Dr. Rhode's office is open: Monday 9am - 7pm, Tuesday 8am - 2pm, Wednesday 9am - 7pm, Friday 8am - 2pm and Saturday 9am - 2pm for your convenience. Phone: 337-310-1600 Toll Free: 877-300-8680 Fax: 337-310-1601 In North Carolina, a board of education may waive its governmental immunity by securing liability insurance, but the board may only waive its immunity to the extent that the board's insurance indemnifies it against the negligence or tort claimed. knowledge without knowing whether it was true or false; (3) with the Temporary or permanent numbness resulting in your loss of taste sciatic nerve runs below piriformis muscle Link Syndrome, piriformis: Irritation of the sciatic nerve caused by compression of the nerve within the buttock by the piriformis muscle. Typically, the pain of the piriformis syndrome is increased by contraction of the piriformis muscle, prolonged sitting, or direct pressure applied to the muscle. Buttock pain is common. The piriformis syndrome is one of the causes of sciatica. The piriformis syndrome can cause difficulty walking due to pain in the buttock and lower extremity. The piriformis muscle begins at the front surface of the sacrum (the V-shaped bone between the buttocks at the base of the spine) and passes through the greater sciatic notch to attach to the top of the thigh bone (femur) at its bony prominence called the greater trochanter. The gluteus maximus muscle covers over the piriformis muscle in the buttocks. The doctor can often detect tenderness of the piriformis muscle during a rectal examination. The piriformis syndrome is treated with rest and measures to reduce inflammation of the piriformis muscle and its tendon. Treatments include piriformis stretching exercises, physical therapy, anti-inflammatory medications, and pain medications. With persistent symptoms, further treatment can include local injection of anesthetic and cortisone medication. Rarely, for severe cases, surgery is performed to relieve the pressure irritating the sciatic nerve. During surgical operations, the piriformis muscle is either thinned, elongated, divided, or removed. How is it diagnosed? Your health care provider will talk to you about when your symptoms began. Since your sciatic nerve begins in the back, it can be irritated from a back injury, such as a herniated disk. Your provider will ask if you have had any injuries to your back or hip. He or she will examine your back to see if the sciatic nerve is irritated there. He or she will examine your hip and legs and move them to see if movement causes increased pain. Your health care provider may order x-rays, a computed tomography (CT) scan, or a magnetic resonance image (MRI) of your back to see if there is a back injury. There are no x-ray tests that can detect if the nerve is being irritated at the piriformis muscle. How is it treated? Treatment may include: placing ice packs on your buttock for 20 to 30 minutes every 3 to 4 hours for the first 2 to 3 days or until the pain goes away. 1. rest 2. taking prescribed anti-inflammatory medications or muscle relaxants 3. learning and doing stretching exercises of the piriformis muscle. 4. When can I return to my sport or activity? 5. The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon the nerve recovers, not by how many days or weeks it has been since your injury occurred. 6. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true: You have full range of motion in the affected leg compared to the unaffected leg. You have full strength of the affected leg compared to the unaffected leg. You can jog straight ahead without pain or limping. You can sprint straight ahead without pain or limping. You can do 45-degree cuts, first at half-speed, then at full-speed. You can do 20-yard figures-of-eight, first at half-speed, then at full-speed. You can do 90-degree cuts, first at half-speed, then at full-speed. You can do 10-yard figures-of-eight, first at half-speed, then at full-speed. You can jump on both legs without pain and you can jump on the affected leg without pain. How I prevent piriformis syndrome? Piriformis syndrome is best prevented by stretching the muscles that rotate your thigh inward and outward. It is important to have a good warm-up before starting your sport or activity. Written by Pierre Rouzier, M.D., for McKesson Health ============================================================================ WELCOME TO DOC PETE'S CHIROPRACTIC Link Piriformis Syndrome Link ============================================================================= Piriformis Syndrome is caused by an entrapment (pinching) of the sciatic nerve as it exits the Greater Sciatic notch in the gluteal region. There are two normal variations for the exit of the sciatic nerve in this region. The first places the sciatic nerve inferior (below) to the Piriformis muscle and superior (above) the gemellus muscle. Entrapment in this area is likely due to a myospasm or contracture (tightening or shortening respectively) of