A Common Cause of Low Back and Sciatic Pain - The Piriformis

As a licensed massage therapist, I specialize in chronic pain and injury management using deep tissue massage therapy. Most of my clients come in with a common complaint: pain in the low back, hips (primarily on one side), and/or shooting pain or numbness down the back of the leg.

More than two million Americans suffer either from back pain or a form of sciatica that is often misdiagnosed and improperly treated. Many suffer from pain for months or years without a proper diagnosis. I work with these symptoms so frequently that I have noticed some common characteristics with this all-too-common pain complaint.

The most common characteristic I find are aggravated trigger points (TrPs) in the piriformis muscle. Piriformis trigger points are often confused for a herniated disc, sciatica, or other back issues, and many sufferers undergo unnecessary and costly tests, injections, and surgeries.

What is the piriformis?

The piriformis muscle is a small external rotator of the hip whose function primarily is to turn the knee and foot outward. It lies deep within the gluteal muscles, originates from the sacral spine, and attaches to the greater trochanter of the femur - the big bony "bump" on the outside top of the thigh. The sciatic nerve passes beneath through an opening called the sciatic notch.

Function

In non-weight bearing activities, foot unloaded and hip extended, the piriformis rotates the thigh outward. When the hip is flexed at 90 degrees it aids in hip abduction.

In weight bearing activities, foot loaded, the pirifomis is often needed to control rapid medial rotation of the thigh - for example, as the foot strikes the ground during walking or running, the knee turns inward.

Piriformis Trigger Points (TrPs)

Symptoms

The myofascial pain component includes pain in the low back, groin, buttock, and hip. A TrP may cause the muscle to compress and irritate the sciatic nerve, causing the pain to travel along the course of the nerve. The pain may radiate down the back of the leg and into the hamstrings, the calf muscles, and possibly the foot. The pain may initially be confused with a hamstring strain. Weakness, stiffness and a general restriction of movement are also quite common. Tingling, numbness, or shooting pains down the leg can also be experienced. Symptoms tend to be aggravated by prolonged sitting or by intense activity.

Causes

Piriformis TrPs are predominantly caused by a shortening or tightening of the piriformis muscle. Piriformis TrPs are commonly associated with sports that require a lot of running, change of direction, or weight-bearing activity. Piriformis TrPs can result from acute overload (as when catching oneself from a fall), from repetitive overload (as with the rapid internal rotation of the weight bearing experienced by walkers and runners with poor biomechanics), or from sustained overload (as when holding the leg bent and turned outward for prolonged periods while driving a car or working at a desk). Sciatic pain from piriformis TrPs is also a common complaint during pregnancy.

The piriformis muscle is responsible for the symptoms of pain by projecting pain from activation of the TrPs and by nerve entrapment upon the sciatic nerve. Once TrPs are activated, the piriformis muscle begins to put pressure on the sciatic nerve. The sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis. The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica.

"Even though your back is flawless, the piriformis muscle in the buttock may tighten, go into spasm, and entrap the sciatic nerve, causing the same symptoms and misery that come with herniated disks." Huffington Post

Treatment and Prevention

The first two steps in treating piriformis TrPs can provide the most significant and immediate relief: deep tissue massage with stretching of the external rotators of the hip. Deep tissue massage techniques such as myofascial release and trigger point therapy are highly effective at reducing active trigger points. Once the TrP is released, there will be a significant reduction in pain.

Following up the massage with flexibility training will help loosen the muscle and help prevent a return of the TrP. I have found that it takes between four and ten massage sessions to move out of the acute pain phase from piriformis TrPs. It may be shorter or longer depending on the cause and severity of the initial injury.

For long-term prevention of piriformis TrPs, self massage and flexibility will be your most invaluable tools. Use a ball (preferably a tennis ball for beginners) for self trigger point therapy, and stretch the piriformis muscle and other external rotators of the hip. With each stretch it is important to breathe into the stretch and only stretch to slight discomfort... NOT PAIN.

Other suggestions to prevent Piriformis TrPs

Our bodies were designed to move. It is important to keep moving. Try not to sit down for more than an hour at a time. Stand up, take breaks, go for a walk, and stretch your body throughout the day. Lack of movement causes muscle dysfunction. Proper movement is key to an active healthy life. With an exercise program that focuses on functional movement patterns with core strength and stabilization, regular full body massage (self massage or professional), and full body flexibility you will reduce your chances for chronic pain and injuries.

