Back Pain – Is it All In Your Head?
Most people are somewhat familiar with the term “sciatica”. Generally, it is a severe pain in the leg, running the course of the sciatic nerve. It can be felt at the back of the leg, running down the inside, and sometimes, into the foot. Sciatica is due to a lumbar, or low back disc pressing on the nerve as it exists the intervertebral foramen – the opening between the bones of your spine. It produces pain, numbness and tingling below the knee and into the foot. So, you seek medical attention, since the pain is limiting your normal routine. After the initial evaluation, your physician sends your for some diagnostic testing – usually x-rays and spinal images – possibly an MRI, and puts you on a course of non-steroidal anti-inflammatory medicines (NSAIDS), such as ibuprofen or naproxen, and a period of rest.
Your test results, however, come back negative, and you still have pain. Don’t despair – a negative result only means there is no bulging disc applying pressure on the nerve. It does not mean the pain you are experiencing is all in your head. Perhaps it is what experts call “piriformis syndrome”.”
Sciatica and piriformis syndrome are very similar – both produce pain, numbness and tingling in the buttocks that can radiate down the back of the leg and into the foot. It can start as a dull ache in the middle of your buttocks, usually only on one side, and radiate down the posterior leg, down to your foot. You can experience pain with walking up stairs or inclines, or with prolonged activities, such as walking, running or even sitting. The main difference is in the cause. Piriformis syndrome is caused by the entrapment or compression of the sciatic nerve, due to the contraction or shortening of the piriformis muscle.
The piriformis muscle is located deep in your buttocks, behind the gluteus maximus muscle (that’s the large muscle that makes up your buttocks). It is a small muscle, running horizontally. The sciatic nerve runs vertically, directly beneath this muscle. The piriformis muscle starts at your lower spine and connects the upper surface of each femur, or thigh bone. Basically, it assists with the motion of rotation at your hip. This is when you spread your knees apart. Piriformis syndrome can strike anyone, though women are slightly more prone to its pain. It can incapacitate anyone from the most seasoned athlete, to the most sedentary person. It can be caused anything from poor warm-ups before activities to sitting too long, which causes a contracture, or shortening of the pirformis muscle, thus applying pressure to the sciatic nerve.
Some common causes for piriformis syndrome are: anomalies in the course of the nerve, such a penetration of the piriformis (meaning pressure directly on the nerve from the tightened muscle); direct or indirect trauma, such as a fall or motor vehicle accident; inflammation or degeneration changes, such as injury, arthritis or swelling after a hip replacement; overuse with repeated bending, lifting, forceful rotation with weight on the lower extremity, squatting with weights or rigorous activities, such as running or jogging; postural abnormalities, such as hyperpronation ( feet excessively turned inward) with walking and hyperlordosis (excessive low back curving, like a pregnant women towards the last few months of pregnancy); anything that causes trigger points, or a hyperirritable spot that causes pain or referred pain (pain in another spot), which will increase muscle shortening. Something as simple as sitting on your wallet in your back pocket can cause trigger points.
Traditional treatment programs, consisting of NSAIDS, rest and ice for acute pain, heat for chronic pain, are common. Your physician may also recommend a few weeks of physical therapy. During physical therapy treatments, you may receive ice/heat, electrotherapy, such as transcutaneous electrical stimulation, or “TENS”, and interferential current stimulation or “IFC”, both are beneficial to block pain and decrease spasms. You will also be given a remedial, or basic, stretching and exercise program, to include piriformis and hamstring stretching, as well as strengthening exercises.
Occasionally, injections of anesthetics and corticosteroids are necessary to decrease acute pain to enable progress with physical therapy. One thing to keep in mind with piriformis syndrome, is that your treatment is far from over after the last physical therapy session. In order to manage your pain and keep it at bay, there are things that you can, and should do on a regular basis. It is a known fact that stress aggravates pain, and worse, it could make you very sick. Keeping your stress level down is an important factor to regaining control over the pain that may limit your activities. Take a short walk or try some deep breathing. Meditation and yoga may help. Tai Chi is an excellent addition to stress-relieving protocol, as well as a way to provide your body some light stretching. Anything that keeps your stress level manageable will aid in your pain relief.
