Could your back pain be piriformis syndrome?

According to the World Health Organization, every year over two million people in North America undergo MRI scans to determine the origin of their leg and lower back/buttock pain. The term sciatica is often used to describe the problem and about 300,000 try to solve it through lumbar spine surgery. Unfortunately, the success rate is low and many find no relief from the pain or symptoms.

Where is the piriformis muscle located?
The piriformis sits around the hip and thigh and is involved in turning the hip out (external rotation). Though small in comparison to other muscles, it is crucial to providing a full range of motion. The piriformis courses behind the hip joint where the muscle and tendon have an intimate relationship with the sciatic nerve.
As the largest nerve in the body, the sciatic nerve supplies the lower extremities with motor and sensory function. The tendon of the piriformis and the sciatic nerve can cross behind the hip joint, in the deep buttock. Each structure is about one centimetre in diametre.

How is the pain caused?
It is thought that in some instances, the piriformis muscle may be tethering the sciatic nerve and causing irritation and friction to the nerve. This theory, although not proven, suggests that when the piriformis muscle is too tight the sciatic nerve is compressed, and it is this pressure that may lead to a decrease in blood flow to the nerve.

How is piriformis syndrome pain different from a herniated disk?
The pain from a herniated disk, usually from a lateral posterior herniation of L5-S1 or L4-5 often has back pain with radiating leg pain. Unlike the herniated disk pain, often in piriformis syndrome the pain in the buttock predominates and can even radiate to the ankle or mid-foot and can affect all five toes. This pain is relived while standing and walking but is worse with sitting and stationary activities.

Natural ways to treat the pain:
Before resorting to prescription drugs, try using these natural remedies:

  • Curcuma :You’ll want to opt for capsules of standardized extract that contain 97% pure curcumin. Curcuma longa, a perennial herb, is a member of the zingiberaceae (ginger) family. And dried curcuma longa is the source of the spice turmeric, giving curry powder its yellow colour.
    But before you reach into your cupboard, several studies published suggest the curcumenol must be standardized for any analgesic effects. Most of the research on turmeric related to pain leans towards neuropathic pain associated with diabetes, however, since it’s a highly safe compound, try 250-500mg per day.
  • Fish Oil: In addition, the use of Fish oil 2000mg of EPA may be added to the regime for synergistic benefit. Studies in the journal of Surgical Neurology (May 06) address fish oil as a safer alternative to using traditional NSAIDs (non-steroidal anti-inflammatory drugs).
  • Valerian: It could also be used at night for easing tension and for general pain relief. It contains substances known as volatile oils that work together to make you Sleepy and relax your muscles.

In the December issue of the Journal of American Medicine, a meta-analysis of 16 studies with 1093 subjects displayed positive results for sleep without side effects. The main causes of the sleep disturbances were associated with chronic pain.
Keep in mind, the research pulled for this article is being applied to sciatic pain. More research needs to be done directly to show positive causative effects of these compounds on piriformis pain specifically. Ultimately, these substances are safe and have the potential as therapeutic agents for the pain associated with piriformis syndrome or discogenic neuropathies.

Suggested treatment plan:

  • Use heated water bottles or pad for acute piriformis related pain
  • Take 300mg of Magnesium daily
  • Take 150mg of valerian before bed
  • Take Fish oil 2000 mg of EPA
  • Take 250-500 mg of turmeric

Stretching exercises to relieve pain:
If the pain is in the right buttock, cross your right leg over your left knee sitting straight up and push gently on the knee for 30 seconds. Repeat this three to five times, alternating legs, once in the morning when you wake up and once before bed.

Your next steps:
Be sure to talk to a qualified practitioner before using any treatment plan. Naturopathic doctors and chiropractors can help you integrate the appropriate measurements and remedies that are right for you.

George Tardik B.Sc.(hon), RHN, RNCP, (ND cand.) has been practicing nutrition for 10 years. He is a fourth year intern at the Canadian College of Naturopathic medicine’s RSNC clinic. He’s been featured on CBC’s Newsworld, Marketplace and Sports Journal. George specializes in metabolism, weight-loss, diabetes and sports nutrition. He practices out of Nature’s Source. For booking appointments, please call 416.242.8500.