Dear Ask The Doctor: Pain in lower back right side and right buttock and right side of right thigh. Docters said nerve compression syndrome. Please help with a good and suitable treatment and if possible exercises. Thank you very much.
Dear Patient: 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 radiate to the hip. Nerve injury can occur with prolonged pressure on the nerve. It has been described bilateral Piriformis Syndrome due to prolonged sitting on a hard surface. 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.