WEAVER'S BOTTOM OR PIRIFORMIS SYNDROME?
Earlier this week I saw a patient for PIRIFORMIS SYNDROME that had come quite a distance to see me. This person had some absolutely brutal FASCIAL ADHESIONS and Scar Tissue around the area of the buttocks / posterior hip. I had treated this person once before --- several months ago; but in the meantime, they had been to an older "Country Doctor" (there are not many of these left) who told this individual that their problem was not Piriformis Syndrome, but was instead something called Weaver's Bottom. Weaver's Bottom?
Although I do not claim to be a very intelligent person, this term, "Weaver's Bottom" was completely new to me --- something I had never heard of before. My patient said that it is what people who used to sit on a hard stool or chair all day long, while weaving on a loom or wheel, used to get. Of course I wanted to know more, so I jumped online and started to read.
Weaver's Bottom is the 'Olde Tyme' common name for something called Ischial Bursitis. Let me help you find your Ischial Tuberosity. First (and this is extremely important), look around and make sure no one is watching you do this (you'll understand why momentarily). Now lean to one side and run your finger along the bottom part of your bottom --- right where you sit. Now feel for what I tell my patients is the "Butt Bone". You just found your Ischial Tuberosity!
In the picture below, the Ischial Tuberosity is bony prominence that is just below the "eyes" of the pelvis ---- the lowest part of the pelvis that you sit on. Now, take a look at how far the Piriformis Muscle is from the Ischial Tuberosity. Although the Sciatica (leg pain) could certainly radiate into the area of the Ischial Tuberosity, I do not typically see Piriformis problems referring pain solely to that particular spot.
There is a fluid-filled sac that sits on the bottom of the Ischial Tuberosity called the Ischial Bursa. The purpose of any bursae is to protect both tendons and bones from the friction that they create when they rub against each other during movement. The word 'itis' means INFLAMMATION; and when used in conjunction with the word, "bursa", you get BURSITIS --- an inflammation of the bursa. Although I think that there are lots of people who suffer with Ischial Bursitis (Weaver's Bottom), my guess is that it is frequently misdiagnosed.
I have always said that much, if not most of what is diagnosed as bursitis, is really Tendinosis. TENDINOSIS is the problem that doctors used to refer to as tendinitis. As far as the medical profession is concerned, it makes no difference to them what they call it because they treat it the same way ---- anti-inflammatory drugs and CORTICOSTEROID INJECTIONS. In some cases of severe Ischial Bursitis, the bursa is actually removed surgically.
There is a direct relationship between the Piriformis Muscle and the Sciatic Nerve --- the nerve that causes leg pain when irritated. Look at the picture on the left. If you move down from the Piriformis, you will see the white tendon of the long head of the Hamstring Muscle anchoring itself to a bony prominence (red). This bony prominence is the Ischial Tuberosity or "Butt Bone" as I called it earlier.
Just from looking at the anatomy of the area, you should start to realize that Weaver's Bottom (Ischial Bursitis) and Piriformis Syndrome (with sciatica or without) are two very different problems that in most cases should be fairly easy to distinguish from one another. For one thing, you will not get sciatica with Ischial Bursitis. For another thing, HAMSTRING TENDINOSIS will usually be helped by our Scar Tissue Remodeling work, but it may very well aggravate a true bursitis.
Sitting tends to aggravate both Piriformis Syndrome and Ischial Bursitis; and Ischial Bursitis is usually caused by either traumatic or repetitive injury --- the same things that can cause Piriformis Tendinosis. This can sometimes make Weaver's Bottom somewhat difficult to distinguish from Hasmstring Tendinosis. This is a very similar phenomenon to BICEPS TENDINOSIS being frequently misdiagnosed as Subacromial Bursitis. Just be aware that MRI will usually fail to identify any of these problems (HERE), and is not typically a good diagnostic tool for them.
THE GIANTS ARE DYING
The experts tell us that the remaining WWII veterans are dying at the rate of nearly 1,000 a day. When I was newly in practice over twenty years ago, I treated scores of these vets. Not so now. It's a sad thought, but with the youngest of these men approaching 90 years old, it won't be long before they are all gone.
Maybe it's because my mom lost her father while she was still an infant (the Ardennes Forrest in Belgium ---- the Battle of the Bulge), but I have always been a student of the Second World War. I probably have about 200 books on the subject in my personal library. But sitting and talking with these men as they open up about their experiences, and listening to what they went through to keep this nation free has always been a privilege; something truly unforgettable. Yesterday I was talking with an elderly woman whose husband is in a nursing home with Alzheimer's. I relayed a story about her husband's brother that she had never heard before.
