor and
sensory neurological deficits. The piriformis muscle should be examined in all cases of
failed back surgery or, even better, before lumbar disc surgery is contemplated.
The piriformis muscle originates on the anterior aspect of the lower sacrum, crosses the
sacroiliac joint and, through its tendon, attaches to the posterior aspect of the greater
trochanter of the hip. Its mechanical importance arises from it being both an external
rotator of the hip and a stabilizer of the sacroiliac joint.
The piriformis is particularly important during the gait cycle as it helps guide the lower
sacrum through a complex rocking and rolling of the sacrum on moving axes between the
innominate bones. The intricacy of pelvic ring mechanics is awe-inspiring (See Dr. Wolf
Schamberger�s excellent coverage of this topic in his book, The Malalignment Syndrome:
Implications for Medicine and Sport. http://www.malalignmentsyndrome.com/theBook.htm
It is therefore hardly surprising that things can go wrong with the piriformis.
Of all the muscles involved in moving the legs and stabilizing the pelvis, the piriformis
seems to be one of the muscles that decompensates more commonly, perhaps because so
much is asked of it.
The piriformis muscle is a �postural� muscle (according to Janda). It therefore tends to
shorten when overloaded, becomes tighter, and develops trigger points. Piriformis muscle
trigger points refer pain in specific patterns (See Travell and Simons� Myofascial Pain
and Dysfunction�The Trigger Point Manual.) http://www.amazon.com/gp/product/0683307711/sr=8-1/qid=1151067841/ref=
pd_bbs_1/103-1899142-6805419?%5Fencoding=UTF8
How is piriformis muscle spasm treated?
There are a number of ways of treating piriformis muscle spasm: by manipulation, by
digital massage of the muscle belly through the rectum, by spray and stretch technique or
by various injection techniques. Piriformus muscle spasm generally responds well to
treatment, leaving a gratified patient and a satisfied physician.
However, on occasion, the piriformis muscle can be unusually irritable and unresponsive
to treatment. When this occurs, one must look beyond the muscle itself and ask why the
muscle is behaving in this way.
Could an interference field be involved?
Other mechanical stresses on the pelvis, such as innominate or sacral shears, or on the
lower extremity, such as fibular, ankle or feet somatic dysfunction, should be searched
for and treated. However, if the tight piriformis persists, it may be that the sympathetic
tone of the muscle, or even of the whole region, is increased. When this occurs, an
interference field in the ipsilateral lumbar sympathetic ganglia is likely present.
Another clue pointing to an interference field �behind� the piriformis syndrome is a pain
pattern extending beyond the referral pattern from piriformis trigger points and not
explainable by sciatic nerve entrapment. Pain felt above the iliac crest should make one
particularly suspicious.
Where does Neural Therapy come in?
Treatment of the interference field in the lumbar sympathetic ganglia is by injection of
procaine as outlined on page 188 of my book, Neural Therapy: Applied Neurophysiology
and Other Topics. http://www.rfkidd.com/booksite/order.html Alternatively, treatment
with a TensCam device (page 65 of the same book) is fast, safe and probably equally effective.
Interference fields in regional autonomic ganglia should always be considered when an
interference field (or somatic dysfunction) is particularly painful or difficult to treat.
Autonomic ganglion interference fields seem to develop when more than one interference
field is present in the region the ganglion innervates or when the afferent neurological
signals are particularly intense.
Sincerely,
Robert F. Kidd, MD, CM
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