Stabbing pain in the buttock for a week

Dear Ask The Doctor:  I have had problems with discs in lower back for last ten years but for last week i have had a very bad pain in left buttock when bending to sit and on standing up. the pain doesnt go down my leg, feels like a stabbing twisting pain, havent started any new exercise regime and havent hurt myself or fallen, what could this be . thanks
 
Dear Patient:  If the pain is localized and does not radiate to the leg and foot, possibly may due to a sciatic nerve local compression at the level of its outlet in the gluteal region by the Piriformis muscle. The piriformis muscle can either irritate or compress the proximal sciatic nerve due to spasm and/or contracture. The Piriformis Syndrome is also referred to as pseudosciatica, wallet sciatica, and hip socket neuropathy. The pain originates in the base of the buttock and may or may not radiate to the hip. The causes are diverse: trauma or blunt injury , prolonged sitting on a hard surface, or just with no apparent cause. Piriformis syndrome remains controversial because, in most cases, the diagnosis is clinical, and no confirmatory tests exist to support the clinical findings. Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome. Approximately 50% of patients with piriformis syndrome have a history of trauma, with either a direct buttock contusion or a hip/lower back torsional injury. The remaining 50% of cases are of spontaneous onset. Diagnostic imaging of the lumbar spine (MRI) is mandatory to rule out associated diskogenic (bulging disk) and/or osteoarthritis. Usually the treatment is aimed to correct the following: tight piriformis muscle, tight hip rotator muscles, hip muscles weakness, and sacroiliac problems. The use of ultrasound previously the physical therapy session may be beneficial, and the proceed with a stretching routine for the piriformis and hip muscles, you should be provided with a home stretching program because the stretches every 2-3 hours (while awake) are critical for the treatment success.

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