This man was stuck in a foxhole somewhere in the South Pacific (maybe Guadalcanal) for the better part of two weeks. It rained the entire time, and he and the rest of his company's clothes and boots were literally rotting off of them. They all had varying degrees of Malaria and Dysentery, and were covered with a wide range of skin conditions collectively called, "Jungle Rot". As he came out of his hole for an attack, a Japanese shell hit close by and knocked him down. He said it felt like someone had hit him in the chest with a baseball bat. He looked down, and there in his the front pocket of his shirt, embedded in the cigarette tin where he kept his Testament, was a jagged, smoking, hunk of shrapnel about the size of a shooter marble. It had literally buried itself in the pages of his Bible. He brought it in and I got to actually hold it in my hands. His Bible kept the shrapnel from going through his heart!
I treated a quiet, unassuming farmer who was a tank commander in Europe. He went through 5 different Shermans over the course of the war. One would get blown up, and if you survived, they gave you another one and told you to get down the road. I knew a gentleman who flew scores of bombing missions in both Europe and the South Pacific. I spoke with a patient one day who told me a story about one of our local pastors. It seems that these two friends who ended up in the same company, wound up together in the Far East and traveled across North Korea together in an old wooden box car. They told me that they have never felt anything so cold in their life. I have heard heartbreaking stories of loss, and dramatic stories of courage too many times to count.
The men that came home, got married, had families, worked all sorts of jobs, went to church, built their communities, and never complained or felt like the world owed them anything. They were thankful to be alive. We could all take a lesson. Thank a veteran today, and remember those fallen heroes that never made it home. Most of that generation --- the 'Greatest Generation' --- was a hero. We could all take a lesson. The giants are dying.
COLD LASER THERAPY AND TRIGGER POINTS
I have been using Cold Laser Therapy (aka Low Level Laser Therapy or LLLT) for the better part of two years. Although it has certainly not helped every person we have treated with it, it has helped a significant percentage, with some of those being characterized as nothing short of "miraculous".
One of the things we have used it for is Trigger Points. TRIGGER POINTS are small knots of muscles that, although they can occur anywhere, usually occur in the trapezius muscle (where the back meets the neck and shoulder). Although our tissue work helps some of these folks, unfortunately these are, much of the time, not simply FASCIAL ADHESIONS.
What does the scientific peer-reviewed literature have to say about COLD LASER THERAPY for Trigger Points? Let's go back a few years and take a look. in the January 2009 edition of JMPT (The Journal of Manipulative and Physiological Therapeutics), a study was published called, "Chiropractic Management of Myofascial Trigger Points and Myofascial Pain Syndrome: A Systemic Review of the Literature" . 112 relevant studies were reviewed, and various forms of Trigger Point treatments were looked at. Here are the results of this study.
Did you catch that? The evidence for Low Level Laser Therapy (Cold Laser Therapy) is strong for dealing with myofascial pain issues --- particularly Trigger Points. To learn how it works, click the link above. Because Trigger Points can be so difficult to completely get rid of, I would suggest the inexpensive TheraCane or Back-Buddy for dealing with these at home and in the office. I would also suggest asking your Chiropractor about using a DAKOTA TRACTION DEVICE. Not sure what I'm talking about? Read my posts on EXTENSION THERAPY and DRY NEEDLING.
GOVERNMENT PANEL SAYS THAT DOCTORS SHOULD SCREEN FOR OBESITY
This latest recommendation by the United States Preventative Services Task Force is a real head-scratcher. For Pete's sake; most people own a mirror and scale. Really; how hard is it to admit that you should probably be doing some things differently --- like maybe some push-aways from the table. Take the bull by the horns and start reading through my posts on WEIGHT LOSS. I promise that the information there will be far better than what your doctor provides you.
GLUTEN FREE ELIMINATION DIET....
"We are in fact considered a human commodity. Our loved ones, our children, our elderly are considered cash cows that are preyed upon by pharmaceutical reps such as myself that are encouraged to go in and build market share without thinking of the consequences to patients, without knowing the misinformation that they are distributing, without being aware that the clinical data has been contrived or that the patient population has been cherry-picked, or that the side effects have been minimized and represented in such a manner as it doesn't present the information correctly."
FASCIA TRANSMITS MESSAGES
ACTING AS SECOND NERVOUS SYSTEM
Fascia researcher, cell biologist and biophysicist, DR. JAMES OSCHMAN recently quoted from a biology book that is over 60 years old (Man on His Nature), which can be seen at the top of the page. The quote pertains to the fact that despite having no nervous system, a paramecium (single cell organism) can swim like a dolphin, avoid creatures trying to eat it, find food, and mate. How is this? How can a single-celled organism do all these things without a brain or nervous system to guide it and provide messages?
And increasing amount of scientific research shows that certain cells found in the connective tissues not only communicate directly with the nervous system, but with can actually communicate with each other as well --- potentially over great distances. Dr Alfred Pischinger (1899-1982) was the head of the Department of Histology and Embryology at the University of Vienna's Medical College. In 1948 he went a step further than ANDREW TAYLOR STILL and described where the "neural" control of the EXTRA CELLULAR MATRIX (the gel-like sugars, proteins, and membranes that lie between the cells and absorb mechanical stress) came from, theorizing that this is where all disease starts --- something that other equally brilliant scientists are increasingly picking up on (HERE).
