Do I Have Piriformis Syndrome?

Piriformis Syndrome differential diagnosis case study
Dr Barry L Marks
Chiropractor, Orange County, CA

This is a case study of a 41 year old female blogger with bilateral buttocks pain who has requested help diagnosing her problem after an unsuccessful course of treatment with her family medical physician. For background see the comments on this post: Piriformis Syndrome…a pain in the butt…

Dear Lisa,

I am sorry to hear of your plight.

The symptoms you describe can certainly be Piriformis Syndrome. There are a few other possibilities as well:

1. Gluteus muscle strain
2. Ischial bursitis
3. Lumbar disc disease

So how to rule them out?

Gluteus muscle strain:
· Clinch your “cheeks,” does it cause pain?
· Lift your knee towards your chest; does stretching your butt cause pain?
· Stand using a table for support or lie on your back, bend your knee at 90 degrees and slowly kick your leg backwards (donkey kick), does that hurt your buttocks?

If these are “yes” then a strain from Nordic trainer is possible.

Piriformis syndrome:
· Are you tender in the center of your buttocks muscles?

· When you put firm pressure into the center of your buttocks does it radiate pain downward or out to the hip area?

· Sit down and lift one thigh up. Reach down and grab your ankle and rotate your foot inwards towards the other leg (externally rotate hip), does this cause buttocks pain?

If these are “yes” then Piriformis syndrome is likely.

Ischial bursitis:
If the center of your buttocks is not unduly tender then try firm pressure on the area of your buttocks where you actually sit. Near the bottom of your buttocks just above the crease where it separates into your thigh you’ll find a bony prominence called the Ischial tuberosity. Firmly probe with your fingers all around that bony point. If it is painful, you may have bursitis.

Lumbar disc disease:
If direct palpation of the buttocks area does not produce pain try the following:

· Bend forward at the waist and try to touch your toes
· Sit and stretch your leg out in front of you
· Cough hard several times
· Lie on your stomach and bend your knee to bring your heel back towards your butt

If these do cause back, buttocks or thigh pain, then you may have a disc bulge or herniation.

Lisa, a competent doctor who specializes in musculoskeletal problems can easily differentiate between these conditions with a physical exam and a look at your x-rays.

Here is my very biased opinion as a Doctor of Chiropractic for over 22 years, a former Associate Clinical Professor at a leading Chiropractic College, a specialist with Post Doctorate Orthopedics training and someone who has worked along side medical physicians in a multidisciplinary Family & Urgent Care practice…

You need a competent chiropractor to evaluate you.

Your family doctor just does not possess the training and knowledge base to help with a musculoskeletal problem like yours. It’s not a knock on medicine; it’s just a fact that they have less training in this particular area. And the zenith of medical providers in medicine for muscles and joints, an orthopedist, will be very limited in his treatment options; more drugs, possibly physical therapy.

A good chiropractor will be able to evaluate you, try a period of treatment aimed at the working diagnosis and then assess your progress. After a brief clinical trial of treatment, if you are not responding, then your Chiro will want to change course and try something else or do further diagnostic testing like an MRI.

Here’s what I would try…

Assuming a physical exam that points towards Piriformis syndrome or other “muscular” problem:

• Heat and interferential electrical stimulation (IFC) surrounding the painful area for 12-15 minutes
• Very gentle post-isometric stretching of the Glute and Piriformis muscles
• 630 nM cold laser at 4,9,33 and 60 settings at the buttocks and thigh during the above stretching
• Chiropractic manipulation as needed of the pelvis and sacrum
• Ice for 10 minutes

I would do this treatment every other day for 2 weeks then re-evaluate.

You should see improvement in this short course of care.

If you do respond to this treatment:

• Continue at 2-3 times each week until the pain subsides and you can sit comfortably.
• Once you can sit comfortably, I would begin a course of rehabilitative exercises and stretches under your doctor’s supervision progressing to home care.

If there is no improvement at all:

• You may have a disc problem so I would order an MRI of the lumbar spine
• If the MRI scan shows dehydration (desiccation) and/or bulging of the L3, L4 or L5 disc, I would consider spinal decompression with a DRX9000

If you must take this path, let me know, because I may be able to find someone in your area within my decompression network whom I can refer you to.

