Ayurvedic Treatment for Piriformis Syndrome

Piriformis syndrome is a rare neuromuscular condition when the piriformis muscle causes compression of the sciatic nerve. The piriformis muscle is the flat, band-like muscle in the buttocks near the upper part of the hip joint. This muscle is very important in movements of the lower body because it helps the hip joint to balance both sides and lifts & rotates the thigh away from the body. This helps in walking, running, shifting the weight from one foot to another, and maintaining the balance. It is used more by sports persons in actions with lifting and rotating the thighs like football.

The sciatic nerve is the largest nerve in the body. It connects trunk to lower limb and passes alongside or goes through the piriformis muscle. It goes down the backside of the thigh and leg, and branches off into smaller nerves that end in the feet. Nerve compression can be happen by spasm of the piriformis muscle.

Signs & symptoms

Pain, tingling, or numbness in the buttocks.

Severe pain in the leg, called sciatic pain.

Tenderness of the muscles in the buttocks.

Difficulty in sitting comfortably.

Pain can be triggered when the piriformis muscle compresses the sciatic nerve, such as while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time.

Causes

Compression or contraction of piriformis muscle on sciatic nerve, which may happen due to trauma or a nearby growth or mass

Pathophysiology

Piriformis syndrome is most often caused by micro or macrotrauma to the buttocks, leading to inflammation of soft tissue, muscle spasm, or both, with resulting nerve compression. Microtrauma can happen from excess usage of the piriformis muscle, like by a direct compression. Superior gluteal nerve is not involved in cases of piriformis syndrome. This nerve leaves the sciatic nerve above the piriformis muscle. Blunt injury may cause hematoma and subsequent scarring between the sciatic nerve and short external rotators.

Diagnosis

There is no definitive test for piriformis syndrome. In many cases, case history, revealing a trauma to the area, repetitive, vigorous activity such as long-distance running, or prolonged sitting will be enough. Diagnosis of piriformis syndrome is made by physical examination of nervous & locomotor systems.

Tests like MRIs to rule out other causes of sciatic nerve compression, such as a herniated disc.

Treatments

Avoid positions that trigger pain.

Rest, ice pack or applying heat may help relieve symptoms.

 Exercises and stretches help reduce sciatic nerve compression.

Osteopathic manipulative treatment helps relieve pain and increase range of motion. 

Anti-inflammatory medicines, muscle relaxants, or corticosteroids.

Iontophoresis – a therapy with electric current

Botox injections

Surgery is a final option.

Prognosis

The prognosis is good in most of the patients with piriformis syndrome. Once symptoms are managed, normal activities can be done. In some cases, a regular exercise routine is advised to avoid recurrence.

Complications

Complications are usually due to surgery done for piriformis syndrome. They include:

  • Nerve injury 
  • Sciatic nerve injury is the most common
  • Infection
  • Bleeding

Disease & Ayurveda

Khallwi/grdhrasi

Nidana

Dhaatukshaya (degeneration of tissues)

Aavarana (obstruction to channels in the body)

Purvaaroopa

Not mentioned

Samprapti

Due to the causative factors Vaata gets vitiated and gets lodged in the lower limbs, especially nerves & muscles, causing the signs & symptoms.

Lakshana

Severe pain in the lower limb

Difficulty to raise the lower limb

Divisions

Not mentioned

Prognosis

Saadhya when the disease is new

Krichrasadhya when the disease is chronic

Chikithsa

Samana

Lepana with soolaharadravyas

Parisheka with warm soolahara-sothahara dravyas

Upanaha with Vaataharadravyas

Sirodhara, kateevasti, kateepichu with Vaatahara taila(once there is no aama)

Sodhana

Sneha (Abhyanga)

Sweda (Potalisweda)

Vasti

Virechana

Raktamokshana

Daahakarma

Commonly used medicines

        Maharasnadi kashayam

Sahacharadi kashayam

Rasnerandadi kashayam

Yogarajaguggulu

Balaatailam

Guggulutiktakaghrutam

Brands available

AVS Kottakal

AVP Coimbatore

SNA Oushadhasala

Vaidyaratnam oushadhasala

Home remedies

Medical professionals suggest the following to ease pain & other disturbances in the legs:

  • Stop the activity that caused the pain.
  • Stretch and massage the muscle.
  • Hold the leg in the stretched position until the pain is relieved.
  • Apply heat to muscles that are tight or tense.
  • Use cold packs on tender muscles.

Diet

  • To be avoided
  •  

Drink enough liquids. Ensure enough hydration.

Heavy meals and difficult to digest foods – cause indigestion.

Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine

Carbonated drinks – makes the stomach more acidic and disturbed digestion

Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)

Milk and milk products – increase kapha and cause obstruction in channels

Curd – causes vidaaha and thereby many other diseases

  • To be added

Light meals and easily digestible foods

Green gram, soups, sesame oil.

Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc

Behaviour:

Protect yourself from very hot & cold climates.

Better to avoid exposure to excessive sunlight wind rain or dust.

Avoid lifting heavy weights and other vigorous physical activities.

Maintain a regular food and sleep schedule.

Avoid sedentary lifestyle. Be active.

Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.

Yoga

Vigorous exercises are not allowed in painful conditions.

Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility. 

Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.

Yoga can maintain harmony within the body and with the surrounding system.

Salabhasana

vajrasana

Bhujangasana

exercises for leg pain

All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.

Research articles

https://www.ncbi.nlm.nih.gov/books/NBK448172/

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