Comprehensive management of piriformis syndrome
and sciatica pain
Depending on the severity of the patient’s
sciatica-type pain and other symptoms, a number of
treatment options may be recommended by a health care
professional. A comprehensive approach to managing
pain along the sciatic nerve from piriformis syndrome
may include a combination of:
Stretching exercise for piriformis
syndrome
A number of stretching exercises for the piriformis, hamstrings and hip extensors
may help decrease the painful symptoms along the sciatic nerve and return the
patient’s range of motion.
Piriformis stretch for sciatic nerve pain
- Lie on your back with both feet flat on the floor
and your knees bent. Pull your right knee
up to your chest, grasp the knee with your left
hand and pull it towards your left shoulder and
hold the stretch. Repeat for each side.
- Lie on your back with both feet flat on the floor
and your knees bent. Rest the ankle of your
right leg over the knee of your left leg. Pull
your left thigh toward your chest and hold the
stretch.
Each piriformis stretch should be held for 5 seconds
to start, and gradually increased to 30 seconds, and
repeated three times each day.
Hamstring stretch for sciatic nerve pain
There are a number of ways to stretch your hamstrings
(the large muscle along the back of the thigh).
- Place two chairs facing each other. Sit on
one chair and place the heel of one leg on
the other chair. Lean forward, bending at the hips
until you feel a gentle stretch along the
back of your thigh and hold the stretch.
- Lie on your back with both legs straight. Pull
one leg up and straighten by holding on
to a towel that is wrapped behind the foot until
you feel a mild stretch along the back of
your thigh.
Again, try to work up to holding each stretch for
30 seconds and repeat three times each day.
Ice and heat for piriformis syndrome
Ice
At the onset of pain, lie in a comfortable position on your stomach and place
an ice pack on the painful area for approximately 20 minutes. Repeat as needed
every 2 to 4 hours.
You may find it more helpful to combine a gentle massage
with the ice. Lie on your stomach and have someone
gently massage the painful area with a large ice cube.
If you apply ice directly to the skin (instead of a
cold pack), limit it to 8 to 10 minutes to avoid an
ice burn.
If specific activities are usually followed by increased
pain, it may be a good idea to apply ice immediately
following the activity.
Heat
Some people find it helpful to alternate cold with heat. If you use a heating
pad, lie on your stomach and place the heating pad on the painful area for
up to twenty minutes. Be sure to avoid falling asleep on a heating pad, as
this may lead to skin burns.
Physical therapy for piriformis
syndrome
In addition to basic stretching, a comprehensive physical therapy and exercise
program can be developed for each patient’s individual situation.
Deep Massage
Deep massage (manual release) by a physical therapist
is thought to enhance healing by increasing blood flow
to the area and decreasing muscle spasm.
Range of motion exercises
A physical therapist can develop a customized program
of stretching and range of motion exercises to help
stretch the muscle and decrease spasm.
Medications for sciatica pain
Since most episodes of pain include some type of
inflammation, non-steroidal anti-inflammatory medications
(NSAID’s) (such as ibuprofen or naproxen) may
help decrease inflammation in the affected area.
Injections for sciatica pain and
piriformis syndrome
For severe sciatica pain, a local anesthetic and
corticosteroid may be injected in directly into the
piriformis muscle to help decrease the spasm and help
alleviate the sciatica pain. The purpose of an injection
is usually to decrease acute pain to enable progress
in physical therapy. For persistent piriformis spasm
that is resistant to anesthetic/corticosteroid injections,
an injection of botulinum toxin (a muscle weakening
agent) may be useful.
Electrotherapy for piriformis syndrome
The application of electrical stimulation to the
rear with a transcutaneous electrical nerve stimulation
(TENS) unit or interferential current stimulator (IFC)
can help to block pain and reduce muscle spasm related
to piriformis syndrome.
By: John
P. Revord, MD
April 8, 2000
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