Piriformis Syndrome Update- A Season of Relief

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Nerves that pass near piriformis muscle
Nerves that pass near piriformis muscle

As I write here on July 21st, 2013, I am just 6 months since my SI Fixation Surgery and I want to continue updating the subject of my diagnosis with Piriformis Syndrome. From my last blog posted 4/9/13 on Piriformis Syndrome, I am singing a different tune, “Oh what a relief it is….”. What is the relief? I’m not on fire. I do not have any burning butt symptoms, nor any burning nerve symptoms going down my medial legs. Many times I was more affected in the Posterior cutaneous nerve and or the Pudendal or Obturator nerve distributions than only the typical Sciatic nerve distribution.

On my last blog, I was having intermittent symptoms depending on how much sitting I was doing. At that time, I was sitting a lot writing the foundation of my entire website:

From April 9th-May 14th, 2013 – I was in a stressful time of diagnosing my Proximal Tibiofibular Joint Instability. See my to be linked to the entire journey on the Proximal Tibiofibular Joint Instability and Surgery. I continued having intermittent symptoms of nerve pain in my legs, especially going down the medial sides out from under my seat bones.  I also had soreness at both ends of my bi-lateral piriformis muscles with the left one more pronounced than the right.

From May 14th-June 10th, 2013 – I was completely non-weight bearing in my post operative protocol following my Proximal Tibiofibular Surgery. In the earlier part of this time, I was still irritated due to the fact I was laying on my back with only my left leg in a CPM machine to keep my knee moving following surgery. Using this machine for several hours would make my left butt sore and feeling knotty. The best relief for me was using my home Infrared heat device to my butt and/or take a Diazepam for minor muscle spasms. During the last week of this time frame, my symptoms were starting to ease up with no explanation(maybe laying around more was what I needed since I never really did that after the SI surgery, and with the leg surgery I had no choice but to be more passive). I had already scheduled to have an injection. I went ahead with the injection in preparation for increasing my exercise once I was not in the wheelchair. I was dealing with enough post operative nerve pain isolated in my lower leg that I certainly did not want more nerve pain coming from pressure over sciatica or other nerves near my piriformis muscle. I was really hoping the injection would do something for me.

June 11th, 2013 –  My sports medicine Dr. PZ Pearce in Spokane gave me my first and only injection thus far into my left piriformis muscle-tendon junction with .5ml 0.5% plain Marcaine and .5ml Celestone (a cortisone) . He prefers the Celestone brand of cortisone over other injections such as Depro-Medrol, or Kenalog. I had modest, immediate relief of symptoms in response to the Marcaine and when it wore off at about 6-8 hours later, I started to feel some pain come back again near my medial side of the piriformis muscle where it connects to the sacrum.

In this video, Vicki Sims, PT of Gainesville, Ga recommends a series of shots into the tendon insertion of the Piriformis Muscle to help calm down the Tendinosis

From June 12-present – My Dr. Pearce was willing to do a second injection as Vicki recommended; however, I have felt like it has not been needed thus far. The cortisone must have kicked in and worked because I have been doing just fine. I really don’t want a 2nd injection if at all possible because I hate the effects of what cortisone does to my Adrenals.  I get extremely worked up for several days then I crash for several weeks following any cortisone injection I get. I really hate this effect so I avoid cortisone at all costs. But on the other hand, I am grateful to have tried this one shot so far.   I started full weight bearing walking June 25th and I have been active with physical therapy for my leg rehabilitation and I have resumed my SI stabilization exercises at home along with doing aqua therapy in my pool. I am sitting less than several months ago, but I still travel each week for many hours in the car and all I can say is I’m doing great.  At the first sign of any tightness of my piriformis muscle, I apply infrared heat to calm down what I believe to be a mild spasm.

July 22, 2013 – My concluding thoughts: The piriformis muscle gets tight or what I call a mild spasm and if it continues with no relief then in my case it can go down hill from there in aggravating the nerves that pass under or around the piriformis muscle. See the photo at beginning of blog that illustrates the various nerves in relation to the piriformis muscle.  Rice heat packs and/or the infrared heat therapy has been my saving grace along with weekly thorough massage. If I really have overdone the sitting and I feel any type of flare up, it behooves me to take 2.5 mg of Diazepem in addition to the manual therapy.  As long as I continue to do well, no more injections; otherwise, I certainly would try another should I have a major flareup again. In the meantime, I have to say I’m thankful to God for this season of relief  in being set free from the previous  full year of burning nerve pain!!

All for now, I will update again in the future regarding piriformis syndrome and its related nerve issues.


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Dr. Trumble, My Upper Extremity Surgeon, at Bellevue Hand Surgery