Piriformis Syndrome: Misdiagnosis and A Positive Outcome

Piriformis syndrome is a painful condition that tends to start in the bottom (to be precise, the buttocks) but sometimes it can start in the pelvis as well, especially if there has been some kind of injury or fall.

The pain, which starts in the bottom then seems to radiate into the hip and thigh area as well as down into the legs and it can even travel as far down as the foot.

To put it succinctly, what is happening is that the sciatic nerve is being pinched or compressed by the piriformis muscle. But this in itself is where there can be a risk of misdiagnosis. The condition can be attributed to being sciatica per se, yet the two conditions are not in fact the same. Yes, with sciatica the sciatic nerve is being pressed or pinched, but with piriformis syndrome, the piriformis muscle is the ‘problem’ muscle in the sense that it is the piriformis that is causing the sciatic nerve to become pinched or compressed.

However, the similarity of the two conditions means that the most obvious condition to choose may be sciatica and this is why patients who have piriformis syndrome can be misdiagnosed with sciatica, even though the sciatica may be in fact caused by piriformis syndrome and it is the piriformis muscle that needs to be treated.

In other words it is important to go to the root of the problem and if it is piriformis, then the piriformis muscle has to be treated.

Botox and Piriformis:

Botox, although by no means a magic bullet can be an effective treatment for piriformis syndrome because it actively inhibits acetylcholine, being released. This is a neurotransmitter that is found within both the peripheral and central nervous systems, but the result of inhibiting its release means that the nerve is debilitated or it is ‘denerved’ for a period of up to 6 months, although usually pain relief is limited to some 3 months.

This denervation means that the patient does not feel any pain or at least pain is significantly reduced. However, it is also quite effective and may be suitable and effective for almost 90% of people with piriformis syndrome.

In addition, Botox has significant advantages over other techniques, because it does not involve any radiation (fluoroscopy techniques are used, not X ray). It is also extremely quick to administer, with the procedure being complete in less than half an hour.

Due to the fact that there is no surgery it is also minimally invasive and although there are some very low risks of contra-indications such as feeling slightly dizzy or light headed, the risks are exceptionally low and consequently the procedure is actually exceptionally safe.

Botox is also extremely useful where a patient has been misdiagnosed with sciatica initially because it relieves pain quickly and consequently it ensures that patients are no longer debilitated by this condition, so they do not have to wait for a long time for pain relief after the correct diagnosis has been made, which can be extremely important when a patient has significant levels of pain!


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