either of these two muscles. The second common site of entrapment is when the sciatic nerve actually pierces the piriformis muscle itself -this can occur in about 1% to 10% of all humans. In this case myospasm and or contraction of the piriformis muscle itself can lead to pain along the back of the thigh to the knee, loss of sensation or numbness and tingling in the sole of the foot. This particular syndrome can often mimic its more notorious counterpart known as sciatica, and that being the case, it is often misdiagnosed as sciatica The main difference between sciatica and piriformis syndrome is in the cause. Sciatica is directly due to a lumbar disc pressing on the sciatic nerve as it exits the intervertebral foramen in the lumbar spine. What both of these complaints have in common is that both can produce pain, numbness and tingling below the knee and into the foot. The main diagnostic tests performed by your doctor of Chiropractic is what distinguishes one from the other. With piriformis syndrome your chiropractor will not get positive tests results that indicate lumbar spine involvement. Often the patient may not be aware that there is a problem. Some cases won't show up until a complete neurological exam is performed on the lower extremity. The patient may have chief complaints ranging from no pain to pain in the lower back to gluteal pain to numbness and tingling in the foot. As can be seen the symptoms in this condition can vary widely making the doctor who is not used to differentially diagnosing this condition from sciatica confused as to the cause of the condition. Many weekend athletes and people who spend long hours sitting are prone to this syndrome. The athlete's cause is primarily due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion. A one-time direct trauma to the pelvis is very rarely a cause for piriformis syndrome due to the protection afforded the pelvis by the overlying musculature and fat. The causes of myospasm are many. Over use as during excessive fast walking without proper warm up and stretching (as during exercise), prolonged sitting, repetitive trauma as in horseback riding and others. As for your treatment, many variables can hamper your successful recovery. Smoking, obesity, job and exercise as noted above in prolonged sitting and not warming up and stretching. Any treatment plan must include stretching of the gluteal muscles as well as stretching of the piriformis muscles. Your Chiropractor can help you by instructing you on the proper exercises and stretches to perform. Many Chiropractors may also prescribe some form of massage be performed to the piriformis muscle in the gluteal region in order to relax these muscles. Also your chiropractor may prescribe certain herbals remedies such as valerian root and passion flower to help relax the associated muscles during your recovery phase. Spinal adjustment as well as hip adjustment may also be required to relieve your symptoms. In my opinion any treatment program which does not start to bring relief in the symptoms within three to four weeks (9-12 treatments) should be re-evaluated. The patient should be given an exercise program that involves stretching of the piriformis and gemelli muscles and strengthening exercises for weak muscles to do at home (hence patient non-compliance can also increase recovery time). After this initial nine to twelve treatments a complete re-evaluation of the symptoms and treatment program should be done to assess the progress and to make necessary changes to speed up recovery. ============================================================================= ============================================================================= Epidemiology Since an estimated 80 million Americans suffer low back pain and sciatica annually, (8) 4.8 to 6.4 million people contract piriformis syndrome annually. One reason for under diagnosis is that MRI, myelogram, CT, is unlikely to turn up any evidence of piriformis syndrome. (9-11) It is a functional syndrome: only certain positions and pressures bring out the pain, paresthesias, and weakness that come with it. Structural imaging studies are of minimal value here. (12-15) Since it is sometimes considered a diagnosis of exclusion, many patients receive painful and pointless surgical and other procedures based on limited inquiries and faulty diagnosis. Piriformis Syndrome is commonest among very active people such as athletes, health club users, joggers, and performers, and those who sit a great deal such as members of the financial community, lawyers, psychotherapists, secretaries and vehicular drivers. After occupational causes, trauma is the second greatest cause of piriformis syndrome. Lifting and other back strain related activities are third, with many other initiating events including misplaced gluteal injections, lipomas, and unusual furniture. Clinical Experience Treatment at first was simply physical therapy, informed and enriched by the generous giving forth of experience from the international medical community. In essence, the therapy lengthened the piriformis muscle, reducing spasm and pressure on the descending sciatic nerve, and giving the nerve enough slack to remove itself from harm's way. See the rest of the website for the specific program. The therapy was helpful, but progress was slow. On the suggestion of Dr. Janet Travell, we began injecting Triamcinolone Acetonide 20mg with 1.5cc of 2% lidocaine into the motor point of the piriformis muscle, just medial to its musculotendinous junction in the lateral buttock. This had only rare minor and transient side-effects on non-diabetics, and shortened the recovery time considerably. On average 10.2 month follow-up time of 1014 cases of piriformis syndrome, more than 80% of the patients had improved 50% or more within three months.(15) It is important to note that these patients had suffered from piriformis syndrome for an average of 6.2 years, and had seen an average of 6.5 clinicians before coming to our offices. Probably due to piriformis syndrome being considered a diagnosis of exclusion, other, less important diagnostic entities had received undue attention in these patients. Among these1014 cases there had been over 400 spinal, trochanteric and gynecological surgeries, none of which was definitive, more than 1500 imaging studies, of which less than 1/5 were relevant, and more than 10,000 appointments with clinicians for diagnostics, epidurals, physical therapy, and alternative methods of pain relief. More recently we have conducted several IRB-approved studies of more specific nerve blocks, using the toxin of the botulinum bacterium. In the latest and most successful of these, we have found that 12,500 units of botulinum B toxin has well above 85% efficacy, and fewer side effects than Triamcinolone and Lidocaine, giving more relief faster, and appearing in early studies to last longer. Containing no steroid, this preparation is also suitable for diabetics. Showing a much more rapid decline in pain levels, and normalization of the FAIR-test, it obviates physical therapy sessions that surpass the cost of the injection. In summary, there are four reasons that botulinum toxin helps in the treatment of piriformis syndrome. A reliable correlation between diagnosis and effective treatment exists. More than 5,000,000 currently improperly treated patients will continue to suffer, and continue to consume health care resources in vain unless and until adequate treatment is afforded them. In clinical experience, injection of botulinum toxin has proven the most effective treatment. Cost-benefit analysis of current data strongly supports injection of botulinum toxin in the treatment of piriformis syndrome. Two other considerations are relevant: Wider applicability. While the anti-insulinemic effect of steroids strongly contraindicates their use in diabetic patients, there are virtually no documented allergic reactions to botulinum toxins. Longer efficacy. Steroid injection without physical therapy is generally effective for 1-3 weeks. Botulinum toxin injections without physical therapy are effective for at least three months. In the past, approximately 15% of patients treated without botulinum toxin injections have had recurrence of piriformis syndrome within three years. As of today, (14 months after our first injection) we have seen 3 relapses following botulinum toxin injections in 61 patients. ============================================================================= Damn, that pain in my ass! Link Here's what you need to know about Piriformis Syndrome (Sciatic Pain). by Jesse Cannone, CFT, CPRS + Steve Hefferon, CMT If you're reading this article, it's a good bet that you have a radiating pain running down ============================================================================= Recovery Tip: In severe cases, the sciatic pain can run from the top of the hip to the bottom of the foot. It is very important to recognize that changes and shifting of pain is often times a sign of improvement. Furthermore as a way of gauging recovery, take note of how far down the leg the pain goes. If the pain goes to the foot one day and then only makes it to the calf and then to the knee and then it can only make it to the hamstring that is a sign of improvement. You should feel good about those noticeable improvements and this should give you encouragement to keep working toward a full remission of pain. So how do you get rid of your pain? Will learning one new stretch be enough? It very well may be. However depending on the severity of your condition you may need to change your activities of daily living to include new stretches, new exercises that include the use of the hip rotators like roller-blading, basketball, tennis, etc, and even better, specific corrective exercise specific to your situation. like those covered in our video. As always, learn as much as you can about your condition, so that you can ask the tough questions to