Try regular massages. Massage is extremely effective in decreasing trigger points, reducing edema and improving tissue health and circulation. A few things to remember when trying massage: do not massage area for ten days after a cortisone injection; avoid compression of the sciatic nerve, which will aggravate symptoms, causing worsening of tingling and numbness; and do not perform friction or very deep techniques if you are on anti- inflammatory medications. In fact, you should try to refrain from taking any medication prior to your massage – it can interfere with your sensations of pain and cause injury, further leading to increased pain, rather than relief. Whereas massage can be uncomfortable, at no time should you experience extreme pain (anything that is sharp, shooting or severely aggravates your current pain).
Stretching and remedial exercise (simple exercise), coupled with relaxed, deep breathing, should be a normal part of your everyday routine to combat pain, not to mention a complete necessity when performing more vigorous activities such a running or using a stair master. You should stretch your piriformis muscle several times per day, not matter what the activity level. This can be done simply by laying on your back with your knees bent, rest your right ankle on your left knee and pull your left leg towards your chest. Hold this for 5-30 seconds at the point you feel a stretch, repeating 3-5 times in a row, 2-3 times per day. Remember to switch legs and perform on the opposite side as well. If you cannot tolerate your ankle resting on your knees, bring up your bent leg towards your opposite shoulder. Use a towel or belt wrapped around your thigh to help if you cannot comfortably perform this stretch.
Hamstring stretches should also be performed. The easiest way is to lie on your back, your legs out straight. Take a belt or large towel and wrap it around one foot. Keeping your leg straight, lift it into the air as far as you can to feel a stretch. Remember to keep the resting leg flat on the floor. Hold for 5-30 seconds, 2-3 times in a row, 2-3 times per day. You can also stretch your hamstrings in standing. Place on leg out in front of the other, or support it on a chair, and lean forward till you feel a stretch behind your knees. Always remember to breath! Holding your breath not only causes your blood pressure to rise, but also limits the oxygen your muscles need to perform optimally.
Strengthening is also important. Simply lie on your side and bend your knee and hip. While maintaining this, alternately bring your knees together and apart. When this seems too easy, try it with your legs straight. You should try this 5-10 times in a row, 2-3 times per day, concentrating on your breathing, as well as your hip muscles. And don’t forget to perform on the other side! Just because your pain is only one-sided, doesn’t mean the opposite side won’t benefit also.
Try a tennis ball – yes, tennis ball. Use a ball while lying on your back, or while standing against a wall. Place the ball on the spot in your buttocks area causing you the most pain, and gently lean into it. You should experience some discomfort, but not actual pain. You may experience “referred pain”, which is pain in another area, say in the back of your legs. Try to hold the pressure until the pain subsides. If you experience numbness and tingling down the back of your leg -stop! This means you are compressing the sciatic nerve, a definite “no-no”. Try frequent position changes, or minor changes in sleeping and sitting. Ã?¯Ã?¿Ã?½ By this, I mean, if you sit all day at a computer, take frequent stretching breaks – at least every hour. Stand and stretch or walk a little to avoid cramping of the muscles. When sitting, you should avoid sitting on your feet, or rolling your legs outwards. You should keep your feet and legs towards the middle of your body. And, don’t forget to watch slouching or straining your neck and back backwards, causing excessive curving of your low back – a definite source of pain.
Sleep patterns should also be evaluated. Side sleepers should place a pillow between the knees to avoid excessive adduction (knees together), which can aggravate the shortened muscle and wake you up. Getting regular rest is also of great importance. Fatigue makes pain worse.
Try a chiropractic evaluation. This can determine if the source of your pain is related to a sacroiliac joint dysfunction. Your sacroiliac joint is the area where the hip bone and the sacrum meet. Your sacrum is the triangular bone that makes up your pelvis area.A chiropractic treatment can re-align this joint, which may be causing the piriformis to be pulled in the wrong direction, thus causing pain.
Though these suggestions do not guarantee a pain-free existence, it can help control your pain levels to return you to a more normal, productive lifestyle. And, whereas these simple solutions can help just about everyone, regardless of what type of pain they experience, an evaluation by a medical professional is important to rule out other life-altering medical problems. The message is clear – you must take time for yourself. Let’s face it, in today’s busy world, no one really has the time to be stricken with pain. A few minutes a day spent on stretching and relaxation can only benefit your overall well-being, whether you are a seasoned veteran in the sports world, or an avid couch potato. So, go on – stretch! You have nothing to lose, but your pain.
