Extremely informative and in-depth presentation on the various symptoms ,anatomy and possible causes of this condition… I’ve been living with Piriformis syndrome for a couple of years now as identified by the community . The pain was triggered due to overextension in Yoga and an old injury to the muscles and or tendons. It has caused me a lot of sciatic pain which I relieved with cortisone injection(temporary relief as you mentioned) and by stretching and strengthening… Not sure at all if I’m doing the right treatments as In Canada 🇨🇦 we have to wait a very long long time to have access to scans and specialists to further diagnose our symptoms. Thanks to TH-cam we have access to professionals like you to further define the condition.
I recently received a diagnosis of bilateral sacral fractures after a failed L4 L5 minimally invasive decompression surgery with an unexpected partial right discectomy. Would there be an association between sacral fractures and piriformis syndrome or gluteal syndrome?
Hi Dr.Simon, I am following always your fantastic videos at your channel,thank you! For piriformis syndrome, what is your protocole in EDX to check for the nerve ,which nerves studies you perform in NCS and which muscles you usually prefer for EMG needle exam. Second, who usually do the piriformis injection (diagnostics vs treatment)either Steroids or botox, the hip orthopedist (blindly)or the radiologist guided by fluoroscopy? Thank you and please keep sharing with us such informative videos (but sometimes the slides are not clear enough,lens? HD?)
Many thanks Dr Sayad! Personally (once it's suspected and if clear that only Sciatic Nerve fibres are impaired otherwise add more..) - I'd make sure the Sural and SP SNAPs, Peroneal/Tibial CMAPs and F-waves, H-Reflex with and without FAIR positioning were done. Working distal to proximal - EMG TibAnt/G.Med/Vast Lateralis/ Semimembranosis/TFL/GMed/GMax as well as lower lumbar Paraspinals. In my practice, patients are referred to me for their diagnostics and so I see referrals from a wide range of specialists, rather than people coming to see me directly and then for me to choose where to send on. Apologies for some of the Audio Visual quality - unlike other TH-camrs - this isn't my day job and I'm often making these very late at night..... Very best, Simon
@@DrSimonFreilich Constant feeling like a lobster has ahold of my buttocks deep inside on both side. No muscle soreness just a nauseating pinching tight feeling in both glutes. Sometimes stretching dampens it been going on for 5 months and have been to physical theropy for 3 it’s only improved slightly but keeps coming back. When I’m driving it really acts up and I can feel it in my lower thigh very aggravating. I’ve had an mri of pelvis and lumbar spine and everything looks great. What could this be besides piriformis syndrome? Please give me some ideas of alternative possibilities
@@jehannemarie1163 I think it's a numbers game. Such a small percentage of the population goes through it that there's no financial incentive to invest in research for it. :-(
I found your lecture very informative. Just a note that I was diagnosed five years ago with an idiopathic sensory motor neuropathy and am now in a wheelchair. I was an avid runner and the gradual onset of hip pain and tingly toes and occasional back spasms that lead to a disabling lower limb neuropathy has now made it clear that what was a mild piriformis syndrome is now a severe disabling sciatic nerve entrapment. Fortunately I have found a peripheral nerve surgeon who can help me. I do not believe piriformis nerve entrapment is as rare as once believed. I think that any patient who suffers from lower back pain or lower limb neuropathy should be assessed by a peripheral nerve surgeon who treats chronic pain.
Todah Achi. I’m quite certain that my old ‘back pocket wallet lifestyle’ caused my nagging hip pain on my right side. It has been almost debilitating at times in the past, but through my efforts to increase my hip mobility along with several techniques of stretching the piriformis directly I have found real relief. I do have to keep it up though or the pain starts to creep back.
This is the great video so much misinformation out there. After five years I finally got a botox injection to confirm and it helped its night and day the pain relief now I can work hard on stretches and physio.
I have an interesting story in the making if you want to hear about it. I believe that I have the piraformis syndrome but there is so little known about it in my area that the orthopedic surgeons wont hear about it. I wish we could have a bit of a chat.
I think have piriformis syndrome and it’s recently got so bad I wake up in pain. Nothing showed up on my MRI so I’m currently undiagnosed. Weirdly I seem to have skipped the ultra sound.
@@rhul0017 my doctor told me to take 2 Ibuprofen with 2 paracetamol every four to six hours and it seems to eased the pain. I can still feel it pinching but I’ve come to accept that over the years.
@@BagofDreams just see some chiropractor, they will solve the prob, i had the same issue, it was very severe, i dont take any medication now, and have less pain now, its healing.
