Post Piriformis Surgery Pain

[2cold scorpio]

Hi All

I have a patient that had part of her piriformis muscle removed on the left side in October 2010. She still has chronic pain there. She is extremely flexible so stretches have minimal impact on her. Does anyone have any ideas on what I can do? I've done cross fiber friction on the scar which has had little result. TrP seems to help but is difficult to tolerate since it sends shooting pain down her leg.

Any advice would be appreciated.

Thank you!

 

[pandy]

Post Piriformis Surgery Pain

Why was part of her piriformis removed?

 

[raymayvl]

Post Piriformis Surgery Pain

That is what they diagnosed to be the problem with her back. (Chronic back pain) They said the piriformis was in constant spasm and that NOTHING would release it.

Over the years, she has had numerous foot surgeries (both feet) and a couple knee surgeries which I'm sure aggravated the situation.

 

[party101]

Post Piriformis Surgery Pain

First suggestion would be to shoot the doctor who recommended the surgery.

I seldom, if ever, treat piriformis directly. Freeing up the lumbosacral region with techniques like this are often all that is needed:

http://www.waltfritzseminars.com/myofascialresource/wp-content/uploads/2010/09/December_2007_Alternate_Lumbar_Lift.pdf

 

[Andrew K]

Post Piriformis Surgery Pain

Thanks for the post, Walt. I have not seen that done before, but it looks absolutely excellent as a good alternative.

 

[Timinator .]

Post Piriformis Surgery Pain

I went through a phase where I was seeing a number of yoga instructors as patients. It must have been lesson time for me, as they all presented with very similar issues: sciatica, piriformis, hamstring spasm/pain, and similar pain syndromes. Hamstring testing showed superhuman (at least for me) hamstring length. Piriformis was tender and in spasm, but I looked elsewhere.

Having them bend forward to touch their toes I noticed that their lumbar curves did not move out of the lordotic extension. I like to see the lumbar spine move from extension, through neutral, and into some flexion. So, I devised this technique which can really reduce the lumbar tightness. Pain went away and their ability to touch their toes improved even further.

This is one of a few go-to techniques that I use with piriformis issues. As I said, I almost never treat the piriformis directly.

 

[PLAYBOY]

Post Piriformis Surgery Pain

First suggestion would be to shoot the doctor who recommended the surgery.

I seldom, if ever, treat piriformis directly. Freeing up the lumbosacral region with techniques like this are often all that is needed:

http://www.waltfritzseminars.com/myofascialresource/wp-content/uploads/2010/09/December_2007_Alternate_Lumbar_Lift.pdf

Though problematic in execution, I completely agree with the sentiment of this comment.

 

[siobhan]

Post Piriformis Surgery Pain

That is what they diagnosed to be the problem with her back. (Chronic back pain) They said the piriformis was in constant spasm and that NOTHING would release it.

Over the years, she has had numerous foot surgeries (both feet) and a couple knee surgeries which I'm sure aggravated the situation.

That is one of the most ridiculous things I've ever heard. I'd love to hear their reasoning as to how removing a portion of the muscle would cause it to relax!

As Walt has already suggested, there are a number of alternative and less direct approaches available to you, many of which probably would have worked just fine before the surgery. *sigh*

“No operation should be carried out unless absolutely necessary . . . nor should a surgeon operate unless he would undergo the same operation himself in similar circumstances," ... The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery

 

[crayzblonde]

Post Piriformis Surgery Pain

“No operation should be carried out unless absolutely necessary . . . nor should a surgeon operate unless he would undergo the same operation himself in similar circumstances," ... The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery

GOOD point!! I wonder how many people would even think to ask this to their doctors/surgeons. Not many I'd wager.

 

[A Chap]

Post Piriformis Surgery Pain

Thank you Walt! That is an excellent option!

Sadly, this is not the patient's first unnecessary surgery. As I have said she has had a number of surgeries and, years ago, they performed surgery on one of her knees/legs that now has made her leg bow. Today, they admit the procedure was a mistake.

I just read a statistic that states the US pays $282 billion a year in medical errors.

 

[Miss?spelled wrong]

Post Piriformis Surgery Pain

I am kind of curious about what caused this issue to begin with. Does she have any other "issues" going on? I ask because I am wondering if it (piriformis pain/issue) could be related to SIJ dysfunction?