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Piriformis Syndrome – another pain in the butt

So, your but hurts?  We previously talked about how sciatica can cause a pain in the butt… but so can piriformis syndrome.

What is Piriformis Syndrome?

The Piriformis is a muscle in the rear end. In your butt. Wheusn it gets tight you can have pain in the tush.  How many more words can we find fro butt? This is fun…

Ok, Ok, so pain in the rump.  What else?  So because the sciatic nerve runs right under (and sometimes in some people it runs right through it).  Nerves don’t like being squished.  When you squish a nerve they do things like get all tingly or numb.  The sciatic nerve, if squished by the piriformis muscle can cause pain, tingling and/or numbness down the leg into the thigh, lower leg and/or foot.

What can you do about piriformis syndrome?

Several things can help with piriformis syndrome:

stretching

ice

massage

and of course chiropractic care.

 

What causes piriformis syndrome?

The piriformis muscle can become tight for any number of reasons and cause piriformis syndrome. Many things including prolonged sitting, injury, prolonged standing and repetitive strain can cause this problem.  It is really common in runners.

 

Easy stretches

One thing that you can do to help a tight piriformis muscle is the piriformis stretch.  See the YouTube video of me doing this one…  Remember to hold a stretch for 20-30 seconds at a minimum to have it make an impact and lengthen the muscle.

 

 

 

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Lower back pain and the dreaded herniated disc

So you slipped/popped/herniated a disc.  Nope nothing sipped or popped really. But this sucker hurts.  Like a lot.

Let’s back up a minute. What the hell is a herniated disc and why does it cause so much back pain?

Ok here is a bit of a small anatomy lesson.  The spine is made up of bony vertebrae and in between them sits a disc that is made of connective tissue with a gel filled middle.  Picture a jelly donut with the donut part actually made up of concentric rings layered like an onion.  Are you with me so far?  Ok, so then really close to these discs are nerves on either side of the spine at each disc level (kind of).  Now that you have that picture in your head I can explain what happens to the discs sometimes when we injure them.

Sometimes with repetitive movement, lots of flexion, sitting, moving, lifting, standing (and just life in general – because these things are cumulative) the jelly in the disc starts to make its way through the concentric rings causing the outer layers of the jelly donut to bulge outwards.  If this bulging is anywhere near the nerve the nerve gets ANGRY. Nerves do not like pressure. Nerves. Do. Not. Like. Pressure.  In fact it only takes 8 mm of pressure to cause the nerve to have altered function and possibly cause pain, numbness or a whole host of other symptoms.  8 mm of pressure is the amount of pressure you feel on the back of your hand if you place a dime on it. So not much pressure on the nerve and you get back pain. This is just mechanical pressure but the nerve can also be irritated by chemical mediators released in the area such as inflammation… ok lets not get too complicated.

Where were we?  Ok, we have a bulging jelly donut and this is causing pain in the nerve.  This could translate into back pain, back pain with leg pain or even numbness and tingling in the leg.  This can get even worse if the jelly makes its way all the way out of the  donut rings and we call this a herniated disc.

Right so what do we do?

Firstly most herniated discs do not like flexion of the lower back or increased intra abdominal pressure.  That means sitting, bending and often coughing and sneezing too.  These things will cause increased symptoms and should be avoided if possible.  Because of the common course of herniation bending forward at the waist actually forces the jelly in the donut backwards causing the bulge or herniation to get worse.

For this reason those with a herniated disc may respond really well to the McKenzie protocol which I prescribe to patients in my clinic.  I am going to upload a video with a simple exercise below but you have to promise me that if you suspect you have a herniated disc to please go check with your health care professional to make sure that this is the thing for you to do. If you do try it on your own and symptoms worsen – STOP.

Ok now that that is out of the way  – the easiest (but not always the correct) McKenzie exercise to show you are simple back bends or extensions.  All I want you to do is stand up and put your hands on your lower back. Then bend backwards keeping your neck in neutral and arching only your back then stand up again.  I want you to do that 5-6 times in a row – all of this should take less than 15-20 seconds.  That is it. If you are doing this right and you do have a herniated disc the pain or numbness in the leg should feel better a little bit better.  If it feels worse please discontinue the exercise!!!