Good luck and please feel free to contact me through this blog with further questions and/or updates of your progress.

Warmest regards,

Dr Barry L Marks
Chiropractor, Author & Lecturer

Car Accident Injuries…

Orange CA
Dr Barry L Marks Chiropractor
on Car Accident Inuries

Local ABC news in LA area to run story on car accident injuries today at 4 pm PST.

It will be interesting to see how they cover the story. I will be watching and will post a review soon.

Let me know if you watch and what your comments are.   

In the meantime, if you want more information on car accidents and car accident injuries, go sign up for my free online seminar available on this blog or go to http://www.truthaboutwhiplash.com

This is scientifc and medical information the auto insurance companies would rather not have you find out.

Car Accident Factoids

You may be hurt even if your car wasn’t

The human threshold for neck injury is only 2.5 mph

Cars can crashed over and over at up to 20 mph and show no damage

A collision of only 10 mph can cause 4x the normal threshold for injury

For more, visit the Free online seminar at http://www.truthaboutwhiplash.com

Dr Barry L Marks Chiropractor, Author and Lecturer has been specializign in car accident inuuries and whiplash for over 22 years. His specailized traignin in chirorapctic orthopedics and whiplash trauma makes him one of Orange County’s premiere car accident injury sepcialists.

Ladies, Don’t Let This Guy Into Your House…

Oh sure he may look good. And many of your friends and relatives might actually approve.

Seriously what’s not to like…

• He’s perfect
• He’s soft, but has just enough of a hard edge to him to keep him interesting
• He can go just about anywhere and is very versatile, so you don’t have to worry about him adapting
• He’s popular…everyone knows him and pretty much likes him. And the fact that he gets around, isn’t really a turn off because he’s just so sweet

But let me tell you the truth about this poser:

• He’s good while he’s with you, but he’s bad news for you
• He’ll cause you to be moody…when you’re with him great, but when he’s gone, you crash
• The more he’s around, the more you crave him, but he leaves you empty and searching for more
• You don’t gain anything meaningful from the relationship…it’s empty

So are you ready to meet this guy?…

Take a good long look at him. Burn the image into your mind so when you see him hanging around the grocery store, cafe or restaraunt you’ll run away before he gets into your blood stream. And be sure to share this with your friends and family. You don’t want them falling for this “wonder” guy.

Ok, so here’s his picture: click

“When Should Children Start Chiropractic Care…?”

Chiropractic Care for Children
I am often asked at what age should children begin chiropractic care. My gut response is… as soon as you learn it is important for the health of your child. But since I’m not that blunt; let me put it like this…

If you leaned that something conclusively caused cancer? Wouldn’t you avoid that product, food or activity– immediately?

If you learned your child had a potentially serious medical problem, wouldn’t you seek out a specialist– immediately?

What Kind of Parent are You?

Are you the kind of parent who believes that children should:

· Eat vegetables?

· Drink water?

· Take Vitamins?

· Go to bed on time?

· Brush their teeth?

· Wash their hands?

· Comb their hair?

· Change their underwear?

If you answered “yes” to at least most of these questions then you are a concerned parent and you want what is best for your children. You are probably the type of person who would want your kids adjusted regularly if you knew it would prevent health problems for them.

Consider this…

· Every living cell, tissue, organ and system of your body works because nerves tell them to.

· If you interfere with the vital flow of information from the nerves to the cell or organ, dysfunction will occur and health will be lost.

· A common cause of interference is in the spinal bones that protect the nerves called a “subluxation”.

· A subluxation is where two or more spinal bones become misaligned or stuck.

· Subluxations may not be painful at first and can accumulate over time due to stress, falls, sports, accidents, heavy work, etc.

· Everyone’s first subluxation occurs when they are born…the birth process causes stress upon the neck and often results in misalignment not readily detectable by pediatricians who are untrained in this area.

· If subluxations are not corrected, they degenerate slowly over the years and cause malfunction and premature damage to the spinal bones and nerves.

· Doctors of Chiropractic are the only health care practitioners specifically trained to locate and correct subluxations. No other doctor is trained in this field. By gently moving the spinal bones by hand to relieve pressure, your chiropractor is unraveling the root cause of your illness.

· Once subluxations are relieved, the body begins to repair itself and health is restored.

