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Pediatric Orthopedic surgeons  who treat Piriformis Syndrome

Piriformis Syndrome

Piriformis Syndrome happens when the sciatic nerve is compressed by the piriformis muscle, which is deeply buried in the buttock. Low back pain extending down one or both legs is associated with this condition. 

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Piriformis Syndrome Definition

Piriformis SyndromeStopping persistent pain from Piriformis Syndrome takes a skilled doctor to diagnose the condition.  Hip and/or buttock pain on one side of the body, together with low back pain that extends down one or both legs, are the telltale signs of this condition. Piriformis syndrome is problematic since sciatica is frequently confused with it. Although the function of the sciatic nerve is affected by both illnesses, sciatica is the outcome of spinal malfunction such as a herniated disc or spinal stenosis.

On the other side, piriformis syndrome happens when the sciatic nerve is compressed by the piriformis muscle, which is deeply buried in the buttock. The ability of your doctor to discern between this condition and genuine or discogenic sciatica depends on their knowledge of the sciatic nerve’s anatomy, physiology, and link to the piriformis muscle. At Medical City Children’s Orthopedics and Spine Specialists, we are specialists in this field.

Piriformis Syndrome Anatomical Information

The piriformis muscle joins to a bony knob on the femur (thigh bone) at the outermost region of the hip from its origin at the front of the sacrum, close to the sacroiliac joint capsule. The piriformis assists in external rotation and abduction of the hip, which are technical terms for turning a hip outward and bringing a thigh out to one side when a hip is bent — like when your child raises a knee and extends a leg to exit a car seat. Additionally, it provides support for standing, running, and walking. The sciatic nerve often descends on the back of the leg immediately beneath the piriformis muscle. But in certain people, the sciatic nerve travels straight through the piriformis, making them more susceptible to piriformis syndrome, also known as piriformis sciatica (as opposed to true, or discogenic, sciatica).

What Distinguishes Sciatica from Piriformis Syndrome?

Even though both illnesses affect the sciatic nerve and are occasionally connected, they are distinct. Sciatica may occur because of a herniated disc or spinal stenosis. The lower back is often where the symptoms are most prevalent, although they can also impact the leg and buttocks. Piriformis syndrome only involves one portion of the sciatic nerve in the buttock being compressed by the piriformis muscle. Though in a more localized location, it might resemble sciatica in some ways.

QUESTIONS AND ANSWERS

What constitutes Piriformis Syndrome, and what symptoms should parents look for?

Piriformis Syndrome refers to a neuromuscular disorder characterized by pain, tingling, or numbness in the buttocks, often radiating down the leg. In children, symptoms may include pain in the buttocks or hip region, discomfort while sitting or engaging in physical activities, and occasionally, sciatic-like symptoms such as leg pain or tingling. It’s essential to recognize these symptoms and seek medical attention for an accurate diagnosis.

What are the treatment options for Piriformis Syndrome in children, and how can we help manage our child's symptoms at home?

Treatment for Piriformis Syndrome in children typically involves a combination of conservative measures. These may include rest, physical therapy to stretch and strengthen the piriformis muscle, and anti-inflammatory medications for pain relief. Home management may involve applying ice or heat to the affected area, ensuring proper posture, and avoiding activities that exacerbate symptoms. In some cases, a healthcare provider might recommend specific exercises or stretches for the child to perform regularly.

Does Piriformis Syndrome mean that my child will suffer with it for a long time, and what can we do to prevent it from recurring?

The prognosis for Piriformis Syndrome in children generally responds favorable with appropriate treatment. Many children experience improvement with conservative measures and lifestyle modifications. It’s crucial to follow the healthcare provider’s recommendations for rehabilitation and activity modification. Preventative measures may include maintaining a healthy lifestyle, incorporating regular stretching and strengthening exercises, and paying attention to proper posture and body mechanics during activities. If the symptoms persist or recur, further evaluation may be needed to address any underlying issues.

Parents should consult with a healthcare professional for personalized advice and guidance based on their child’s specific condition. In some cases, additional imaging studies or consultations with specialists may be recommended to rule out other potential causes of the symptoms.

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Causes of Piriformis Syndrome

Your child’s piriformis syndrome may have an anatomical cause. Primarily, this condition is the combination of a split sciatic nerve, a split piriformis muscle, and/or an abnormal sciatic nerve route. Secondarily, piriformis syndrome is far more frequent and is brought on by inflammation of soft tissues, muscular spasms, or both, which compresses the nerve. Inflammation, scarring, and contractures of the piriformis muscle can result from direct trauma to the buttock. A significant incident like a vehicle accident or a tumble might have caused this. However, the piriformis muscle gradually stiffening as a result of inadequate muscular conditioning probably provides the most frequent reason. Patients with piriformis syndrome frequently engage in activities like long-distance running or extended standing without properly stretching and strengthening their piriformis muscles.

Symptoms of Piriformis Syndrome

Sciatica occurs as the primary symptom of piriformis syndrome. This condition causes nerve pain, burning, numbness, pins, needles, or tingling that originates in the buttocks and travels down the back of the leg. It may feel electric-like and firing. Additionally, people may have pain or discomfort there. Due to the nerve’s position, sciatica pain occurs frequently deep in the buttocks. It frequently becomes worse when treatment does not occur.

  • sitting
  • running
  • walking
  • bending the knee completely
  • rotating the hip outwardly

Piriformis syndrome patients frequently experience persistent hip or buttock pain that grows worse with hip motion. Long durations of sitting or lying in postures that impose pressure on the buttocks cause pain.

