Symptoms of Piriformis Syndrome

Most commonly, patients describe acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Typical piriformis syndrome symptoms may include:

• A dull ache in the buttock
• Pain down the back of the thigh, calf and foot (sciatica)
• Pain when walking up stairs or inclines
• Increased pain after prolonged sitting
• Reduced range of motion of the hip joint

Other signs and symptoms reported include low back pain, diminished muscle stretch reflexes, diminished muscle strength, loss of sensation, resting external rotation of the hip, pain on rectal or vaginal palpation and dyspareunia.

 Sciatic Pain From Piriformis Syndrome

Because of the close proximity of the sciatic nerve to the piriformis muscle, it is possible for some cases of Piriformis Syndrome to irritate the sciatic nerve, causing sciatica symptoms. Anatomical variation in the relationship of the sciatic nerve to the piriformis muscle is often cited as a necessary prerequisite to the development of the condition. Normally the sciatic nerve exits below the muscle but, in some people, the nerve or a portion of it actually passes through or above the muscle, making more likely to be irritated by the piriformis muscle. There is some research that suggests that these anomalous arrangements occur just as frequently in asymptomatic individuals as in those with a diagnosis of Piriformis Syndrome, suggesting that anomalous anatomical arrangement is not a precursor.

Diagnosing Piriformis Syndrome

Special tests for this condition include the Piriformis test, the Freiberg's test (internal rotation and extension of the hip), the Pace's test (hip flexion with added abduction), and the Beatty's test (tonic contraction of the piriformis muscle in the side-lying position).

It is noteworthy that some refer to the Bonnet's test as a specific provocative procedure for Piriformis Syndrome. This test is described in various ways, with one version performed in like manner to the Piriformis test. Another version involves the addition of internal hip rotation to the Straight Leg Raise (SLR) test. However, it has been demonstrated that the addition of the internal rotation to the SLR test has the potential to aggravate the patient's sciatica, regardless of the aetiology.

Radiographic imaging (X-Rays) for Piriformis Syndrome is reported to be of limited value. Magnetic Resonance Imaging and Computed Tomography may reveal enlargement of the piriformis muscle, anatomical variations and localised oedema of both the muscle and the sciatic nerve. In addition, these imaging technologies help to rule out serious pathological conditions.

Given that Piriformis Syndrome is a controversial clinical diagnosis, clinicians should always seek to rule out other and more serious causes of buttock pain and sciatica. On the other hand, it may be important to consider the possibility that this syndrome exists to avoid the over-diagnosis of lumbar disc herniation and unnecessary spinal surgery.

Piriformis Syndrome Stretches

There are a number of ways to stretch one's piriformis muscle. Two simple and effective stretches include:

Lie on the back with both feet flat on the floor and both knees bent. Pull the right knee up to the chest, grasp the knee with the left hand and pull it towards the left shoulder and hold the stretch. Repeat for each side.

Lie on the back with both feet flat on the floor and both knees bent. Rest the ankle of the right leg over the knee of the left leg. Pull the left thigh toward the chest and hold the stretch. Repeat for each side.

Each piriformis stretch should be held for 5 seconds to start, and gradually increased to hold for 30 seconds, and repeated three times each day.

As Piriformis Syndrome is mostly due to an overly tight piriformis muscle, these exercises can prove to be very effective as they release tension and help to relax and lengthen the piriformis muscle.

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So how can you look after your pelvic alignment?

Firstly, being aware of the things that can be throwing your pelvis out of alignment. Do you cross you legs? Carry your wallet in your back pocket? Sit at your desk twisting to one side to see your computer monitor? Have a think about your day to day habits and see if you can identify any potential hazards.

Secondly, be active in your spinal health. HealthySpines.org Total Back Pain Solution outlines a simple exercise program that can be done in ten minutes,three times a week to maintain optimal spinal health, keeping your back strong, stable and flexible.

The following exercises may be of benefit to decrease pelvic misalignment. However, it is one of those problems that can become quite 'stuck' in place if it has been untreated and left to become chronic over time. 

