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