****Important note – if you have bowel or bladder changes such as a loss of control you need to seek emergency care – as in go to the Emergency Room.  Do not pass go, do not collect $200. Ok?

Good.

Right, so if this exercise does make the leg pain or numbness less but increases the lower back pain that is actually ok and expected… If it does some of all of these things you can do this up to once an hour.

You still need treatment and fast so please contact me or another health care provider so that we can help you  – hope this helps!!!

Exercise video listed below (underlined: “McKenzie Exercise” please click it and it will take you to the video)

McKenzie Exercise video click here

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Foot pain, Fallen Arches and Tight Muscles

So I put it out there on facebook and I did get a request for this article…  Its a pretty broad topic but suffice it to say that I do treat these things. Often.

Feet are amazing things really.  We walk on them all day and pretty much forget about them until they hurt.  There are a huge number of diagnoses related to feet some of the most common being plantar fasciitis, fallen metatarsal head (fallen arches), stress fractures, tarsal tunnel syndrome, turf toe, sesmoiditis and the list goes on and on and on…

From a simple sprain to chronic pain, there are a host of different solutions for different problems.

One of the things you hear associated with foot pain is often the prescription of custom made orthotics.  These little insoles can be amazing as therapy for the right foot condition. The drawback is that they are also expensive.  Although lots of people have plans to cover some or all of the cost, some people aren’t as lucky.  While they are a useful tool for things like fallen arches (fallen metatarsal heads) they aren’t the only solution.

When a patient comes to me with foot pain, fallen arches and tight calves I always prescribe strengthening exercises for the small muscles of the feet.  – these are easy to do exercises that will help support the natural arch and help a person retrain themselves to avoid the problem in future.  These include fun things like picking up marbles with your toes, and scrunching towels with the toes as well as learning to position the foot in the proper “short foot” position. (this one is much harder than the other two and really needs to be shown in person in a hands on fashion).

Also effective are muscle techniques such as ART for the muscles of the foot and scar tissue treatment if that is deemed to be a problem in the specific patient and adjustments of the small bones of the feet. If these bones are ‘stuck’ and not moving through their normal range of motion it causes inflammatory changes surrounding the joints and irritation and inflammation in those regions – this decreases the range of motion even further and increase the pain – all super easy to solve with a small corrective adjustment in the area.

The last thing I did want to mention was that if you have a fallen arch it tends to put a bunch of strain on the calf or back of the lower leg – the mechanics of the arch falling actually pulls on the gastrocs/soleus complex- those two giant muscles at the back of your leg attached to the Achilles tendon. This makes the muscle appear tight or reflexively be tight – stretching it will really do very little as the problem is in the foot to begin with  – correcting the arch with exercise, hands on treatment and an arch support (custom or otherwise) is the first course of action – this will likely improve the tightness in the back of the lower leg – if not then we can show some stretches to remedy this at that point but in general it corrects itself if we have done the rest of the therapy.

So, if you are suffering with foot pain please don’t wait any longer! Call us to find out how we can help you.

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Have a more comfortable and healthy Pregnancy with Chiropractic

I am a chiropractor and a mom.  I have been through a pregnancy and a really rough delivery.  I know the pain that can happen during pregnancy – I had some pretty severe back pain during my pregnancy and at times had difficulty getting out of bed.  With some self care, a specific stabilizing belt that I wore for a couple of months, and some care from chiropractic friends, I managed to make it through it all while continuing to practice right up until I had the baby.

It can be rough. But it doesn’t have to be – there is help out there.  I love helping pre- and post-natal women and have been doing it since I started practicing almost 17 years ago.  I have to say I developed a much MUCH better appreciation for what pregnant women go through regarding pain after my own.  I really feel we are best at providing treatment when we can really empathize with the problem.

Over the years I have seen it all from sciatica to round ligament pain to swollen and sore legs and feet, carpal tunnel syndrome (from swelling due to pregnancy), headaches and neck pain and way more.  More than once I have been called in for an emergency house call for someone who couldn’t get out of bed because of back pain during pregnancy and after the birth of the baby.  I am always honoured to be able to help.