Running/walking

Change the way you walk and run. Heel strike is the most common dysfunction in running/walking gait. As soon as the heel strikes the ground, the knee rapidly moves into external rotation followed by rapid inward rotation. This places repetitive trauma on the piriformis muscle and leads to TrP formation and activation. I suggest hiring a coach who instructs forefoot or midfoot strike running form.

Replace your shoes. Modern running shoes promote heel strike. I advocate shoes with as little cushion and arch support as your body can handle.

Be smart with a shoe and form transition. Your body has adapted to how you walk and the shoes you wear. A fast transition without proper instruction and training raises your risk of significant injury. Below is a great article about what is wrong with your running/walking shoes.

What Happens to Our Foot When We Wear Traditional Shoes. Dr. Nicholas A Campitelli

Lower Back Pain Relief - Therapeutic Chair Positions

What is the best type of office chair to have? What is the best type of couch to have? How long should I remain seated while I am at work? What is the proper way to sit in my chair? These are some of the most important questions to have answered especially if you have lower back pain. Sitting is not inherently bad, but we tend to abuse the time that we sit in our chairs, especially at work and at home.

Some people claim to sit for up to 4 hours at a time without even taking a bathroom break. That is really tough on the body, especially the back and legs. The longer you stay in a seated position on your chair or couch, the more your body conforms to the surface on which you are sitting. The result is disproportionate muscle tension.

In a nutshell, what that means is that your body is out of balance and will cause undue stress at certain pressure points. For example, extended sitting causes hamstrings and hip flexors to be placed in positions that exacerbate tightness in the lower extremities. That is why when you get up from a low surfaced couch or chair after sitting for 30 minutes or more, you find it very difficult to stand up straight. It can take you 30-60 seconds before your body feels like it can stand up straight again. Has this ever happened to you?

Unfortunately there is no perfect answer with regards to purchasing or using the best office chair, couch or seat. Rather, there are certain components of a chair that you should consider that set up the appropriate ergonomic position conducive to a healthy back. The reason why we cannot recommend the perfect chair is because we all have different body types. As such, we all have different needs.

The key components to a good chair or couch are those that allow you the following functions/capabilities:

1. The chair seat should have a "tilt" mechanism to allow you to raise your buttocks slightly higher than your knees
2. The ability to raise the chair up and down for height
3. Firmness or a slight bulge in the lumbar section where your lower back meets the chair

The "tilt" function is important because it allows you to change the angle of the seat so that your gluts are in a favorable position compared to your knees. It is essential that you place your knees in the appropriate position to acquire the appropriate angle. Ideally you want slightly more than 90 degrees bend in your knees.

Should you be in the wrong position where your knees are higher than your gluts, it will cause increased tightness in your hip flexors which will reduce the natural lordotic curve in your lower back. This causes increased disproportionate muscle tension and causes additional lower back pain.

The ability to raise the chair up and down seems rudimentary, but don't underestimate its importance. It is essential that you have the appropriate height in order to acquire the proper angle mentioned above, as well as being able to place your feet firmly on the ground or foot stool.

You should make every effort to ensure that you do not dangle your feet while sitting in a chair. This may sound silly, but everyday there are many people who site this way. When your legs dangle, it creates a distraction force through your lower leg which can eventually irritate the lower back, hips and knees.

Last, firmness or a slight bulge where the lower part of the chair where meets your back will ensure lower lumbar support so you can maintain the natural curve of your spine. In addition it will maintain the adequate support needed to maintain a healthy back from extended hours sitting.

If you sit in a chair daily as part of your work environment, hobbies, or others, and you find that you continue to have chronic lower back pain issue, evaluate these items out and make the appropriate adjustments. By doing this, you will put yourself in a winning set up for finally stopping your back pain.

Thank you.

Symptoms of Endometriosis

Endometriosis is a chronic and quite often, painful condition of the endometrial tissue, which is the tissue that lines the uterus, starts growing outside the uterus as well. This growth can occur on the fallopian tubes or ovaries and can also form outside the pelvic area. Often in the early stages it can appear as normal bodily changes that occur during the menstrual cycle however as it progresses the pain will become worse and eventually will lead to a decline of the woman's general health and potentially the health of her reproductive organs.