Dr. Oschman shows how all bodily motion --- no matter how small --- generates electric fields that are caused by the compression, deformation, and stretching of LIGAMENTS, TENDONS, FASCIA, BONES, and other COLLAGEN-BASED CONNECTIVE TISSUES. In nerve-like fashion these messages spread throughout the surrounding tissues like ripples on a pond, providing information to other areas of the body. And if you have followed my BLOG POSTS ON FASCIA, you already realize that these messages travel through the water-based ECM at the speed of sound in water ---- 750 mph as opposed to just over 150 mph, which is the speed that nerve messages travel.
Although many others have since followed his lead, Dr. Pischinger went so far as to state that Fascia is an organ (HERE is the brand new research on this). Furthermore, he says that it is the body's single largest organ ----- the only system that touches every other system (even though most physicians will tell you that SKIN is the largest organ). Although we now know that in the human body, the nerves branch down until they touch / affect each cell in the body, we are seeing that Dr. Pischinger was not far off. Pischinger was one of the first to recognize the incredible importance of Fascia when he said over a half century ago that, "The fascia must be looked upon as a single organ, a unified whole, the environment in which all body systems function."
University of Vermont's DR HELEN LANGEVIN (a neurologist and endocrinologist who is also affiliated with Harvard) has shown that Fascia forms a body-wide network that functions in a nerve-like signaling capacity. Like nerves, the impulses travel by way of cells that electrically polarize and depolarize. However, it does not stop there. TISSUE REMODELING, MECHANICAL LOAD, CELLULAR DEFORMATION, POSTURAL CHANGES, and changes in motion or position (PROPRIOCEPTION), also transmit signals. These signals are altered by decreased function that is caused by things like CHRONIC PAIN or injury (or MICROSCOPIC SCAR TISSUE). Interestingly enough, Dr. Langevin keeps going. She goes as far to discuss the probability of a relationship between the Connective Tissues (Fascia) and organs / organ systems. Although the conditions needed to validate this relationship have been shown to occur in "laboratory test tubes", it has not yet been proven in living humans.
What should you take away from all of this? Only that properly functioning Fascia and Connective Tissues are absolutely critical to one's overall health. We have seen doctor after doctor after doctor --- brilliant men of science (Oschman, Pischinger, Ingber, Still, and numerous others) who have pushed the controversial idea that all disease arises from abnormalities in the body's Connective Tissues (HERE or HERE). Their belief is not arising from thin air, but from decades of clinical experience and research. Maybe this is why in our clinic, we frequently get COMPLETELY AMAZING RESULTS! Ignore the Fascia and other Connective Tissues at your own peril. And for those who really like what they are seeing with fascia research, I have 160+ articles on the subject all neatly categorized into one post (HERE). Enjoy!
ICE -VS- HEAT
AND THE RELATIONSHIP TO...SOFT TISSUE BRUISING
An important concept to remember is that you cannot injure the tissue without injuring the tissue's capillary bed as well. Because these capillaries are quite thin, they can be torn or broken relatively easily. Let's say that you were hit in the thigh by a line drive baseball while pitching to your son. As the tissue was impacted, it deformed / stretched. This is normal and good. Unfortunately, the blow by the baseball was too intense and occured too quickly for the soft tissues in your thigh to overcome the mechanical stresses / load placed upon it. In other words, the tissue tore.
Bear in mind that usually this "tissue tearing" is something that occurs microscopically. In other words, testing with advanced imaging techniques (MRI, CT, Diagnostic Ultrasound) might show some swelling, but are not likely to show the tissue damage itself --- even though it was the tissue damage that caused the swelling to occur.
When this happens, there are chemical mediators that are released (INFLAMMATION) which, while not to be considered swelling, attract swelling to them via vasodilation. In other words, these mediators we call Inflammation can actually make the blood vessel dilate to a larger size! As you can imagine, the worse the tissue injury, the worse the swelling. And the worse the swelling, the more things that can go wrong. Some of this is because the initial Swelling and Inflammation is the first step in forming SCAR TISSUE. This is why it is important to control swelling. Oh, and by the way, when the capillaries are torn enough, they can actually leak red blood cells into the fluid around the tissue (Interstitial Fluid). This is called a BRUISE.
My advice is to only use heat for old (chronic) injuries and then use it systemically ---- whole body heat in the form of a bath, shower, jacuzzi, etc. Local heat has the potential to cause lots of problems. Instead use ice. Just be smart about how you do it. No more than 10-20 minutes (depending on the area being treated) and never directly on the skin. One more thing. Even though anti-inflammatories work, they have lots of potentially serious side-effects, which is why we recommend ice instead of drugs!
BREAKING MICROSCOPIC ADHESIONS,
SCAR TISSUE, AND TISSUE FIBROSIS
WHY BREAKING SCAR TISSUE CAUSES BRUISING
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration