Adam Rufa - 5/26/2006

Question
Hi, Adam...
My husband has bi-lateral piriformis syndrome. He's in good shape. (He's 53 and his dr. told him he's a man of 30.)

He's had two sets of cortisone injections in the piriformis muscles with a little, short-lived relief, Myoblock injections (strain B of botulinum), physical therapy and chiropractic treatments.  Otc the medications don't help at all.  We've ordered DVD's off of the internet to relieve back pain.  He had orthotics made, did exercises, iced, and saw a great chiropractor.

He can't seem to get any relief from it.  It's a VERY stubborn case and I can even feel the knots in his buttocks from the muscles. It works on his psyche, too, being in pain all the time and not being able to sit.

Any advice at all?

Thanks!

Answer
I rarely ever see a true piriformis syndrome (especially bilateral). Almost always, the piriformis is reacting to a problem somewhere else. The key is to find what is keeping the piriformis in spasm and correcting it if possible (this can be difficult).

It sounds like you have tried multiple things to help his problem. Unfortunately, in rare cases low back pain can become a chronic disorder. There are many factors involved in this process. One of the problems can be psychosocial stressors or "fear avoidance". Have your husband look into getting a book called "explain pain." This book has some great information on chronic pain and may be helpful. (http://www.noigroup.com/booklist.html)

Spinal stabilization has been shown to be one of the most effective treatments of chronic low back pain. A concentration on the multifidi and transversus abdominus may be helpful.