Endometriosis is a difficult condition to diagnose because it does not follow any real pattern and many of its symptoms can mimic other health issues such as ovarian cysts, ectopic pregnancy, irritable bowel syndrome, ovarian cancer, fibroid tumors, colon cancer and even appendicitis. The more common symptoms are; pain before and during menstruation, pain during intercourse, general pain through out the month in the pelvic region which can become severe and debilitating, heavy or irregular menstrual periods, lower back pain, painful urination or bowel movements during the menstrual period, fatigue, constipation or diarrhea or even infertility. Other symptoms that can be caused by Endometriosis are headaches and low grade fevers, as well as depression or low blood sugar and the woman can become prone to allergies or anxiety. Painful ovulation or menstruation can also be a sign of this condition and contrary to what many believe, menstruation should not be painful.

Rarely Endometriosis can travel to the lungs and can cause the patient to cough up blood, or have a shortness of breath, a collection of blood or pulmonary nodules in chest cavity. These symptoms will usually coincide with the menstrual cycle.

It is quite possible for the most debilitating symptom of this condition is chronic fatigue. It is not fully known why the fatigue occurs but it is believed to be caused by either the chronic pain or medications that the woman could be on or if it the bodies method of trying to cope with the condition.

Abdominal bloating can also be another symptom of this condition. It is believed to be caused by inflammation of the pelvic cavity or else Irritable Bowel Syndrome which is also common in women with Endometriosis.

The urinary tract symptoms of Endometriosis are normally caused by the tissue lying on the outside of the bladder and can appear in the form of blood in urine, a burning sensation during urination or painful urination, tenderness around the kidneys, pain radiating toward the groin from the buttocks, or urinary frequency or urgency or possibly retention.

Pain that radiates from the buttock down the leg is common where Endometriosis has affected the sciatic nerve. Sometimes it can restrict the hip ligaments and cause severe pain and limping. This pain, if it follows the cyclic pattern of the menstrual cycle can often be caused by Endometriosis.

As you can see from these symptoms of Endometriosis, it is understandable how it might have taken awhile to diagnose this condition, however medical research has made great leaps forward in both recognizing that these symptoms could be caused by Endometriosis and so can start looking for ways to treat it sooner rather than later which will lead to the healing of the condition and the return to a normal life.

5 Hot Pilates Exercises for Chronic Lower Back Pain

Chronic lower back pain is among the most common injury suffered by both gender in all age group, but most significant in the elderly. There are many options available. If it is not too serious, you can choose to use non-invasive method like medication. Or play an active role in your own recovery by turning to Pilates if you prefer a more natural and long-term relief.

Specific Pilates exercises can strengthen core muscles to help in fighting off chronic lower back pain because your postural muscles groups are in charge of your form. If you have good core endurance, it will be reflected in your overall posture and prevent back injury.

Here are 5 great tips to get cracking:

1. Pelvic Tilt
Pelvic tilt is one of the best Pilates exercises that is used to assess your core strength especially if you have chronic lower back pain. It is a functional move. The ability to perform pelvic tilt means your lumbar spine is able to articulate and move. This mobility plays an important role in your recovery.

To perform the exercise, lie on your back. Bend your knees with feet flat on the floor. Inhale to prepare and exhale by slowly pressing the small of your back firmly into the floor and lift hips up slightly. Start by lifting only to the level you can. Draw your bellybutton down to your spine as you exhale during the lift. Avoid lifting pelvis higher than your middle back as tension will build up in the back of the neck. Repeat 5-10 times.

2. Knee Sway
Knee Sway relieves tight vertical spinal column muscles that are tired and weak. It adds instant relief and acts to quickly take away radiating lower back ache.

Lie on your back. Knees bend and feet wide on the floor. Keep knees about hip width or imagine you have a big basketball between your knees. Inhale to prepare, exhale slowly and turn both knees to one side without collapsing your knees together. Always remember to engage your abdominals when moving both knees from one side to the other. Repeat 5-10 times.

3. Alternate Knee Lift
Alternate Knee Lift helps to stretch tight weak lower back muscles and train abdominals at the same time. It is a simple beginner exercise and a safe exercise to start on your journey to strengthen your back.

Lie on your back. Knees bend and feet wide on the floor. Keep knees about hip width. Inhale to prepare, exhale slowly lift one leg (knee still bend) off the floor and towards your chest about waist level. Avoid bringing your knee too close to the face. Repeat 5-10 times for one leg and switch to the other leg.

4. Swan Prep
This exercise alleviates chronic lower back pain by strengthening your back extensors. Such muscles are usually overstretched and weak in people with back pain.

To start, lie on your tummy on the floor, face down. Put your palms at chest level, near your armpits, under your shoulders. Your elbows are bent. Keep the back of your neck long with your nose floating off the floor. Inhale to prepare, exhale slowly and lift your bellybutton up and away from the floor. Keep the abdominals lifted as you press your palms into the floor. Exhale as you lift the chest slightly off the floor with the back of the neck long and face looking down. Avoid lifting chin up and looking forward. Face should always be looking down. Repeat 5-10 times.