1: Pulling your knee to your chest will help to stretch out tight hip muscles, and create some movement in the Sacroiliac joint if it is not moving enough. Hold for 10 to 30 seconds on both sides.

2: Lie on your back with your legs stretched out flat. Cross one foot over the other knee, then pull that leg towards your chest. Hold for 10-30 seconds then relax back down. You will feel a stretch, but it should not be painful, if it is then just back off a bit. Hold for 10 to 30 seconds on both sides.

3: Lying flat on your back, slowly attempt to raise one leg 6 to 12 inches off the floor and hold there for 10 seconds. Repeat on the other side.

This is also good to strengthen the abdominal muscles, which are important spinal stabilisers.

4: Start in a kneeling position, then sit back onto you feet.Stretch your arms out in front of you along the floor.

Feel the stretch in your low back and hold for 10 seconds.

5: Move back onto your hands and knees, then gently lift one leg behind you as far as you comfortably can.

Hold for 10 seconds then do the same on the other side.

6: Lie flat on your back with your knees bent. Notice that your lower back is arched up off the floor slightly.

Suck your tummy in, and press your lower back onto the floor and hold for 10 seconds.

7: Sit-ups are great for really getting your abs strong.

Lying on the floor as above, lift your upper body (head and shoulders) off the floor by curling up.

Don't try to lift to high, just enough to get your shoulders slightly off the floor. Repeat 10 times.

You can do more sets of 10 as you get better!

Try these pelvic alignment exercises out, just remember to go easy at first. If you are still concerned about your pelvic alignment, consult your health professional. Chiropractors and some physical/physio therapists are specifically trained to identify pelvic misalignment.

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What's The Catch?

The problem with any brace, whether it is a posture brace, or a back, knee, or ankle brace, is that you can quickly become dependant on them. What this means is that the brace will give you 'artificial' support, meaning in turn that your own muscles no longer need to do the job of providing support and a result, the muscles can start to weaken. This can actually make the problem you are trying to correct (poor posture, bad back, flat feet etc.) even worse. 

This is why it is crucially important that you wear your brace ONLY for short periods of time, around 30 minutes maximum. Of course a smarter way is always to actually strengthen muscles that are weakened or out of balance with other muscles. Particularly with poor posture and back pain, you must work on strengthening your posterior chain muscles. Healthyspines.org's Total Back Pain Solution online exercise program specifically shows you exactly what to do in order to strengthen these vital spinal stabilising and postural muscles.

So be sure to follow a postural exercise program as well as using your postural brace. This way you are guaranteed to get long lasting postural correction, not just a temporary fix.

Are There Different Types of Braces?

There are a number of different types of back braces for posture, from the cheap and simple, to expensive custom made braces, and even tech savvy braces that can connect to your smart phone.

If your doctor has addressed your posture with you, then they may recommend one of their favourite brands. They may also recommend that you have a brace custom made for you. For some people with special needs, such as scoliosis, this may be your only choice, but it could set you back hundreds or even thousands of dollars.

If there is one thing that most back braces have in common, it is that they are unattractive and not very comfortable. Especially the older styles of back braces, which were once used for people with back issues or pain, are particularly uncomfortable.

The Best Back Braces For Posture Correction.

HealthySpines.org recommends the following Postural Braces.

1/ The Smart Back Brace

The Smart Back Brace is a new product that was released in Dec 2016 and is using the latest technology to improve posture. It is unlike anything else on the market, and it’s not just a shoulder brace! It’s a smart, Bluetooth-connected device that trains you to stay in proper posture. It’s compatible with both iPhone and Android. This kind of tech does not come cheap of course, and this is one of the more expensive posture braces, running at around $100.

The Smart Back Brace was designed to provide the maximum benefits for you:

• Improve your posture by wearing SBB just 15-30 minutes a day
• Maintain your good posture by teaching your body how to hold it
• Better posture will make you feel better not only physically, but also mentally
• Actively monitors your posture.
• 30 day money back guarantee.
• Available for purchase here.

