We see patients on a regular basis who have at some point undergone steroid injections for issues that can potentially be solved using other methods. One of the most common conditions that we see that fits that bracket is almost certainly Piriformis Syndrome. To understand why injections may not be the most beneficial form of treatment for piriformis syndrome it’s important to know why it occurs and what exactly it is.
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What is piriformis syndrome?
Piriformis syndrome is essentially a disorder in the piriformis muscle, this is located in the buttock area, and commonly causes muscular tightness and spasms in that area. It can also be accompanied by sciatic nerve pain or numbness and tingling that runs from the buttock down the backs of the legs and into the feet – although sciatic pain will usually only affect one leg at a time. What’s vital to understand is that a muscle isn’t tight for no apparent reason, there is always an underlying cause, with that in mind it would be logical to make the assumption that piriformis syndrome is more of a symptom than a condition in its own right, because it signals a potential dysfunction in another area. When piriformis syndrome is labelled as its own condition it can lead to the misunderstanding that injections may be the best type of treatment, but if we identify it as a symptom then it doesn’t make sense to treat that and not the underlying condition.
With the idea that muscles don’t go into spasm on their own, rather they are controlled by impulses travelling from the brain and transported through the spinal cord. The piriformis muscle is controlled in the bottom of the lumbar spine going into the sacroiliac region, in the lower back, specifically around L5-S1. If you have an injury in that area, such as increased compression or irritation, or a condition like a slipped disc or spondylolisthesis, this can create inappropriate signals that cause the muscle to tighten – this is also why it can affect the sciatic nerve as they’re controlled in similar regions of the spine.
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What do steroid injections do?
So now we understand what the piriformis is, where it’s located and how it can be irritated, how much sense does injecting the piriformis itself with steroids make? Not only is it not treating or touching the underlying cause in any way, it’s probably not going to offer any kind of long term relief as a result of this. Steroid injections are essentially designed to reduce irritation and offer pain relief by aiming to reduce the amount of inflammation present. Now this may offer relief in the form of reduced pain for anywhere from a couple of weeks to a few months, but is by no means a permanent solution to the problem and it will almost certainly recur because the underlying cause is still existing. Infact, injecting the piriformis could potentially be risky because it may increase the likelihood of other types of injuries within the muscles or tendons. Injecting steroids into an area that for the most part is otherwise healthy, would most certainly not be a decision to take lightly, especially when considering that the way the steroid injection would bring down the inflammation in itself is not entirely healthy.
There are a number of studies out there, most commonly performed on the achilles tendon or the supraspinatus tendon, that show firstly that injections give a temporary reduction in tensile strength in the tendon. Translated, this means that the tendons are not able to withstand any stress during this time, and leave them susceptible to further injury such as ligament or tendon tearing or rupturing. Using this type of treatment in already unstable area could potentially bring a whole host of other issues with it, not just the looming thought that it’s not a permanent solution.
Treating the underlying cause to achieve relief
So what is the best way to treat piriformis syndrome? Treating the true cause and source of the problem is the first step. Visiting a local practitioner or professional to you who is able to identify this should be your first port of call so that the problem can be effectively found and treated.
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At The Mayfair Clinic we run a series of orthopaedic tests during your examination that will help us find the root cause of the problem, followed up with x-ray imaging where appropriate and we finish up with a diagnosis and a recommendation of a treatment plan. Let’s say you’re suffering from a slipped disc that is affecting the piriformis muscle, we would arrange a treatment plan for you that targets and treats the slipped disc, as well as using our other therapies to give pain relief to the piriformis muscle. We do this by treating the surrounding areas to improve their function, as well as the underlying cause, so in this case we would not just treat the spine but also the lateral hip rotators, the glutes, hamstrings and calf muscles as well, to make sure the body is more in harmony.
If you’re considering seeking out steroid injections for piriformis syndrome, ultimately it’s your decision as to whether you think it will be a beneficial treatment. But educating yourself on the piriformis muscle, what causes piriformis syndrome, and asking yourself if you have undergone any in-depth examination procedure to identify what the exact underlying cause is, are all things that can help you make a more informed choice on whether that is the right course of treatment for you. It’s definitely a treatment that requires a little more thought processing, but if you’re making an informed decision it’s more likely to be one that your body will thank you for later.
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