5. Cat
Cat is a great for back stretching and improving flexibility. It can also be used as a warm-up for other Pilates exercises.

Get on all fours with your knees and your hands on the floor. Check to have your palms under your shoulder. Inhale to draw your tummy in and round your upper back to the ceiling and your eyes to your belly button as in an angry cat. Exhale as you arched your back (tummy dropping to the ground) and look upwards. The move resembles a stretching cat. Repeat as many times as you are comfortable.

Cool Down with Child's Pose
Child's Pose is one of the easiest and most relaxing Pilates exercises.

Start with all fours. Sit back on your heels. Your butt should be on your heels. Your chest should be on your knees. Your knees should be shoulder width apart as you keep your toes together. Drape your body over your thighs. Your forehead should rest on the floor or on the back of your palms. Next, stretch your arms out to your front. Deeply breathe and relax as you remain in the position for several minutes. This should help to release tension in your neck, hips, and lower back.

Cause of Lower Back and Groin Pain: The Iliolumbar Ligament

The iliolumbar ligament connects the fifth lumbar vertebra to the crest of the ilium, or hip bone, in the lower back. It is one of the thick, strong ligaments that supports the sacroiliac (SI) joint, which forms where the ilia meet the sacrum at the base of the spine on each side.

The ligaments around the SI joint facilitate pelvic stability and, since the pelvis is attached to the base of the spine, spinal stability. The lumbar spine is a highly mobile segment that bends forward, backward and sideways as well as rotating. The ligaments that attach to lumbar vertebrae are susceptible to injury if this spinal segment is overexerted.

Causes

The iliolumbar joint can be injured in a number of ways, including lifting a heavy object, impact from a fall or repetitive rotation of the lower back. Iliolumbar syndrome occurs when the ligament is chronically torn or strained. This is usually the result of a repetitive use injury, such as sustained by golfers, tennis players, or others who constantly twist at the lower back.

Ligaments have a difficult time healing; they naturally receive poor blood supply, meaning they do not get fresh oxygen and nutrients to facilitate healing. When a ligament is injured, inflammation in the region can cause pain in the area and in other parts of the body. The SI joint is affected when any of its supporting ligaments is injured; the joint loses support and becomes unstable. Inflammation in the area can cause the joint to seize up and interfere with nerves that pass through the area to other parts of the body.

Symptoms

Stabbing lower back pain, usually on one side

Hip pain

Groin pain

Pain on inner or outer thigh

Pain when bending to either side

Pain when twisting the spine

Misalignment of the L4 and/or L5 vertebrae, if ligament has been weak for prolonged period of time

Treatments

Treating an injured ligament is difficult; while any motion can irritate it, prolonged periods of rest and immobility carry their own risks. Treatment of the ligament depends on the severity of the damage.

If you have only a minor strain of the iliolumbar ligament, ice and a brief period of rest followed by gentle stretching and eventually strengthening exercises should suffice to recover.

More severe strains may benefit from friction therapy, a form of massage designed to stimulate the ligament just enough to break down scar tissue without aggravating the injury. Exercise therapy follows to build strength and flexibility in the hips, buttocks and lower back.

Iliolumbar ligament syndrome that doesn't respond to these forms of therapy may benefit from prolotherapy, a relatively new form of treatment for ligament injuries. It involves the injection of irritants into the ligament area to spark the body's inflammatory response, which is part of the healing process. Since ligaments receive poor blood flow, the body's initial inflammatory response may have been too weak to facilitate healing. Ligaments are expected to heal after 3-10 sessions of prolotherapy.

Injury to the iliolumbar ligament is fairly distinct in that it causes SI joint and lower back pain along with groin pain. If you have these symptoms, help your doctor arrive at an effective treatment plan for your pain.

Lower Back Pain: Causes and Treatments

Lumbar pain, or lower back pain, is one of the most common causes of seeing your doctor. Because this is a problem so prevalent, as it affects millions of people around the globe, we wanted to provide some information. Sadly, some people try to avoid the problem of lower back pain. Some other people seek the wrong treatment. The main problem is that lumbar pain can be due to a serious condition, that should not be ignored. Therefore, knowing the cause and the appropriate treatment is extremely important.