2/ComfyMed Posture Corrector Clavicle Support Brace

Probably the most comfortable posture brace available. The ComfyMed Posture Corrector Clavicle Support Brace features a new hybrid design combining the light weight and freedom of movement of a simple Figure 8 Brace with the support and comfort of a traditional full brace. This simpler posture brace is also a more economical choice.

• EASY TO PUT ON - The only brace that you can put on and adjust by yourself.
• STAND TALL AND CONFIDENT - For the Treatment and Prevention of Cervical and Thoracic Conditions such as bad computer posture
• UNISEX - SIZE REG 29" TO 40" - Measure your Chest under your arms.
• Money back guarantee.
• Available for purchase here.

Is This the Right Kind of Thing for You?

Whether you are looking at a back brace because you want an easy way to improve your posture, or because you are having back or other health issues that this can help you with, finding the right back brace for you is essential.

Ideally, this is not the device you would want to wear for a long period of time each day, because you could actually start relying on it.

But, by wearing a brace, you will be able to strengthen and retrain your muscles without building a dependence on the device.

Because these particular back braces come with a money back guarantee and is also a very affordable price, it is the preferred solution for people who really want to make a change in their posture quickly and effectively.

You will feel better while wearing modern back braces for posture, and your friends and family will also notice that you walk, stand, and sit straighter, too.

So as well as making sure you feel better now, with good spinal care you will be ensuring your future wellbeing too!

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The 4-7-8 Breath.

This technique calls on you to rest your tongue gently on the ridge of tissue behind your upper front teeth, then inhale quietly for a count of four through your nose, hold your breath for a count of seven, then exhale with a whooshing sound for a count of eight through your mouth.

Repeat it four times and you'll be amazed when you emerge feeling quieter and calmer.

What's important is the holding part, it actually flicks off the tap that is essentially pouring stress chemicals into your body.

Interestingly, the 4-7-8 breath has three specific effects over our stress levels:

1. The physical effect

If something happens in the environment, you go into this fight or flight mode – you can't concentrate and your heart is beating faster.

But if you can slow your breathing down it will slow down the other processes because most of them need oxygen to get going. So physically, you're telling your body to 'slow down'.

2. The concentration effect

The fact the 4-7-8 breath is not a rhythm and you have to hold it for quite a long period of time distracts you from your stressful thinking.

You really have to concentrate [on the counts] and it brings you into the present moment and calms you down.

3. The emotional effect

This breathing technique gives you a sense of control – if you can do the breathing successfully you're going to feel like you're doing something to change a situation.

That feeling of being in control of one part of your life is going to make you feel you can manage the other stress in your life better. A minute is all it takes!

When you're sucked in a stress vortex, it can feel like it will require weeks on a Caribbean beach to turn off the brain chatter. Techniques like the 4-7-8 breath prove that all you really need is a minute to change your hyperactive thought patterns.

You find that no matter what technique you use to slow down your breathing, a minute is about what it takes to feel a difference.

If you find it difficult to hold your breath for seven counts and exhale for eight, then Hall says you might like to start off with smaller counts.

Normally I get people to start with three or four seconds breathing in and three or four seconds breathing out, then work up to holding your breath in the middle.

Then you work up to breathing out for longer than breathing in and once you're good at that, switch to something like 4-7-8.

learning how to slow down your breathing is a lot like putting a lid on a bottle: it might not stop your anxiety instantly, but it will certainly stop more of it from gushing out.

Many anxiety sufferers breathe too fast and shallow. When confronted with a feared scenario they breathe rapidly which leads to increased shortness of breath and further hyperventilation. Typically, a stressful situation causes a bodily reaction, like hyperventilation, and our mind negatively reacts to the unpleasant sensation of hyperventilation, causing further stress and increased hyperventilation. Slow breathing can relieve anxiety and prevent you from having a panic attack, if you do it as soon as you notice yourself over-breathing or becoming anxious.

