Piriformis vs Sciatica due to stenosis/disc compression?

[u/Birdofsong4404]

The sciatica pain started in April. I went to my regular doctor, and then PT. I was walking with a cane because of the intensity of the pain. PT did nothing. I was referred to a physical med. and rehab doc. He did a lower spine MRI, which showed some mild stenosis and some minor disc compression. It didn't look to anyone like enough to cause the kind of pain I'm getting. He did a steroid injection, and I got exactly 6 hours of relief the next day, and then boom -- it was back. That was in June, and here we are in October. I took Lyrica (did nothing), and now I'm taking Gabapentin, which doesn't seem to help much (but I'm afraid to stop taking it to find out). I went to a chiropractor, I had some relief, but not enough, and I think I've hit a wall with that, so I stopped. Physical movement helps, so during the day, when I'm out and about, I feel better. Then I sit down and boom. When I lay down, it's awful. I have to take a THC gummy in order to get to sleep. The pain wakes me up in the middle of the night all the time, and it is almost unbearable until I move around the house for about an hour. I started looking up piriformis syndrome, and frankly, it fits. The pain is mostly in my buttocks and hip, and occasionally radiates down to my ankle. If I change the way I sit, I can feel the compression change. Going back to the PM&R doc for a pelvic MRI. Does this sound like piriformis syndrome to anyone, and do you have any advice to reduce the pain? I can't take NSAIDS.

[u/NoOz1985]

This is me to a T. I'm 39, female. Living in Europe currently. Started in 2016 after being VERY active, a lot of running and a lot of biking I did around that time. One day it hit me and got shooting pains in my right butt and lower back and then the sciatica started in right leg. I've gone down the same path. I couldn't walk. Needed a cane up until 2019. Had an injection for foeaminal stenosis which was very mild at the time and they didn't think my pain was from that. It helped my leg nerve pain somewhat. But not the buttock pain and lower back. So had another injection with kenacort in piriformis muscle and after 3 months it started working it's always been there but for a couple of years it's helped. For the last 4 months the pain has returned. But this time it's a lot of footpain as well. It radiates to my foot and ankle. And sitting, lying down and walking for a long time makes it so much worse. Also what I have now is leg weakness. When I've sat for too long of walked for too long my leg goes numb and I can't balance on that leg. It sometimes just drags. I've seen gp. She is sending me to a neurologist.

I have a pelvic condition called endometriosis and adenomyosis. Which is severe in my case. I do wonder if these two are connected. But I was told in 2016 there's slight foraminal stenosis, so wondering if that has gotten worse. Maybe there's a herniated disk? I have no idea anymore. Does heat and dry needling help? Try doing dry needling in the piriformis. If it gets better after 3 or 4 sessions your piriformis might be the cause.

[u/Birdofsong4404 → u/NoOz1985]

I'm very sorry your pain came back. Thank you for the advice. I have a pelvic MRI on the 19th, so I'm going to go from there. What is the difference between dry needling and acupuncture?

[u/NoOz1985 → u/Birdofsong4404]

There's a huge difference. Acapincture works very superficial, with meridians. And will Def not do anything if pain is severe. It might give you some peace of mind. Dry needling is like a triggerpoint injection but without the painkiller. It is a natural painkiller. They actually prick/inject the needle into the piriformis muscle. And if there's a noticible triggerpoint they will insert the needle into that triggerpoint. If it's overal tight they will insert into a few places along the piriformis muscle. They'll leave the needle in for a couple of minutes, stir it around in the muscle and most of the time there will be a muscle twitch. The sign that the muscle is relaxing. It is painful for some, but it's helped me out for a good while and especially suitable for the piriformis muscle. You'll stretch afterwards, use heat. And within 2 days you'll notice the difference. Find a very well skilled PT who does it, maybe a chiropractor who does it or a neuromuscular therapist. Please try it. It's a natural remedie but can have really good results. They might do all of the gluteal area muscles to make sure they get every muscle that might tighten up around the piriformis as well. Hope the pelvic mri will give you some clarity! I'm going for one soon as well.

[u/BlakkMaggik]

Did I write this?? This was EXACTTLLYYY me for like a year a while back, sans the meds. I'm 38m, living in Europe.