· Proper health requires periodic spinal hygiene, much like oral hygiene requires regular brushing and cleaning. You don’t allow plaque to build up on your teeth, so why would you allow subluxations to build up and cause spinal decay?

One last thing to consider… Did you know that many of the back and neck problems you suffer with as an adult began when you were a child? Save your child years of suffering… Don’t let your child’s spine decay.

So, now I’ll turn the question around to you…when should you have your children start chiropractic care?

Right now!

You may follow this link for a special offer for Orange County children and their parents:
http://www.drmarks.com/chiropractic_care_for_children.htm

OC Mountain Lion Warning!…?

Foothill Ranch, CA | South Orange County

A man allegedly has encounter with mother mountian lion when he tries to pet cubs!

Man escapes with lacerations that required stitches, but a Dept of Wildlife authority says the wounds are NOT consistent with a mountain lion aka cougar.

This is a sensitive subject for local residents because mountain lions have killed in the recent past within a mile or two of this location. Authorities have closed the Whtiting Ranch Wilderness Park while they hunt down the lion to relocate it to a wilderness area further South in San Diego County.

Personally, my BS meter is on high alert as this man is known to locals as a homeless man who lives in and around the local shopping center.

File this under “suspicious.”

See a video of the whole story:
http://abclocal.go.com/kabc/story?section=news/local/orange_county&id=6310231

“When You Must Eat Out…”

For many families, 1/3 of their meals are eaten out of the home. The problem with that is that your choices for truly healthy meals are nearly zero. Foods that are packaged for kids are ways to advertise the next blockbuster movie, not necessarily nourish your little ones.

The way we feed our kids is beginning to show up as real health problems.

Diseases on the Rise in Kids

• Obesity
• Type II diabetes
• Eating disorders
• Digestive problems; acid reflux, GERD
• Food allergies and sensitivities

The Problem with “Kids’ Meals”

• Packaging and “Free” toy inside is the most costly part…they should just give you the food for free!
• Meals come with drinks… soda is the last thing kids should be drinking
• Usually come with fries… a tasty concoction of fried fat and starch
• The more they get them, the more they want them

My Suggestions:

• Don’t order “meals” – buy ala cart
• Don’t buy drinks – empty calories from sugar with no redeeming nutritional value at all – drink more water
• If you do want drinks, then order unsweetened tea, milk or OJ
• Don’t order fries – delicious? Yes. healthy? Absolutely not. Probably the worst food available.
• Save soda, fries and other really bad foods as treats to allow on special occasions.

Best Fast Food Choices:
El Polo Loco or other broiled chicken
El Polo “BRC” (Beans, Rice and Cheese burrito)
Subway tuna or turkey on wheat bread
Salads as long as you don’t use all the dressing… cut it in half if you have to have it.
Starbuck’s fresh fruit and cheese plates, yogurt parfait, citrus fruit salad with almonds
McDonald’s yogurt parfait or grilled chicken sandwich

“Toxic Brains…”

There are so many things out there in our world toady that cause damage to our brains.

Environment
In the environment we have electromagnetic fields (EMF) from cell phones, power lines, computers and TV’s. All of which have been shown to cause some effect on the brain. Particularly sensitive are the growing brains of children. How much cell, TV and computer time do you expose your kids to each day.

Diet
Then there are the dietary pollutants that we afflict our brains with by ingesting preservatives (MSG and glutamate derivatives), and others.

Have you noticed how many “low sugar”products are on the market? In our quest to eat fewer calories from simple carbs like sugar to fight obesity and diabetes, we are eating huge amounts of artificial sweeteners (Aspartame), which many studies have shown are not good for us. And again, the affect of aspartame on growing brains is especially troublesome. In order to fight fat, we’re causing brain damage!

Trauma
Lastly, there is physical damage caused by trauma like auto accidents, sports injuries, slips and falls, etc. I’m not talking about overt head trauma either. Many studies have shown a relationship between low speed auto accidents and brain injury (MTBI). The sudden jerking of the neck causes the brain to slosh within the skull vault and cause stress on the brain. In sports, studies have concluded that “heading” the ball in soccer causes brain damage. More and more elite soccer players are developing brain ailments much like boxers. American Football players also are showing greater and greater signs of brain malfunction after retirement.