While writing this blog I found some information directly from the Canadian Chiropractic Association – so I though why try to re-write something so well written? The following was taken directly from the Canadian Chiropractic Association Website –

“At least 50% of pregnant women will experience back pain, with many suffering from severe discomfort that impacts their activities of daily living. Pregnancy-related back pain can be multi-factorial and rarely only has one cause. Back pain, wrist pain and leg cramps are the most common complaints reported.

The average healthy weight gain is approximately 30 lbs, most of which is around the abdomen adding a significant frontal load. The added weight puts stress on the back, hips, knees and feet/ankles. Additional weight can lead to altered posture and biomechanics as we change the way we sleep, stand, and move during pregnancy. As the baby grows and the uterus expands, the abdominal muscles also stretch and lose their ability to support as they did. The change in posture, shifting forward, may cause pain and discomfort specifically in the lower back.

During the third trimester, levels of the hormone “relaxin” increase and contribute to the loosening of joints in order for the pelvis to accommodate for enlarged uterus, the baby and later birth. However, the loosening of joints can decrease joint stability and further alter posture. Other structures including musculature may be taxed, resulting in a predisposition to pain and injury. This may result in back pain.

Women report pain and discomfort including:

  • Neck pain
  • Low back pain
  • Mid-back pain
  • Pelvic pain and pressure
  • Aching legs and buttocks
  • Peripheral swelling
  • Sciatica or shooting pain down the leg/foot
  • Fatigue and low energy
  • Night-time muscle spasms
  • Carpal tunnel syndrome
  • De Quervain tenosynovitis
  • Sleep disturbances

Studies have shown that manual therapy, including chiropractic, can help decrease pain in pregnancy and labour. Chiropractors can provide safe, effective and drug-free conservative care to relieve pain and improve function during pregnancy and after birth.

 

Reduce back and pelvic pain: Conservative care including spinal manipulation and mobilization of joints and soft tissue therapy can help reduce pain and improve function.

Relieve fatigued, aching muscles: Chiropractic treatment plans can include soft tissue therapy and various modalities including TENS, IFC, and acupuncture among others. Chiropractors can also recommend exercises to help rehabilitate postural changes.

Help prepare for childbirth: A chiropractor can recommend safe, effective exercises and stretches to help prepare your body for the baby’s delivery.

Ensure a faster recovery: As part of a comprehensive plan of management, chiropractic treatment can help manage quicker recovery and address post-natal biomechanical complaints and rehabilitation.”

 

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Sciatica – it can be a pain in the butt (also in the thigh, leg, groin…)

Sciatica can be an amazingly painful condition.  The symptoms can include back pain with pain into the butt, thigh, calf, sometimes the foot and even the groin.  There can even be pain into the genital area.   Amazingly sometimes there is no back pain at all but just a combination of pain in the other regions mentioned (leg, butt, thigh, groin etc…).

I have had patients come in to see me embarrassed about their symptoms (especially with the groin or genital pain) and confused because their family doctor really had no suggestions or solutions.

Here is the cool thing:  We can help you fix it.

If its chronic and has been around a long time, or if it is relatively new and only been there a week or two there are a ton of things we can do.

Often sciatica results from inflammation in and around the sciatic nerve.  This big nerve travels down your leg and provides motor power and sensation to the whole leg.  This is why the pain can be is such varied locations.  Prolonged standing often really aggravates this pain.  Sometimes it is difficult to find a position that is at all comfortable.  Sleep can even be interrupted.

When I treat this condition I always do deep tissue treatment to the sacroiliac joints and piriformis muscle.  This joint and muscle are the closest things to the sciatic nerve and the piriformis muscle actually lays right on top of the sciatic nerve and can compress it if it is too tight.  So muscle treatment, treatment of the joints to relieve the inflammation in the area and restore motion to the joint are key in solving this problem.  Prescription of exercise is also key to stretch tight muscles and strengthen the core to ensure this condition doesn’t come back.

I too have suffered with sciatica and know what a pain in the butt it can be.  It doesn’t need to be suffered with – there is something that we can do about it.