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Sunday, December 22, 2013

Sciatica and Piriformis Syndrome

Dear dr Blake,
    My name is Susan (name changed) I'm 33yrs old and suffer from piriformis syndrome. I was given your name by Dr Stephen Pribut, top sports podiatrist in Washington, DC. I have been injured for over 2 1/2 years now (in April it will be 3). I am in constant pain. I got injured as I was working as a nurses aid in a retirement home and I was helping a resident use the restroom. Well as he was standing there his knees gave out and he dropped and I jerked forward and twisted right. I immediately felt excruciating pain in my low back into my behind. Well about 8 months after I got hurt they finally did a second MRI and discovered my piriformis syndrome.
Dr Blake's comment: You will be able to see from the videos below what they saw in that MRI. What Dr Filler, neuro-surgeon, will say is that 25% of low back surgeries fail since they are actually piriformis syndrome in disguise. 

 I've tried everything from PT, pool, ice, heat, injections, chiropractic and finally surgery. Well my muscle is still tight and I still have immense pain and feel like I'm sitting on a rock. 
Dr Blake's comment: The importance of one of the below videos is that a percentage of piriformis syndrome patients have injured their SI joint (Sacro-Iliac) and the piriformis is in spasm to protect that joint. This could have easily happened in Susan's injury. 

Anyways I'm from Longview, Washington. Do you know anyone around here that specializes in this! My Dr is an Ortho surgeon and he has only done this maybe 4-5 times in his whole career! I'm desperate to have my life back! I'm even willing to travel I just need help!
Thank you for listening to me

Dr Blake's comment:

Hey Susan, I am so sorry. I would seek the advice of Dr Mark Reeves at the Virginia Mason Clinic in Seattle! This is a common problem and someone there should be familiar. Keep me in the loop and to speedy healing. Rich

Susan's Response: Thank you! I'm interested that you say it's common because I have been told it is an uncommon issue and most of the drs around here won't even take me as a patient because they don't know how to treat it and some have even said they've really never heard of it before! Lol so I hope dr reeves can take on my case and give me some relief! I need it! This pain is excruciating (hence the reason I've been awake since 3 and emailing you back so early!!) I'm just so ready for relief! And to be active again!! I appreciate your help and will definitely keep you updated!
Have a good morning
Dr Blake's comment: Perhaps a call to Dr Filler's Santa Monica office to see if they know someone in the Seattle area. All my Piriformis/SI joint issues see Dr Irene Minkowsky in San Francisco, so I am spoiled. She is a physiatrist specializing in that area. I would definitely have a non-surgeon tell you that you need more surgery. The videos below speak of some elements of rehabilitation, but as of now, there has to be a reason for your pain, and a common cure. 

After sending a note on her progress, Susan replied: 

Thank you. I talked to dr reeves and he referred me to a dr chun. I had another MRI done on Monday. And will get my results the 31st (10 days from now). You can share my story or whatever you would like to do. I was stuck in bed all week because of my pain. They taped my feet together so my hips would be in a certain way for the MRI and it was excruciating!! I couldn't walk by myself after that. I had one person on each side of me helping me. I just want to have my life back!! I can't do my normal life for the last 2 1/2 years! It would be nice to be active again! Anyways I'm trying to get into see dr chun I just need my referral and approval through labor and industries. :) I appreciate your help! 
Thank you 

Dr Blake's comment: So, I have a variety of very good videos below talking about so much of the syndrome. For Susan, Rehabilitation can not even start until we create a pain free environment. I am hopeful that Dr Chun can begin that process. The first stage of Injury Rehabilitation is Immobilization and Anti-Inflammatory. Susan is trying her best to Immobilize, but something is hindering her recovery. Since the piriformis is an external hip rotator in gait normally, which helps support the arch (preventing internal tibial and talar motion with pronation), as a podiatrist I will use a lot of highly corrected Inverted Orthotics to help this condition. If the problem lies in a jammed SI joint, the same orthotic can make the patient temporarily worse. Thus, the art of medicine. 

This is a good place to start a discussion on Sciatica and Piriformis Syndrome. Here are a few good videos discussing anatomy, diagnosis, and some elements of treatment. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.