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Typical Spinal Fracture Symptoms

The main clinical symptoms of vertebral fractures typically include one or a combination of the following symptoms:

• Sudden onset of back pain
• Standing or walking will usually make the pain worse
• Lying on one’s back makes the pain less intense
• Limited spinal mobility
• Height loss
• Deformity and disability

The symptoms of a spinal fracture vary depending on the severity of the fracture, and it’s location. Symptoms may also include back or neck pain, numbness, tingling, muscle spasm, weakness, bowel/bladder changes, and even paralysis. Paralysis is a loss of the ability to move the arms or legs, and may indicate a spinal cord injury. However, it is important to know that not all fractures cause spinal cord injury/damage.

What Are The Causes Of Spinal Fractures? 

Car accidents (45{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), falls (20{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), sports (15{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), acts of violence (15{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}), and miscellaneous activities (5{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999}) are the primary causes of spinal fractures. Diseases such as osteoporosis and spine tumors also contribute to fractures.

Who Is Affected By Traumatic Spinal Fractures?

80{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999} of patients are aged 18-25 years.
Men are 4 times more likely to have a traumatic spinal fracture than women.

Types Of Spinal Fractures.

There are several different types of spinal fractures: Compression, Burst, Flexion-distraction, and Fracture-dislocation. Each of these types of fractures is described below. Other terms used to describe a spinal fracture include stable, unstable, minor, and/or major.

Compression Fracture: This type of fracture is very common in patients with osteoporosis, or patients whose bones have been weakened by other diseases (such as bone cancer). Each spinal vertebra can only absorb so much pressure. If there is a sudden force involving a lot of pressure on the vertebra, it may not be able to handle the stress and will collapse and fracture.
A wedge fracture is a subtype of compression fracture. With a wedge fracture, part of the vertebra—usually the anterior (front) part—collapses under pressure causing the vertebra to become wedge shaped.

Burst Fracture: Burst fractures are caused by a severe trauma, for example a car accident. They can happen when the vertebra is essentially crushed by sudden, extreme force. Unlike compression fractures, it’s not just one part of the vertebra that’s fractured. In a burst fracture, the vertebra is fractured in multiple places. Because the vertebra is crushed completely, bony fragments can spread out and cause spinal cord injury. Burst fractures are more severe than compression fractures.

Flexion-distraction Fractures: If you’re in a car accident where your body is pushed forward, you may get a flexion-distraction fracture. Your spine is made to flex forward, but if there’s a sudden, excessive forward movement that places incredible stress on the spine into flexion, it may break a vertebra or vertebrae. 

Fracture-dislocation: If you have any of the above fractures and the vertebra(e) moves significantly (dislocation), you have a fracture-dislocation. They can make your spine very unstable.

Fracture of the Transverse Process: Fractures of the transverse processes of the lumbar spine are considered relatively common with blunt force trauma associated with contact sports and motor vehicle accidents (MVA).  Transverse process fractures may also arise as a result of avulsion (the bone being broken and pulled off by the muscle) from forceful muscle contractions involving the quadratus lumborum or psoas major muscles. In the absence of abdominal trauma and when the fracture is non-displaced, transverse process fractures are considered benign with a return to normal activities after 4 to 6 weeks.

The risk of internal organ damage is high in cases where the mechanism of onset is MVA, although these complications are usually found in cases with multiple fractures involving the pelvis and the ribcage. 

Stable and Unstable Fractures

Stable fractures don’t cause spinal deformity or neurologic (nerve) problems. With a stable fracture, the spine can still carry and distribute your weight pretty well (not as well as if there weren’t a fracture, but it’s still able to function with a stable fracture).
Unstable fractures make it difficult for the spine to carry and distribute weight. Unstable fractures have a chance of progressing and causing further damage. They may also cause spinal deformity.

Major and Minor Fractures

Minor fracture means a part of the posterior (back side) elements of the vertebra has broken—parts of the spine that are not as important to spinal column stability, or stability at the fractured level. The posterior elements include the spinous process and the facet joints (also called the articular processes). If you fracture this part of the vertebrae, it’s usually not too serious.
Major fracture means that part of the vertebral body, the pedicles, or the lamina has fractured. Fracturing the vertebral body is considered major because it helps carry so much weight and distribute the force of your movements. If it’s broken, you can have serious problems with the vertebrae lining up correctly. Fracturing the pedicles or lamina is dangerous because of the increased possibility of nerve damage. Additionally, the pedicles and lamina provide a lot of necessary support to keep your spine stable. If they fracture, your spine may be unstable.