Make that two cases in CA. Three weeks ago I underwent a complete replacement of my right hip. After one week post-op, a deep aching (charlie horse type) pain developed in my right butt cheek. I cannot sit for more than five minutes! Sometimes, along with this intense pain, I'll have tingling on the top of my right foot. Given the piriformis muscles are above the hip joint I can only conclude the cause is this syndrome. Correct me if I'm wrong.
@@DrSimonFreilich Todar Raba. During my post-op visit with the surgeon's PA, I did mention this issue. The PA was of the opinion that as the muscles healed the pain would resolve. I can only hope she is correct and would feel better to have a definitive diagnosis.
Dr. Simon, the PA was right about my pain subsiding with time. Thirteen weeks post hip replacement surgery and I have no lingering issues, I am in heaven.
Hmm... a lot to think about. I also watched your piriformis vs deep gluteal video. I've had an MRI on my low back, showing a number of problems that I've basically had for years; received pain patches and a PT referral. I'm eager to get to the bottom of what's causing this excruciating pain in my right buttock and hip (that I have never experienced) when lying down (in any position). I'm not terribly hopeful for PT but might learn something. I think more radiological diagnostics might be in order. Thank you. Wish you were in California. Do you do telephonic consults?
I have a constant pain in my lower back, right hand side. I also suffer from foot pain, right foot, which often ends up in episodes of foot weakness, numbness and inflammation. The foot pain flares up intermittently and my calf also stiffens up. A physiotherapist diagnosed piriformis syndrome and gave me some stretching exercises to do. A lumbar X-Ray showed nothing particularly bad, other than normal wear and tear. This has being going on for years. Any ideas Dr. Freilich? Thank you.
Hi Martin-I can't answer individual people's questions, but suggest you see an Orthopaedic doctor. Lumbar Xray is a 1950's investigation that has limited use in modern day evaluation. There's so much more information to be gleaned via MRI... Bw Simon
I have L5S1 disc herniation and the specialist said my buttock and shooting nerve pain is cause by this. I noticed a lump literally where I believe the piriformis muscle is. And pain subsides when sitting or laying on tennis ball. Is this piriformis syndrome?
Hello, my right foot is in a externally rotated position while supine. I can hold it up but get a pain in my hip then it justs falls back down again. I have no pain only when trying to keep my foot up. Could this be Piriformis Syndrome related ?
Great video! Love the evidence-based info. Important to get good credible information from experts. Curious to know why piriformis syndrome would cause symptoms on both sides of the hips? Mine started on one side, and now I have pain on both sides. Fairly certain I have piriformis syndrome based on your video.
Is it possible for the superior and/or inferior gluteal nerves to suffer entrapment/impingement/compression in the deep gluteal space, rather than the sciatic nerve? I know the sciatic nerve is the main candidate for impingement because it's by far the largest, but I would think that in theory it could also happen to other nerves in the area too, no?
Constant feeling like a lobster has ahold of my buttocks deep inside on both side. No muscle soreness just a nauseating pinching tight feeling in both glutes. Sometimes stretching dampens it been going on for 5 months and have been to physical theropy for 3 it’s only improved slightly but keeps coming back. When I’m driving it really acts up and I can feel it in my lower thigh very aggravating. I’ve had an mri of pelvis and lumbar spine and everything looks great. What could this be besides piriformis syndrome? Please give me some ideas of alternative possibilities
@@jocelynegil6859 EMPI. It was prescribed years ago by my doc before TENS units became available over-the-counter. I have also tried and liked OMRON (bought from Target years ago as well) though it looks different now than what I had. I liked the simplicity of the OMRON, but I already had the EMPI so thought it was more frugal to use the unit I already had. I am better now, so don't currently use the TENS, but am glad it's in my arsenal against pain. It also seems to release endorphins, which is a happy side effect *for me*.
Extremely informative and in-depth presentation on the various symptoms ,anatomy and possible causes of this condition… I’ve been living with Piriformis syndrome for a couple of years now as identified by the community . The pain was triggered due to overextension in Yoga and an old injury to the muscles and or tendons. It has caused me a lot of sciatic pain which I relieved with cortisone injection(temporary relief as you mentioned) and by stretching and strengthening… Not sure at all if I’m doing the right treatments as In Canada 🇨🇦 we have to wait a very long long time to have access to scans and specialists to further diagnose our symptoms. Thanks to TH-cam we have access to professionals like you to further define the condition.
I watch many videos on back and hip pain. You do one of the best job at explaining. Superb video.