your healthcare providers and get the best care possible. One last point, sciatic pain is not caused by a lack of prescription medications so don't think that taking some anti-inflammatory or muscle relaxants will fix it. it won't! Also, many people are able to eliminate sciatic pain within days just by performing a few exercises and stretches. but not general exercise. the exact corrective exercises and stretches they need to do. ============================================================================= Piriformis Syndrome Link A Real Pain in the Butt Dr. Tim Maggs For the Washington Running Report ============================================================================= If you've ever felt pain in the hip, pain in the center of the butt, or pain down the back of the leg, you likely are suffering, at least partially, with piriformis syndrome. The piriformis is a muscle which runs from your sacrum (mid-line base of spine) to the outer hip bone (trochanter). This muscle truly works overtime on anyone who runs at all. The muscles in and around the gluteal region help with three areas: 1) rotation of the hip and leg, 2) balance while one foot is off the ground, and 3) stability for the pelvic region. Needless to say, all of these characteristics are needed by runners. Conclusion-the piriformis muscle is pretty important for all of us. Injuries to the Piriformis This muscle is a prime candidate for repetitive motion injury (RMI). RMI occurs when a muscle is asked to perform beyond its level of capability, not given enough time to recover, and asked to perform again. The typical response from a muscle in this situation is to tighten, which is a defensive response. This tightness, however, manifests itself in several ways to a runner. The first symptom suggesting piriformis syndrome would be pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint, producing a bursitis. A bursitis is an inflammation of the fluid filled sac in a joint caused by an elevation of stress and tension within that joint. The second symptom suggesting piriformis syndrome would be pain directly in the center of the buttocks. Although this is not as common as the other two symptoms, this pain can be elicited with direct compression over the belly of the buttocks area. A tight muscle is a sore muscle upon compression due to a reduced blood flow to that muscle. The third symptom suggesting piriformis syndrome is a sciatic neuralgia, or pain from the buttocks down the back of the leg and sometimes into different portions of the lower leg. The sciatic nerve runs right through the belly of the piriformis muscle and if the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, tingling, and numbness. Simple Physiology Any muscle repetitively used needs to have an opportunity to recover. This recovery can either be on Nature's clock, or can be facilitated and sped up with proper knowledge and treatment. Since the muscle is tightening due to overuse, continued use will only make it worse. This injured muscle needs to relax and have increased blood flow to it for more rapid healing. The tightness also reduces the normal blood flow going to the muscle, reducing the speed wit which the muscle can recover. To encourage fresh, oxygen-rich blood to the muscle is the most powerful means of getting the muscle to begin to relax and function normally. Multiple massages per day to this area are greatly encouraged. The next step in this "recovery" process is to use a tennis ball under the butt and hip area. While sitting on the floor, roll away from the side of involvement and place a tennis ball just inside the outer hip bone under the butt area. As you begin to allow your weight onto the tennis ball, note areas of increased pain and soreness. Trigger points will tend to accumulate in a repetitively used muscle, and until these toxins are manually broken up and eliminated, the muscle will have an artificial ceiling with regard to flexibility potential and recovery potential. So, if it's sore and hurts while you are sitting on it, you're doing a good job. Let the ball work under each spot for fifteen to twenty seconds before moving it to another area. Once you've been on the ball for four to five minutes, put the ankle of the involved leg over the knee of the noninvolved leg (crossing your legs). Now place the tennis ball just inside the outer hip bone again and work the tendon of the piriformis muscle. While this pain is typically excruciating and takes some time to effectively reduce, the benefits here are huge. Be patient, be consistent, and good things will happen. Additional Treatments Due to the fact that the sciatic neuralgia and the hip bursitis or tendonitis are both inflammatory in nature, ice, or cryotherapy, over the involved area fifteen to twenty minutes at a time will be beneficial. This should be done multiple times per day. Stretching of the hip muscles should not be done until the acute pain is gone. Then, begin with gentle stretching, such as the