Spinal Fracture Risk Factors

Aside from partaking in risky activities or extreme sports, the biggest risk factor for spinal fracture is due to a decrease in bone density. If your bones are slowly becoming weaker, possibly due to osteoporosis or osteopenia, it is not something that you notice or feel. Unfortunately for most people, the first indication that they are losing bone density is from a spinal compression fracture. The following list indicates several risk factors for spinal fracture.

Aging: As we age, our bones naturally lose some density and become weaker, so the risk for fractures increases.
Being female: Bone loss is more common in women, especially post-menopausal women. Women lose bone mass at an accelerated rate in the first 5-7 years after menopause. During menopause, women experience a steep drop in estrogen, which is a female sex hormone that protects bones. When estrogen levels decrease, bones may lose density and become prone to fractures.
Having a pre-existing spinal fracture: It sounds obvious, but having one spinal fracture greatly increases your chances of having another. Over time, multiple fractures can cause a loss of height, and you may notice your spine starting to hunch forward. Your doctor may refer to this forward curve as a condition called kyphosis.
Unhealthy lifestyle habits: Smoking, drinking large amounts of alcohol, and not exercising can all affect healthy bone density. Smoking and heavy alcohol consumption affects your body’s ability to absorb calcium. Living a sedentary lifestyle makes bones weak, making them prone to bone loss.

How is a diagnosis made?

In most cases of a spinal injury, paramedics will take you to an emergency room (ER). The first doctor to see you in the ER is an Emergency Medicine specialist who is a member of the trauma team. Depending on your injuries, other specialists will be called to assess your condition. The doctors will assess your breathing and perform a physical exam of the spine. The spine is kept in a neck or back brace until appropriate diagnostic tests are completed.

X-ray test uses x-rays to view the bony vertebrae in your spine and can tell your doctor if any of them show fractures. Special flexion and extension x-rays may be taken to detect any abnormal movement.

Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of your spine. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. It is especially useful for viewing changes in bony structures.

Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your spine. Unlike an X-ray, nerves and discs are clearly visible. It may or may not be performed with a dye (contrast agent) injected into your bloodstream. MRI is useful in evaluating soft tissue damage to the ligaments and discs, and assessing spinal cord injury.

 

What treatments are available?

Treatment of a fracture begins with pain management and stabilization to prevent further injury. Other body injuries (e.g., to the chest) may be present and need treatment as well. Depending on the type of fracture and its stability, bracing and/or surgery may be necessary.

Braces & Orthotics do three things, 1) maintains spinal alignment; 2) immobilizes your spine during healing; and 3) controls pain by restricting movement. Stable fractures may only require stabilization with a brace, such as a rigid collar (Miami J) for cervical fractures, a cervical-thoracic brace (Minerva) for upper back fractures, or a thoracolumbar-sacral orthosis (TLSO) for lower back fractures. After 8 to 12 weeks the brace is usually discontinued. Unstable neck fractures or dislocations may require traction to realign the spine into its correct position. A halo ring and vest brace may be required.

Instrumentation & Fusion are surgical procedures to treat unstable fractures. Fusion is the joining of two vertebrae with a bone graft held together with hardware such as plates, rods, hooks, pedicle screws, or cages. The goal of the bone graft is to join the vertebrae above and below to form one solid piece of bone. It may take several months or longer to create a solid fusion.

Vertebroplasty & Kyphoplasty are minimally invasive procedures performed to treat compression fractures commonly caused by osteoporosis and spinal tumors. In vertebroplasty, bone cement is injected through a hollow needle into the fractured vertebral body. In kyphoplasty, a balloon is first inserted and inflated to expand the compressed vertebra before filling the space with bone cement.

Vertebral fractures can be a serious health problem, particularly if the spinal cord or internal organs are damaged/injured. Usually the sudden onset of pain is a strong indication for the possibility of spinal fracture, and professional medical help should be a priority.

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