Natural treatment for hip tendonitis causing a sciatica.

sciatique-tendiniteSciatica or sciatic pain can be caused by a gluteus medius tendonitis or the piriformis muscle.

According to the Journal of the American Osteopathic Association, 6% of patients complaining of lower back pain are actually suffering from piriformis syndrome.

Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction.

Piriformis syndrome is most common in middle age. Women are more susceptible to the syndrome than men. This is likely because the wider girth of the female pelvis puts more strain on the muscles and nerves in that region.

The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve.

Piriformis syndrome is a peripheral neuritis of the sciatic nerve caused by an abnormal condition of the piriformis muscle.

It is estimated that at least 6% of patients who are diagnosed as having low back pain actually have piriformis syndrome. Delay in diagnosing piriformis syndrome may lead to pathologic conditions of the sciatic nerve, chronic somatic dysfunction, and compensatory changes resulting in pain, paresthesia, hyperesthesia, and muscle weakness.

The piriformis muscle is innervated by spinal nerves S1 and S2—and occasionally also by L5.

In as much as 96% of the population, the sciatic nerve exits the greater sciatic foramen deep along the inferior surface of the piriformis muscle.

In as much as 22% of the population, the sciatic nerve pierces the piriformis muscle, splits the piriformis muscle, or both, predisposing these individuals to piriformis syndrome. The sciatic nerve may pass completely through the muscle belly, or the nerve may split—with one branch piercing the muscle and the other branch running inferiorly or superiorly along the muscle.

Rarely, the sciatic nerve exits the greater sciatic foramen along the superior surface of the piriformis muscle.

There are two types of piriformis syndrome :

  • Primary piriformis syndrome has an anatomic cause, such as a split piriformis muscle, split sciatic nerve, or an anomalous sciatic nerve path.
  • Secondary piriformis syndrome occurs as a result of a precipitating cause, including macrotrauma, microtrauma, ischemic mass effect, and local ischemia.

Among patients with piriformis syndrome, fewer than 15% of cases have primary causes.

Causes of piriformis syndrome :

Piriformis syndrome is most often caused by :

  • Macrotrauma to the buttocks, leading to inflammation of soft tissue, muscle spasm, or both, with resulting nerve compression.
  • Microtrauma may result from overuse of the piriformis muscle, such as in long-distance walking or running or by direct compression. An example of direct compression by men is the wallet neuritis : repetitive trauma from sitting on hard surfaces.

Piriformis syndrome, gluteal tendonitis symptoms :

The most common presenting symptom of patients with piriformis syndrome is increasing pain after sitting for longer than 15 to 20 minutes. Many patients complain of pain in the buttocks. 

Patients may complain of difficulty walking and of pain with internal rotation of the leg, such as occurs during cross-legged sitting or ambulation.

Pudendal nerve and piriformis syndrome

The pudendal nerve has branches in the regions of the rectum, perineum and the clitoris or penis. The rear end of the pudendal nerve exits at the base of the piriformis muscle.

This placement makes the pudendal nerve susceptible to any irritations the muscle may be causing the sciatic nerve.

Differential diagnosis of piriformis syndrome :

Piriformis syndrome may mimic other conditions.

A complete neurologic history and physical assessment of the patient is essential for accurate diagnosis. This history and physical assessment should encompass any trauma to the buttocks and the presence of any bowel and bladder changes.

  • an osteopathic structural examination with special attention to the lumbar spine, pelvis, and sacrum, as well as any leg length disparities
  • the diagnostic tests previously mentioned
  • deep-tendon reflex testing and strength and sensory testing

My specific osteopathic treatment for gluteal tendonitis and piriformis syndrome

Fabien Claude-Storz, Osteopathic manipulative techniques in Hong-Kong and Paris include high velocity low amplitude, muscle energy, counterstrain, myofascial release, craniosacral, and lymphatic drainage.

Articulatory osteopathic manipulation techniques are applied by advancing and retreating from a restrictive barrier in a repetitive manner to advance that barrier and increase the range of motion.

High velocity, low amplitude technique is most often used in cases of piriformis syndrome to correct associated sacral and pelvic somatic dysfunctions.

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Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am. 1999;81:941-949.

Sciatica, gluteal tendonitis, piriformis syndrome