I recently received a diagnosis of bilateral sacral fractures after a failed L4 L5 minimally invasive decompression surgery with an unexpected partial right discectomy.
Would there be an association between sacral fractures and piriformis syndrome or gluteal syndrome?
Hi Dr.Simon, I am following always your fantastic videos at your channel,thank you! For piriformis syndrome, what is your protocole in EDX to check for the nerve ,which nerves studies you perform in NCS and which muscles you usually prefer for EMG needle exam. Second, who usually do the piriformis injection (diagnostics vs treatment)either Steroids or botox, the hip orthopedist (blindly)or the radiologist guided by fluoroscopy? Thank you and please keep sharing with us such informative videos (but sometimes the slides are not clear enough,lens? HD?)
Many thanks Dr Sayad! Personally (once it's suspected and if clear that only Sciatic Nerve fibres are impaired otherwise add more..) - I'd make sure the Sural and SP SNAPs, Peroneal/Tibial CMAPs and F-waves, H-Reflex with and without FAIR positioning were done. Working distal to proximal - EMG TibAnt/G.Med/Vast Lateralis/ Semimembranosis/TFL/GMed/GMax as well as lower lumbar Paraspinals. In my practice, patients are referred to me for their diagnostics and so I see referrals from a wide range of specialists, rather than people coming to see me directly and then for me to choose where to send on. Apologies for some of the Audio Visual quality - unlike other TH-camrs - this isn't my day job and I'm often making these very late at night..... Very best, Simon
@@DrSimonFreilich Constant feeling like a lobster has ahold of my buttocks deep inside on both side. No muscle soreness just a nauseating pinching tight feeling in both glutes. Sometimes stretching dampens it been going on for 5 months and have been to physical theropy for 3 it’s only improved slightly but keeps coming back. When I’m driving it really acts up and I can feel it in my lower thigh very aggravating. I’ve had an mri of pelvis and lumbar spine and everything looks great. What could this be besides piriformis syndrome? Please give me some ideas of alternative possibilities
If you want to see one I have a good one hear in ca
good guy same in MD
We are all born with a type of piriform one of the 6 types you show . But what make that one day we have thisvsyndrom with pains ?..
That my friend is the $64,000 question!
@@JaleelJohanson62 of course ...🤔
@@jehannemarie1163 But sadly, nobody seems to have a solid answer for it. :-(
@@JaleelJohanson62 why medical services donnot look further more for this disease , it is so painfull
@@jehannemarie1163 I think it's a numbers game. Such a small percentage of the population goes through it that there's no financial incentive to invest in research for it. :-(
too much theory
Hi! I am seemingly suffering from poriformis syndrome or sciatica. Aside from exercise should nerve vitamins help?
I found your lecture very informative. Just a note that I was diagnosed five years ago with an idiopathic sensory motor neuropathy and am now in a wheelchair. I was an avid runner and the gradual onset of hip pain and tingly toes and occasional back spasms that lead to a disabling lower limb neuropathy has now made it clear that what was a mild piriformis syndrome is now a severe disabling sciatic nerve entrapment. Fortunately I have found a peripheral nerve surgeon who can help me. I do not believe piriformis nerve entrapment is as rare as once believed. I think that any patient who suffers from lower back pain or lower limb neuropathy should be assessed by a peripheral nerve surgeon who treats chronic pain.
Todah Achi. I’m quite certain that my old ‘back pocket wallet lifestyle’ caused my nagging hip pain on my right side. It has been almost debilitating at times in the past, but through my efforts to increase my hip mobility along with several techniques of stretching the piriformis directly I have found real relief. I do have to keep it up though or the pain starts to creep back.
This is the great video so much misinformation out there. After five years I finally got a botox injection to confirm and it helped its night and day the pain relief now I can work hard on stretches and physio.
Thanks for being clear! No other vidoes is so clear
I have an interesting story in the making if you want to hear about it. I believe that I have the piraformis syndrome but there is so little known about it in my area that the orthopedic surgeons wont hear about it. I wish we could have a bit of a chat.
I think have piriformis syndrome and it’s recently got so bad I wake up in pain. Nothing showed up on my MRI so I’m currently undiagnosed. Weirdly I seem to have skipped the ultra sound.
How is it now?
@@rhul0017 my doctor told me to take 2 Ibuprofen with 2 paracetamol every four to six hours and it seems to eased the pain. I can still feel it pinching but I’ve come to accept that over the years.
