Herbal USA

Piriformis syndrome refers to sciatic nerve pain caused by entrapment or pinching of the sciatic nerve as it exits the greater sciatic notch in the gluteal region. Entrapment in this area is due to myospasm or contracture of either the piriformis or gemellus muscles. The main symptoms of this condition are deep, chronic, nagging aching and pain in the buttock and thigh on the involved side, pain aggravated by sitting, squatting, or walking, possible low back pain, and occasional pain, numbness, and tingling below the knee and into the foot. Many weekend athletes and people who spend long hours sitting are prone to this syndrome. In the athletes case, it is due to improper stretching and inadequate warm-up exercises as well as over-use during activity. In the case of those who sit for prolonged periods of time, inappropriate posture causes contracture of the piriformis muscle. Females are more prone to this syndrome by a 6:1 ratio.

The Western medical diagnosis of this condition consists of first ruling out lumbar disk herniation. The affected leg is often externally rotated when relaxed, such as when lying face down with one’s feet hanging over the edge of the bed or examination table. Various physical examination maneuvers confirm the diagnosis (e.g., Freiberg’s maneuver, Pace’s maneuver, Beatty’s maneuver, and the Mirkin test). The Western medical treatment of this condition mainly consists of stopping any offending exercises or activities. While many clinicians prescribe stretching exercises, the authors of The Merck Manual say such exercises are “rarely beneficial.”Corticosteroids are sometimes injected into the site where the piriformis muscle crosses the sciatic nerve, presumably reducing fat around the muscle.

CHINESE DISEASE CATEGORIZATION: Piriformis syndrome is categorized as bifeng, thigh wind, gu tong, thigh pain, and yao tui tong, low back and leg pain, in Chinese medicine.

DISEASE CAUSES: External injury and over-taxation combined with former heaven natural endowment insufficiency and aging

DISEASE MECHANISMS: Traumatic injury may sever the channels and vessels causing blood stasis and qi stagnation, thus resulting in pain. It is also possible for over-taxation, natural endowment insufficiency, and aging to result in malnourishment of the sinews and vessels, also causing pain. In addition, some Chinese sources also say that piriformis syndrome may be due to wind damp cold impediment hindering and obstructing the free flow of qi and blood, resulting in pain.

Treatment based on pattern discrimination:

Qi Stagnation & Blood Stasis Pattern

Liver Depression Qi Stagnation With Blood Vacuity Pattern

Liver-Kidney Yin Vacuity With Blood Stasis Pattern

Wind Cold Damp Impediment Pattern

Remarks

1. Piriformis syndrome in females is usually due to a combination of liver depression, blood not nourishing the sinews, and blood stasis, with blood vacuity in females mostly being associated with concomitant spleen vacuity. In women in their late 30s and 40s, this combination of patterns is commonly complicated by yin or yin and yang vacuity.

This entry was posted on Tuesday, May 31st, 2011 at 11:13 am and is filed under Herbal Therapy. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.