The Risk Factors for Piriformis Syndrome?

There are several risk factors that might increase a person’s likelihood of developing piriformis syndrome.

  • According to some research, girls are 6:1 more likely than males to experience piriformis syndrome because of anatomical variations.
  • Anatomical variations in the sciatic nerve’s connection to the piriformis muscle may cause this condition. For example, in certain individuals, the sciatic nerve passes through the piriformis muscle, perhaps increasing the risk of sciatic nerve compression.
  • The sciatic nerve may get compressed or entrapped as a result of direct trauma or damage to the buttock region, which can result in swelling, hematoma development, or scarring.
  • Long periods of sitting can cause compression of the sciatic nerve. Due to its tendency to develop in those who frequently sit against their wallets while on a hard surface, piriformis syndrome has also been referred to as “pocket sciatica” or “fat wallet syndrome.”
  • Inflammation, spasm, and hypertrophy (enlargement) of the piriformis muscle can result from overuse or repeated motions, such as those involved in long-distance walking, jogging, cycling, or rowing. This might make sciatic nerve pain or entrapment more likely.

Diagnosing Piriformis Syndrome?

Our doctors will conduct a medical assessment. To assess your child’s level of pain, the doctor will place the injured limb in a variety of postures. Additional testing will occur if it is believed your child’s sciatica is being caused by something other than piriformis syndrome. The diagnosis of this condition cannot be made with a CT or MRI scan. But these tests can reveal whether something else is putting pressure on the sciatic nerve.

Tips for Avoiding Piriformis Syndrome

Piriformis syndrome can sometimes stop if the patient maintains good posture and uses the correct form when engaging in physical activity. Before engaging in any physical exercise, always warm up and gradually build intensity. Avoid exercising or jogging too much on slopes or uneven surfaces. If your child has significant pain, take a break from what he or she is doing and recommend your child take some time to relax.

Treatment Options for Piriformis Syndrome

Ice Pack or Ice Massage

Take some time to apply ice to the affected area as soon as your child gets sciatica or pain in his or her buttocks. Put your child in a comfortable posture lying on his or her stomach. For 20 minutes, apply an ice pack to the painful region. Repeat as often as necessary, every 2 to 4 hours. An ice massage, if feasible, might also help. Gently massage the region with a big ice cube while your child is lying on his or her stomach. To prevent having an ice burn, keep the massage to less than 10 minutes. Ice the area after the activity, not before.

Heat Therapy

Alternating between hot and cold temperatures can reduce discomfort for some people. For up to 20 minutes, while your child is lying on his or her stomach, apply a heating pad to the affected area. Avoid dozing off on a heating pad to avoid burning.

Anti-inflammatory medication

Ibuprofen and other over-the-counter anti-inflammatory drugs help alleviate pain and reduce swelling.

Electrotherapy

To relieve pain and reduce piriformis muscle spasms, electrical treatment with a transcutaneous electrical nerve stimulation device or interferential current stimulator can also help.

Stretching and Physical Therapy

Progressive muscle stretching provides a key component to an effective therapy for piriformis syndrome. In order to relax the piriformis, hamstring, and hip muscles, enhance flexibility, regain range of motion, and promote muscle healing, your doctor may have your child perform some simple stretching exercises. Additionally, a thorough physical therapy regimen that incorporates deep massages and range-of-motion exercises can lessen muscular spasms and improve blood flow to the region, promoting further recovery. Stretching and physical therapy is the most effective treatment for piriformis syndrome.

Piriformis Injections

Your doctor may occasionally provide an injection right into the piriformis muscle. Using topical anesthetics and corticosteroid creams may reduce the pain. Your doctor could suggest Botox injections in extreme situations to relax the muscles and relieve strain on the sciatic nerve. Both injections are intended to reduce pain sufficiently for your child to stretch the piriformis muscle and get physical treatment, leaving the muscle relaxed and extended when the injection wears off.

Surgery

After treating the condition with all of the options and the pain remains, your doctor may in rare instances, suggest surgery to finally stop the pain.

Piriformis Syndrome Exercises

  • Exercises that combine stretching and strengthening are crucial.
  • As soon as your child feels comfortable, start stretching exercises. But only when pain permits.
  • Flexibility enhancement lessens strain on the nerve. It should therefore lessen pain.
  • Your child may also start doing exercises to build up hip muscles, particularly the piriformis. As a result, the muscle will get stronger and better able to handle any demands imposed on it in the future.
  • Children should use muscular energy strategies to increase muscle stretch.
  • It’s vital to stretch the hamstrings, groin, hip abductors, and lower back in addition to the specialized exercises.

Summary

Sciatic nerve entrapment by the piriformis muscle refers to piriformis syndrome. The condition may only last momentary or it may continue for days and weeks producing aches, tingling, numbness, and pain. People can treat their conditions at home or in conjunction with a doctor, depending on the severity of the ailment. Both exercises and some drugs can help. In extreme situations and after every other treatment has been tried, the doctor may suggest surgery as an option.

As pediatric orthopedic doctors, our doctors at the Medical City Children’s Orthopedics and Spine Specialists are experts in treating piriformis syndrome in children.  Give us a call to make an appointment and we will help your child get back to normal without any pain. For your convenience, we have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX.

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Footnote:

WebMD: Piriformis Syndrome

 

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