Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
As one of six muscles in the lateral rotator group of the gluteal region, the piriformis muscle serves as both a rotator and an abductor, depending on the position and posture of an individual. Yet, the orientation of the muscle as it runs deeply through the buttock can sometimes result in irritation or compression of the sciatic nerve, as it is positioned vertically beneath the muscle. As a result, individuals experience pain in the hip, buttock and hamstring that may extend down the back of the leg and into the foot. Similar to sciatic pain, this is known as piriformis syndrome.
While the causes of piriformis syndrome involve tightening and inflammation of the muscle, irritation, injury or bleeding in the area surrounding the muscle can also contribute. In turn, biomechanical components can play a role, such as over pronating feet that results in overuse of the muscle. Thus, classifying piriformis syndrome involves eliminating other possible causes (herniated disc and sacroiliac joint dysfunction) and noting specific pain patterns and movements that cause increased pain. Some of the more common symptoms associated with piriformis syndrome are listed below:
- Aching in the buttock (usually on one side)
- Pain extending down the back of the thigh, calf or foot (sciatic nerve pain)
- Pain when walking upstairs
- Pain after sitting for a long time (pain is relieved when lying down)
- Impaired range of motion in the hip joint
Diagnosis of piriformis syndrome requires careful assessment of a patient’s medical history, present lifestyle, activities and muscle habits. Yet, clinical testing aimed at stretching the piriformis muscle (FAIR testing: flexion, adduction and internal rotation) and provoking the sciatic nerve provide invaluable diagnostic information for physiatrists for treatment and rehabilitation.
Treatment and Rehabilitation for Piriformis Syndrome
Early treatments of piriformis syndrome will likely focus on pain management and reducing suspected inflammation. Under the direction of a physiatrist, this is accomplished through a combination of conservative methods including rest, ice or heat therapy, ultrasound, electrical stimulation, TENS machine or steroid injections. Once pain and inflammation are at bay, patients are better able to tolerate rehabilitation.
Treatment and rehabilitation for piriformis syndrome may include any of the following:
- Re-alignment of the pelvis and spine
- Joint mobilization to restore range of motion
- Massage to release muscle tension, spasms and increase blood flow
- Acupuncture, dry needling (reduces muscle tension)
- Core stability and hip strengthening exercises
- Assistive devices, including orthotics to restore foot and lower extremity alignment
While physical therapy and conditioning play a critical role in rehabilitation, physiatrists emphasize the power of patient education and awareness of body mechanics. For instance, some activities, postures, positioning and muscle habits may require modification in order to promote healing. This is while preventing injury or recurring pain in the piriformis muscle.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
Dr. Liss invites you to contact the Howard Liss, M.D. Rehabilitation Institute today.