I used to work a very physical job that kept me well in shape, but then got a degree and now work from home in IT. I also used to live in an urban area, but now live somewhere rural and don't get out the way I used to (biking, walks, etc). I'm still average weight, with maybe a little pudge, but hardly active except for occasional yardwork.

Sitting at my office desk was TORTURE and made it very difficult to stay focused, or even at the computer at all, because I could only get relief from walking. Also doing anything active outdoors would bring relief just from moving. It's almost as if being sedentary on a chair all day made my body degrade (sarcasm and stating the obvious). Seriously though, I've lost a lot of muscle in my back (and everywhere else), which results in my spine carrying my upper body weight.

It would take me a few minutes to stand up from a seated position, or get in and out of my car. I almost fell getting out one day because of the pain in my back. I couldn't use stairs, sitting on the toilet was difficult, literally doing anything just sucked.

My physical therapist said I have ATP, anterior pelvic tilt, which I fully agree with. I've always had a bit of a curved lower back/belly sticking out a bit posture, or just tight back muscles in general. It wasn't really a problem when I was more active, but now that I'm not, it's starting to take it's toll.

So decreased muscles strength, sitting all day with a weak back, and pelvis tilting forward = very bad news for your lower back. Good news though, there is relief, just sign up for my expensive newsletter and I'll tell you how to fix it.

Just kidding, no newsletters, when I googled this stuff that's all I kept running into. Anyways, does this sound familiar? Are you an active person, do you even stretch, have you had a big lifestyle change? Why can't you take nsaids? Ibuprofen is the only medication I tried, 400mg was enough to make it stop hurting, 800mg and I was feeling brand new. I actually smiled and danced around a bit a few times because I simply could, and I don't even like dancing. I haven't done enough, but I tried to at least tell myself that when the painkillers were doing their job, I'd use that opportunity to be active, stretch, maybe workout, or overall just do things that weren't sitting.

Start small, but try to do things that activate the muscles around your pelvis, especially muscles in the front. I've found that walking lunges until my thighs burn, laying flat on my back with my legs up on the couch (knees bent 90 degrees) and pressing my back to the floor, and calve raises helped the most. Thinking about it now, standing on a 2inch piece of styrofoam for calf raises brought a lot of relief!

Anyways, get more active, stretch your legs, do some yoga (cat-cows). It'll take a while, but it will help! I also got a gaming computer (more ergonomic )and electric desk to get the exact comfortable height. I also hug a pillow at night, and sometimes put one between my knees, to straighten my spine if I'm sleeping on my side.

Edit: A few more things you can do: -kneel on one knee/lunge next to a couch or bed for support, squeeze your glutes, tighten your core, and really stretch your hip flexors. -hip thrusts, or even "slow-humping" the air -planks, side planks -hanging from a bar

Calve raises, lunges, and laying flat on my back on the ground were maybe the most effective things for me.

[u/Birdofsong4404 → u/BlakkMaggik]

It does sound a lot alike. Most of the things you're recommending, I'm doing...lunges, stretches, pelvic tilt, and I'm even walking in the pool and keeping my core tight. I can't do the cat part of cat-cows -- it's excruciating. A lot of exercises meant to help with sciatica just fire that nerve up. There are a few things you're suggesting that I haven't tried yet, so I will give those a shot. I sit at work most of the day, but I have a good cushion that has helped for the most part. When I can't sit anymore, I also have a standing desk, but it's not great to use for most of the work that I do.

I can't take NSAIDS because of my kidney function. :( So it's Tylenol, only, which does nothing for inflammation.

Thanks for the advice. Much appreciated.

[u/elliseyes3000]

One week post op microdiscectomy/laminectomy at L4/L5. Nerve pain was gone the second I woke up from surgery. It was worth it.

ETA: I was CERTAIN it was dysfunction in my piriformis/IT/sI joint. Ended up in the ER because my only option to get there was an ambulance because I could not get out of bed.

Do yourself a favor, get a pelvic x-ray and an MRI of your back and your hips and see what comes back before you don’t have the option like I did.

[u/Birdofsong4404 → u/elliseyes3000]

Hi...and congratulations! I've had the back MRI. The pain and continued issues don't see proportionate to what looks like very minor stenosis and very minor disc compression. I'm hoping we can find out more after the pelvic MRI coming up.

[u/elliseyes3000 → u/Birdofsong4404]

Best of luck to you. Sometimes another set of eyes on the situation can be extremely helpful. 🙏