@@BagofDreams just see some chiropractor, they will solve the prob, i had the same issue, it was very severe, i dont take any medication now, and have less pain now, its healing.
@@rhul0017 thanks I’ll give it a try. 👍
Make that two cases in CA. Three weeks ago I underwent a complete replacement of my right hip. After one week post-op, a deep aching (charlie horse type) pain developed in my right butt cheek. I cannot sit for more than five minutes! Sometimes, along with this intense pain, I'll have tingling on the top of my right foot. Given the piriformis muscles are above the hip joint I can only conclude the cause is this syndrome. Correct me if I'm wrong.
Hi Cynthia, I think you need to speak with your surgeon to check this out further. Bw Simon
@@DrSimonFreilich Todar Raba. During my post-op visit with the surgeon's PA, I did mention this issue. The PA was of the opinion that as the muscles healed the pain would resolve. I can only hope she is correct and would feel better to have a definitive diagnosis.
Dr. Simon, the PA was right about my pain subsiding with time. Thirteen weeks post hip replacement surgery and I have no lingering issues, I am in heaven.
Incredibly helpful
Hmm... a lot to think about. I also watched your piriformis vs deep gluteal video. I've had an MRI on my low back, showing a number of problems that I've basically had for years; received pain patches and a PT referral. I'm eager to get to the bottom of what's causing this excruciating pain in my right buttock and hip (that I have never experienced) when lying down (in any position). I'm not terribly hopeful for PT but might learn something. I think more radiological diagnostics might be in order. Thank you. Wish you were in California. Do you do telephonic consults?
I have a constant pain in my lower back, right hand side. I also suffer from foot pain, right foot, which often ends up in episodes of foot weakness, numbness and inflammation. The foot pain flares up intermittently and my calf also stiffens up. A physiotherapist diagnosed piriformis syndrome and gave me some stretching exercises to do. A lumbar X-Ray showed nothing particularly bad, other than normal wear and tear. This has being going on for years. Any ideas Dr. Freilich? Thank you.
Hi Martin-I can't answer individual people's questions, but suggest you see an Orthopaedic doctor. Lumbar Xray is a 1950's investigation that has limited use in modern day evaluation. There's so much more information to be gleaned via MRI... Bw Simon
@@DrSimonFreilich Very good, thank you for your reply. Happy New Year and Shalom, Martin.
I have L5S1 disc herniation and the specialist said my buttock and shooting nerve pain is cause by this. I noticed a lump literally where I believe the piriformis muscle is. And pain subsides when sitting or laying on tennis ball. Is this piriformis syndrome?
You'll have to ask your specialist but I doubt it. Bw Simon
Hello, my right foot is in a externally rotated position while supine. I can hold it up but get a pain in my hip then it justs falls back down again. I have no pain only when trying to keep my foot up. Could this be Piriformis Syndrome related ?
Great video! Love the evidence-based info. Important to get good credible information from experts. Curious to know why piriformis syndrome would cause symptoms on both sides of the hips? Mine started on one side, and now I have pain on both sides. Fairly certain I have piriformis syndrome based on your video.
Is it possible for the superior and/or inferior gluteal nerves to suffer entrapment/impingement/compression in the deep gluteal space, rather than the sciatic nerve? I know the sciatic nerve is the main candidate for impingement because it's by far the largest, but I would think that in theory it could also happen to other nerves in the area too, no?
Hi Dan, thanks for the question, and yes that can happen. Bw Simon
Constant feeling like a lobster has ahold of my buttocks deep inside on both side. No muscle soreness just a nauseating pinching tight feeling in both glutes. Sometimes stretching dampens it been going on for 5 months and have been to physical theropy for 3 it’s only improved slightly but keeps coming back. When I’m driving it really acts up and I can feel it in my lower thigh very aggravating. I’ve had an mri of pelvis and lumbar spine and everything looks great. What could this be besides piriformis syndrome? Please give me some ideas of alternative possibilities
I know the lobster.
How are you doing now? Any help?
Whatever I have, which seems like PS or DGS, using an ice pack and TENS on my gluts has helped the most … so far!
What tens machine you use?
@@jocelynegil6859 EMPI. It was prescribed years ago by my doc before TENS units became available over-the-counter. I have also tried and liked OMRON (bought from Target years ago as well) though it looks different now than what I had. I liked the simplicity of the OMRON, but I already had the EMPI so thought it was more frugal to use the unit I already had. I am better now, so don't currently use the TENS, but am glad it's in my arsenal against pain. It also seems to release endorphins, which is a happy side effect *for me*.
Well done. Thank you