Statistics of Lumbar Pain:

To show just how widespread this problem is, some interesting statistics have been provided below.

o Only in the USA, 31 million people suffer from lumbar pain on a frequent basis.

o Of people working in the US, about 50% have lower back pain one or more times a year.

o Most of the times, the cause of the pain is not a serious health condition, but the result of poor mechanics or a chronic trauma.

o Roughly $50 million are spent every year by americans, to treat lower back pain alone.

o Nearly 80% of the USA population will suffer lumbar pain at least once in their life.

o The leading cause of disability in people under 45 years old is lower back pain.

Causes of Lower Back Pain:

As we have said before, the pain caused by a lumbar problem can be something only mild or experienced only once, but in some cases, it could be potentially serious. Although pain can be linked to different parts of the spinal structure to include bones, joints, muscles, and ligaments, thanks to advancements in medicine this is a treatable condition.

- Minor Causes:

o Infections or stones in the kidneys.

o Slouching or other poor postures.

o Twisting, Bending or Lifting improperly.

o Stress, for whichever cause.

o Excess weight

- Serious Causes:

o Arthritis.

o Embolus

o Degenerative Disease.

o Diseases of an Abdominal Organ.

o Fracture

o Herniated Disc

o Injuries during Sports.

o Car Crash.

Preventing Lumbar Pain:

Evidently, there are some instances of lower back pain that would be out of a person's control but often, making wise decisions is all it takes to prevent pain from developing or in the case of existing back pain, from worsening. These are some of the things we can do to reduce the likelihood of developing back pain.

o Adopt a healthy lifestyle to include eating well-balanced meals, exercising daily, maintaining a healthy weight, stopping smoking, reducing alcohol consumption, and avoiding illicit drugs.

o Stretch to warm up before any physical activity or workout and again at the end of the session.

o Adopt good postures, when walking, sitting, etc...

o Use a moderately firm mattress, to provide good support.

o Always lift using bended knees

o Use an ergonomic chair, which is especially beneficial for long periods of computer work

o Choose low heeled shoes with good insole cushioning

o When sitting or driving for long periods, take breaks.

Summary:

Minor lower back pain can be very disruptive to a person's life but when severe, the problem can be completely debilitating. Pain can affect the upper, middle, or lower back and due to the long list of possible causes, the most important thing to help a person get relief is to seek medical attention. Remember, this kind of back pain is typically associated with something minor that could be easily remedied but because this could also be a symptom of a serious underlying cause, it should never be ignored.

But, until the cause of the pain has been identified, it is difficult to say which treatment option is the more appropriate, therefore, it is very important to seek medical advice.

Lower Back Pain And Kidney Pain - How To Tell If Your Back Pain Is Caused By A Kidney Infection

It is important to remember that kidney pain and back pain can have similar symptoms that have entirely different causes. You can have back pain symptoms that are caused by a kidney infection, while another person could have the exact same symptoms caused by a back problem.

When lower back pain is caused by a kidney problem.

Your kidneys are located to the left and right side of your spine directly above your hips. Pain from an infection in your kidneys will usually occur near this same general area, although it can radiate outwards thus complicating diagnosis. Many people describe the symptoms as a general tenderness or ache and not "pain." A strong, stabbing pain may be related to back problems and not the kidneys. The pain or tenderness can be due to an infection or it could be related to some type of injury to the kidneys themselves. For instance, an injury caused by a fall could compress one kidney impacting and damaging it.

In addition to kidney pain caused by accident or injury there are also symptoms that are associated with a kidney infection. Pain caused by an infection is much more common than that caused by physical trauma. In addition, with infections in the kidney there will often be other symptoms such as a fever, pain while urinating or blood in the urine.

How to tell if you have a kidney infection and what to do about it.

If you have a kidney infection, you will likely have some of the following symptoms: fever, chills, backache and pain. Nausea and tenderness near the infected kidney can also occur. Your doctor will diagnose the condition through tests of kidney functioning or by a bacterial test. Why two types of tests? Because there are two common types of kidney disorders, each with a different cause. Treatment and pain relief will likely include rest and antibiotics for any bacterial infections. Usually the treatment will last for several weeks, but certain people may have structural issues and require longer-term treatment.

The bottom line is that you want to get the right information about what might be creating your pain symptoms - do not self-diagnose. A kidney infection left untreated for many years can have catastrophic implications for your health. If there is a history of kidney infection in your family, or you have recently been in a fall or car wreck or had some other trauma that could have damaged your kidneys, you should consider seeing a doctor. The treatment for low back pain caused by poor posture or over exertion is different than the treatment for low back pain caused by a kidney infection. You want to treat the right condition.