What to do about our toxic brains

• Limit cell use
• Limit TV and computer screen time
• Limit computer gaming
• Avoid artificial sweeteners (diet foods and drinks)
• Never allow children to eat or drink “low sugar” foods.
• Take a multivitamin and mineral everyday
• Take antioxidants (Vit A, C, E and others) each day
• Take Omega-3 fatty acids each day
• Avoid head trauma whenever possible
• After a head trauma make sure to take supplements designed to reduce the damage of chemical reactions in your brain associated with concussion

Please carefully consider the effect your environment, diet and physical activity has on yours and your children’s brains and take positive steps towards protecting them.

“The Wonders of Vinegar…”

Here’s a topic that was inspired by a question from my patient, Alex, who heard about vinegar for sore throats, but wanted to know of any other medical uses. Here are the ones I could come up with off the top of my head… ok, so some aren’t medicinal, like the one for ‘Pepe LePew”, but they do have to do with living a natural and healthy life, so excuuuuse me!

Common uses of vinegar:

• Use apple cider vinegar in warm water as a throat gargle. Rinse your mouth and brush your teeth after to protect the enamel of your teeth.
• A tablespoon or two of apple cider vinegar “straight up” for indigestion or for the tender foots out there, dilute in warm water and sip genteely.
• Vinegar can help the sting of a bee or jellyfish. 
• Apple cider vinegar is a good astringement for your face and hair to remove excess oils.
• Apple cider vinegar can be used as a skin toner.
• Vinegar is superior to tomato juice at getting rid of skunk spray.
• And everyone knows that white vinegar is an awesome natural household cleaner, ant poison, coffee pot de-gunker, soap scum remover, mineral deposit ridder, window cleaner, etc.

As always, thanks for the original question Alex, I hope this helps everyone. It really is better to remember the inexpensive, old home remedies before reaching for a bottle of toxic chemicals.

“5 Steps to get more fruits and vegetables into your diet:”

Here’s a message endorsed by your mom… See, she called me and told me you don’t eat enough fruits and veggies. She’s concerned because she’s been on the internet lately surfing sites like mine and she’s discovered that fruits and veggies can prevent a lot of health problems like heart disease, cancer, diabetes and obesity.

So to keep moms everywhere happy, I am writing to you.

I understand why you don’t eat enough of these foods and it’s strictly because of convenience. Am I right? I mean, if these things were packaged better, you’d eat more of ‘em.

Who wants to peel an orange in their car? Who wants to cut a watermelon at their desk at work? Trust me, I’ve done it and it’s messy!

Here’s the trick I use to get more fruits and veggies into my diet each day. Oh and by the way, with a little modification, this plan can help you save a ton of $$$. I’ll tell you that later.

5 Steps to getting more fruits and vegetables into your diet:

1. Buy lots of fresh fruits and vegetables, about a week’s worth
2. Wash and Cut all of it into bite size pieces
3. Separate out into daily portions and put into zip lock bags, keep in fridge
4. Each day grab 3-5 bags of various fruits and veggies and take them with you to work
5. Snack on the fruit all day (Mom says you can eat as much as you want…I agree)

Now here’s the $$ saver I promised.
How much do you spend on a lunch that is filled with bad stuff like cholesterol, additives, and useless simple carbs? Probably a lot. Instead of eating lunch out and spending $$$ on overpriced artery clogging junk, take a healthy and delicious lunch with you.

In addition to the fruit and vegetable bags, make up some bags with protein items to make a complete meal.

Proteins to consider:

• My favorite mix: unsalted walnuts and almonds (no smoked ones), dried cranberries and blueberries. This is awesome in yogurt
• Hard boiled eggs
• Tuna: either mix your own at home or ready to go pouches
• Salmon: prepare night before or ready to go packs
• Sliced chicken or turkey
• Ezekiel sprouted, gluten-free bread to put your tuna, salmon, chicken or turkey on

This will make your lunches more nutritious, which will make mom happy. You’ll also save on money, which will make you happy. you’ll have more to spend on gas!

The key to eating more fruits and vegetables is to make it more convenient. Pick one night a week or a weekend day to prepare food for the following week. Your fridge will be stocked with baggies of good food just waiting for you to mix and match and take with you. Go ahead and try it.