cross-legged stretch, while pulling up on the knee. The muscle should have increased flexibility before an active return to running. Finally, I always discourage the use of pharmaceutical anti- inflammatories. Not only do they greatly aggravate the intestines, they suggest an artificial wellness that can lead to bigger problems. Proteolytic enzymes, such as bromelain, are both natural and extremely beneficial with no side effects. For more information, visit your health food store or check out Rehab Plus on our website. For further information, Dr. Maggs can be reached at (518) 869-1884, his Web site: Dr. Maggs or via e-mail Running Doctor ============================================================================= lose the back pain Link Sciatica (Sciatic Pain, Piriformis Syndrome) ============================================================================= Sciatica commonly refers to pain that radiates along the sciatic nerve and is typically felt in the buttocks, down the back of the leg and possibly to the foot. Sciatica is one of the most common forms of pain caused by compression of the spinal nerves. Often the leg pain often feels much worse than the back pain. Numbness, tingling, and a burning or prickling sensation in the back and legs are also common symptoms. Sciatica is actually a symptom and not disease. The term literally means that a patient has pain down the leg from compression on the sciatic nerve. Usually a herniated disc causes the sciatic pain. The diagnosis is what is causing the compression (such as a disc herniation). Most cases of sciatica are caused by a simple irritation to the nerve and will get better with time. However, some sciatica symptoms may indicate a permanently injured nerve. This is particularly if true weakness or numbness is present in the back or the leg. ============================================================================= A Real Pain in the. Link ============================================================================= A while back I noted that very often I will be visited by a runner complaining that his or her "sciatica is acting up." Generally, what they are saying is they have some pain in the back of the thigh, maybe some in the buttock, low back or even into the calf. Sciatica, by definition, is an inflammation or irritation of the sciatic nerve, the largest nerve in the body, which originates in the lower spine in the form of five separate nerve roots which join together and traverse the buttock and descend into the lower limb all the way to the toes. The problem is, sciatica is a vague term that doesn't really tell us very much about the underlying reason for these symptoms since there can be several explanations for them. Some of the possible causes of this ailment which reviewed then included sacroiliac joint dysfunction, lumbar spine arthritis or herniated discs, chronic hamstring strains and a rather esoteric-sounding problem called the piriformis syndrome, which we want to look at in more detail now. The piriformis muscle is a relatively large structure found in the buttock, originating on the sacrum (the lower part of the spine, or tailbone) and crossing over at a slightly downward angle to the outside of the hip, attaching to the outer portion of the upper thighbone (femur). Its function is to laterally rotate and extend the hip joint. It is only one of several muscles in the buttock which, as we've said, is an area through which the sciatic nerve passes, but the piriformis has been singled-out as a potential cause of sciatica because anatomists have found that in a fair number of people, all or part of the sciatic nerve goes directly through this particular muscle. (The exact percentage of people is unknown - studies vary widely with some experts reporting 20% and others as many as 60%!) The speculation is that in these subjects, a tight piriformis muscle will "squeeze" the nerve, causing irritation and subsequent pain. Runners, of course, would be more likely to have a tight piriformis since they would be using it more often and more intensely, especially during the push-off phase of gait when hip extension and lateral rotation are needed most, but theoretically anyone could experience this problem really if posture and biomechanics of walking are abnormal. Is it real? Does piriformis syndrome really exist? Well, the fact that we call it a syndrome - which in the medical field is a code word for "we don't really know exactly what it is or know for sure what really causes it" - tells us a lot. It seems reasonable that the piriformis, like any muscle, can become overused and painful, especially with running. But, like any muscle, this irritated muscle can cause radiating or referred symptoms which would mimic sciatica pain while there may not necessarily be any actual injury to the nerve itself. Or, conversely, there are other potential causes of nerve inflammation in the buttock with no involvement of the piriformis muscle. My favorite example