On each side of the spine, there are five pairs on nerves that exit through the intervertebral foramina and the sacral foramina. These are the opening in the sides of the lumbar spine and the sacral foramina. These nerves together combine to form a large nerve known as the sciatic nerve, which travels the length of the lower body. These nerves exit through the bottom of the lumbosacral spine, from L4 to S3. If these nerves become constricted due to a herniated disc, bone spurs, or spinal stenosis, we may experience the symptoms of sciatica. The sciatica is a long nerve, whose main pathway and its branches extend from the buttocks through the foot. If the nerve is constricted at any point along this nerve pathway, patients may experience leg pain and other changes in strength and sensation. Entrapment of the sciatic nerve outside the openings of the spine is usually caused by muscle strains and spasms, though there are many possible causes of sciatica.
Piriformis Injections: Piriformis injections are used to treat continued pain and nerve changes when the cause of the patient's symptoms is due the tightness or spasm of the piriformis muscle. Due to a variety of factors, the piriformis muscle may shorten or become persistently tight. The tightness of the Piriformis muscle, which lies just above the sciatic nerve, causes pressure on the nerve. This pressure on the nerve may produce leg pain and other neurologic symptoms, including tenderness and sudden pain in the buttocks region. Sitting may aggravate the patient's symptoms, and area may be especially painful when first waking in the morning. Common treatments used to reduce inflammation include icing, and medications to reduce the inflammation around the nerve. Complementary therapies to icing and anti-inflammatory medications include heat therapy and massage.
Ideally, some combination of these treatments mentioned above will reduce pain levels and reduce tension in the muscles. These treatments are not targeted to cure the cause of the patient's pain, but it may provide enough relief so that patients may begin an exercise program that will enable them to stretch and strengthen the muscles associated with the lumbosacral spine. By freeing up the muscles, and providing patients with enough comfort to continue an exercise program, these conservative treatments may enable the patients to establish a routine that prevents sciatica in the future.
These are great ideas, assuming that the treatments just mentioned provide enough relief to allow patients to exercise and live a normal life, while they are stabilizing their lumbosacral spine through a physical therapy program. In some cases, these treatments provide little relief, and the Piriformis Muscle remains in a state of tension or muscle spasm. In these cases, Piriformis Injections maybe performed in order to decrease acute pain. Here are the two available options that target the treatment of the piriformis muscle.
Piriformis injection: With this treatment, a corticosteroid and local anesthetic may be injected directly into the piriformis muscle. These two medications may have the effect of decreasing the pain and muscle spasm. The purpose of the treatment is to help get the patient back into a physical therapy program that they can tolerate. If this treatment does not provide the desired benefits, then the next step in their pain management program may be a Botox injection.
Botox Injection: If these injectable medications don't reduce the muscle spasm of the piriformis, then the patient may be treated with an injection of botulinum toxin (Botox). Botox is a muscle weakening agent, which may finally loosen the muscle fibers to reduce pressure on the sciatic nerve.
If some combination of these treatments manages to work, then patients may be able to continue a stable therapy program at home or in a therapy clinic that allows them the stretch and strengthen the lumbosacral muscles.
Muscle Strengthening: Muscle strengthening involves exercises to build up the strength of the hip abductors, external rotators and extensors. This treatment involves three types of rehabilitative exercises, non-weight bearing exercises, weight bearing exercises, and ballistic exercises. These exercises are designed to activate the muscles around the piriformis muscle that are also responsible for the movement of the hips and buttocks. Non-weight bearing exercises are designed to focus on isolated muscle recruitment. Ballistic exercises are designed to increase both power and speed of the activated muscles.