Friday, February 17, 2012
I received an interesting email from a lady with the following described signs/symptoms:
Hope you can send me in the right direction. For about 6 weeks I have suffered pain in my right buttock with tingling and pain down my right leg and into the calf of my leg. After reading all the posts that have been sent to you I can understand that my symptoms are likely related to the sciatic nerve. I did not have a fall but simply overdid fast walking which I think is the cause (the music in my headphones was quite lively!). Have been to the physical therapist which made it really hurt, been to the doctor who prescribed a lot of ibuprofin and a muscle relaxer. This is painful when I have to stand still but not when walking. It is painful when sitting for a long period of time. I can bend in any direction and the spine works fine with no pain. After reading online I thought perhaps it might be piriformis syndrome. I see that others recommend Stretching for that. However, you often tell people to avoid stretching because it makes sciatica worse. What to do? Are there certain diseases that can cause this (I had a bladder infection about two weeks after the pain started and took the medication for that and that is gone.) Thanks for your help.
THOUGHTS ABOUT DIAGNOSING AND TREATING PIRIFORMIS SYNDROME
Your self-diagnostic train of thought is remarkably intuitive. It would seem logical that you do not have a lumbar disk problem causing the sciatica, although there are rare cases of such that present with absolutely no back pain. I think you're very likely to have a "Piriformis Syndrome". Stretching is indeed an important aspect of treatment for such in the long run. However, it is often very much contra-indicated in the initial treatment phase because it could very well have been the long strides (during your fast walking exercise) that over-stretched the Piriformis, causing the initial and likely current spasm. You will almost certainly benefit from appropriate physiotherapy modalities like electrical muscle stimulation over the belly of the muscle and perhaps some deep-pressure massage to relieve the spasm. Sleeping, especially on the side could be irritating the condition and it might be advisable to place a large, fluffy, pressure-reducing foam pillow between your knees to relieve the stretching on the piriformis muscle. The side that is is up, is the side that will get stretched. I personally use and recommend the Nimblepedic Comfort Touch Memory Foam Pillow for this purpose.
Anti-inflammatory meds and muscle relaxors I find to be pretty useless in these cases. Stretching will often irritate until the initial spasm is overcome. This is because stretching the tight muscle often forces it into contact with an already inflamed sciatic nerve. In the long run you might need to have your gait evaluated to note whether there is a problem with shoes or bio-mechanical dysfunction of the foot and ankle that might have led to the onset. For example, pronation, a functionally short leg, or toeing out while walking can all be related. Shoes and/or orthotics can often be a sensible solution. I suspect that the reason walking is not seeming to exacerbate the pain is because you are not being as overzealous with your stride as you were before. However, this does throw up a red flag that makes us want to make sure that your lower abdominal or pelvic organs are not referring pain down your leg. You should have a good evaluation from you internist as well.
When it comes to conditions affecting nerves from the lumbo-sacral area, the nervous system regulation of organs in that region can be affected, leading to a weaker organ that is more prone to infection. Although it may have indeed been coincidental, either condition could have impacted the other.
I think this case is an interesting one that a lot of folks might relate to, so I decided to make a post of my advice to her.