is something actually designated in the medical literature as "fat wallet syndrome," which is found most often in long-distance drivers (truckers, salesmen). The prolonged pressure of a billfold full of cash and credit-cards on the sciatic nerve is a not-infrequent cause of sciatica. (The cure, of course, is for me to relief the patient of the offending object.) ============================================================================== Clair Davies talks about Trigger Points and Referred Pain The Trigger Point Therapy Workbook; You're Self-Treatment Guide for Pain Relief Buy this book,, "The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief" : Link The Book Introduction Link ============================================================================== They've tried chiropractic, acupuncture, magnets, pain diets, and herbal therapy. They take their pain medicine and dutifully do their stretching exercises. Sometimes they feel better for a while, but the pain always comes back. Nothing really seems to get to the bottom of the problem. Despite being told there are no guarantees of success, they fear surgery may be the only solution. They're beginning to wonder if anybody really knows anything about pain. If all this describes your own situation or that of someone you care about, this book may provide the help you've been seeking. It proposes to give you a sensible explanation of what's wrong and help you find the real cause of your pain. Even better, it may well show you how to get rid of the pain yourself, hands-on. No doctors. No pills. No bills. There is growing evidence that most of our common aches and pains-and many other puzzling physical complaints-are actually caused by trigger points, or small contraction knots, in the muscles of the body. Pain clinic doctors skilled at detecting and treating trigger points have found that they're the primary cause of pain roughly seventy-five percent of the time and are at least a part of virtually every pain problem. Even fibromyalgia, which is known to afflict millions of people, is thought in many instances to have its beginning with trigger points. Trigger points are known to cause headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, and many kinds of joint pain mistakenly ascribed to arthritis, tendonitis, bursitis, or ligament injury. Trigger points cause problems as diverse as earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow and genital pain. Trigger points can also cause colic in babies and bed- wetting in older children and may be a contributing cause of such childhood horrors as scoliosis, attention deficit disorder and dyslexia. They are a cause of sinus pain and congestion. They may play a part in chronic fatigue and lowered resistance to infection. And because trigger points can be responsible for long-term pain and disability that seem to have no means of relief, they can cause depression. The problems trigger points cause can be surprisingly easy to fix; in fact most people can do it themselves if they have the right information. That's good, because the time has come for ordinary people to take things into their own hands. The reason is that an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points, despite their having been written about in medical journals for over sixty years. There has been, and continues to be, great resistance to the whole idea. Why has the medical profession not embraced the idea of trigger points? Partly, it's because trigger points are commonly confused with acupressure points. Acupressure, which has come down to us from ancient Chinese medicine, is alleged to have a positive effect on supposed flows of energy throughout the body. Although acupressure and other Eastern methods of healing do seem to have a beneficial effect, they're very resistant to solid scientific investigation and are viewed by many doctors and a large segment of the public as quack medicine with no proven results. If you don't know the difference, the claims about trigger points sound like quack medicine too. Our knowledge of trigger points, however, comes right out of Western medical research. Trigger points are real. They can be felt with the fingers. They emit distinctive electrical signals that can be measured by sensitive electronic equipment. Trigger points have also been photographed in muscle tissue with the aid of the electron microscope. Most of what is known about trigger points is very well documented in the two-volume medical text Myofascial Pain and Dysfunction: The Trigger Point Manual, by Janet Travell and David Simons. These books tell virtually all there is to know about trigger points, and the prospects for pain relief are very exciting. Much of the information in the Trigger Point Manual is couched in difficult scientific terms but basic trigger point science isn't hard to grasp if it's put into everyday language. Travell and Simons describe a trigger point as simply a small contraction knot in muscle tissue. It