HERNIATED DISC OR PIRIFORMIS SYNDROME?
Is this question being answered correctly the majority of the time? I'll answer by quoting a research project from UCLA's Cedars Sinai Medical Center, done in collaboration with L.A.'s Institute for Nerve Medicine. The study was published in in the February, 2005 edition of the Journal of Neurosurgery: Spine, and stated, "Most spine specialist consider Piriformis Syndrome to be extremely rare. However, the authors conclude that although it is rarely diagnosed, it is actually a common cause of sciatica - possibly as common as the well known herniated disk syndromes."
"Rarely Diagnosed". Interesting. But it's not like this is anything new. One of the top three medical journals in the world, The Lancet, first described PIRIFORMIS SYNDROME in 1928 by declaring that it was "difficult to diagnose". I have been treating Piriformis Syndrome sufferers for over 15 years and saying the same thing! In fact, if you go back and look at what I have written over the past ten years, I have at different times called Piriformis Syndrome one of the most "Secret, Misunderstood, and Misdiagnosed" epidemics of recent history. Probably because we sit too much, eat DEGENERATIVE DIETS, and spend far too much time on concrete. But that's another post for another day.
When you look at the VIDEO TESTIMONIALS of people with a 20-40 year history of Piriformis Syndrome who I have successfully treated, an almost universal thread emerges. Not a single one of them had ever as much as heard the term "Piriformis Syndrome" until they met me. Not that it would have mattered. I am not convinced that doctors making the correct diagnosis would help these people in any meaningful way. If you have suffered with Piriformis Syndrome for any real length of time, you probably know all too well what I am talking about. Unfortunately, I'm not sure a whole lot has changed since 1928!
A press release concerning this research was put out just days before the article hit the Journal of Neurosurgery. Eworldwire.com went on to say this about the UCLA study: The most common cause for sciatica in the study proved to be a diagnosis called "Piriformis Syndrome" - one of several disorders the investigators report on that arise due to entrapment of the sciatic nerve in the area of the hip. Currently, the report says, when a patient experiences painful persistent sciatica - pain radiating down the leg - physicians often look only for a herniated lumbar disk relying upon lumbar MRI scanning. Surgery for the disk herniation is often carried out to treat the sciatica. Why is understanding this statement so critical? Mostly, it has to do with avoiding unnecessary and ineffective surgeries.
You see, depending on whose research you choose to believe, somewhere between 50% and 70% of the adult American population is walking around with low back (lumbar) DISC HERNIATIONS that they are completely unaware of (HERE). They are unaware of them because they have no overt symptoms. No back pain. No numbness or tingling. No weakness. No SCIATICA. In fact, other than these people showing a Disc Herniation on their MRI, they have absolutely nothing that would lead anyone (including themselves) to believe they have any sort of problem at all. And this is where things get dicey.
If UCLA is correct in their conclusion that Sciatica due to Piriformis Syndrome is, "possibly as common as the well known herniated disk syndromes," (it was the #1 cause of Sciatica in their study of 240 individuals) we begin to see the makings of a full-blown conundrum.
As I wrote about A FEW DAYS AGO, doctors love positive tests. And nothing represents a more "positive" finding on an MRI than a Disc Bulge. It's real. It's visible. It's tangible. It's something that doctors can point to ---- and something that they can aim their NEEDLES and KNIVES at. But when the prestigious Journal of Bone and Joint Surgery weighed in on the subject and said that, "Piriformis Syndrome is estimated to cause 6-8% of sciatica, but is more common in the general population because it has been under diagnosed and under treated." the astute realized that something was not adding up.
The Dec 1991 issue of the medical journal Pain, came to a similar conclusion over twenty years ago, "Although rarely recognized, the piriformis syndrome appears to be a common cause of buttock and leg pain." Wikipedia says that, "diagnosis is difficult due to few validated and standardized diagnostic tests". "Rarely Recognized". "Under diagnosed" "Few validated and standardized diagnostic tests". If UCLA is correct, I would call these last three quotes "under" statements! Think for just a moment about what is going on here.
The Journal of Bone and Joint Surgery is saying that Piriformis Syndrome represents significantly less than 10% of the Sciatica (6-8%), while UCLA is saying that it is approaching 40%. That is a big difference. And no matter how you slice it, it's impossible to get around the fact that over 50% of the adult population is walking around with asymptomatic Disc Herniations in their lumbar spines see earlier link).
As a chiropractor, I can assure you that hip pain, low back / upper buttock pain, and SCIATICA are all extremely common conditions ---- "Dog Common" as I like to say. On top of this, Piriformis Syndrome ---- a problem that UCLA is now saying is as prevalent as, or more prevalent than Herniated Discs ---- is being universally realized as being misunderstood and under reported (sounds like my description from earlier). This all adds up to bad scenarios that are occurring around the country with stunning regularity.
By the way, Disc Problems such as herniations or DEGENERATION tend to respond like gangbusters to SPINAL DECOMPRESSION THERAPY. However, the very same Non-Surgical Spinal Decompression will usually make Piriformis Syndrome worse! If you think that you might have Piriformis Syndrome, come in and talk to me. There may be hope for you after all. Or to view more Video Testimonials of our patients who have been helped after suffering from decades of severe Piriformis Syndrome, simply go HERE.
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).