often feels like a partly cooked piece of macaroni or like a pea buried deep in the muscle. A trigger point affects a muscle by keeping it both tight and weak. At the same time, a trigger point maintains a hard contraction on the muscle fibers that are directly connected to it. In turn, these taut bands of muscle fiber keep constant tension on the muscle's attachments, often producing symptoms in adjacent joints. The constant tension in the fibers of the trigger point itself restricts circulation in its immediate area. The resulting accumulation of the by-products of metabolism, as well as deprivation of the oxygen and nutrients needed for metabolism can perpetuate trigger points for months, or even years, unless some intervention occurs. It's this self-sustaining vicious cycle that needs to be broken. The difficulty in treating trigger points is that they typically send pain to some other site. Most conventional treatment of pain is based on the assumption that the cause of pain will be found at the site of the pain. But trigger points almost always send their pain elsewhere. This referred pain is what has always thrown everybody off, including most doctors and much of the rest of the health-care community. According to Travell and Simons, conventional treatments for pain so often fail because they focus on the pain itself, treating the site of the pain, and overlooking and failing to treat the cause, which may be some distance away. Even worse than routinely treating the site of the pain is the pharmaceutical treatment of the whole body for what is usually a local problem. Painkilling drugs, the increasingly expensive treatment of choice these days, give us the illusion that something good is happening, when in reality they only mask the problem. Most common pain, like headaches, muscle aches, and joint pain, is a warning-a protective response to muscle overuse or trauma. Pain is telling you that something is wrong and needs correction. It's not good medicine to kill the messenger and ignore the message. When pain is seen in its true role as the messenger and not the affliction itself, treatment can be directed to the cause of pain. Luckily, referred pain is now known to occur in predictable patterns. The valuable medical advance made by Travell and Simons and their brilliant illustrator, Barbara Cummings, has been in delineating these very patterns. Once you know where to look, trigger points are easily located by touch and deactivated by any of several methods. Unfortunately, the two clinically oriented methods put forth in The Trigger Point Manual don't lend themselves to self-treatment. The goal of this book is to build on the work of Travell and Simons and provide a more practical and cost-effective approach to pain therapy: a classic do-it-yourself approach, rather than multiple professional office visits. This new approach is a system of self-applied massage directed specifically at trigger points. Significant relief of symptoms often comes in just minutes. Most problems can be eliminated within three to ten days. Even long-standing chronic conditions can be cleared up in as little as six weeks. Results may be longer in coming for those who suffer from fibromyalgia, chronic fatigue, or widespread myofascial pain syndrome, but even they can experience continuing progress and can have genuine hope of significant improvement in their condition. Self-applied trigger point massage works by accomplishing three things: it breaks into the chemical and neurological feedback loop that maintains the myofascial contraction; it increases circulation that has been restricted by the contracted tissue; and it directly stretches the trigger point's knotted muscle fibers. The illustrations in this book show you how to find the trigger points that are generating your specific problems, as well as the exact hands-on techniques for deactivating them. Special attention has been given to designing methods of massage that do no damage to hands that may already be in trouble from overuse. This book's primary use is as a self-instruction manual, but it can also be used as a textbook for classroom use. This simplified and direct approach to treating myofascial pain with self-applied massage can constitute a foundational course in trigger point therapy in any professional training curriculum. Students in chiropractic colleges, physical therapy departments, and massage schools will derive particular benefit. If they can learn how to interpret their own referred pain and how to find and treat their own trigger points, they will know exactly what to do when they encounter similar problems in their future clients. A class in self-applied trigger point massage would be a boon in medical schools for exactly the same reasons. When new doctors can learn how to fix their own pain with self-applied massage, they are in better touch with the realities of pain and with the great potential in the treatment of trigger points. Such an addition to medical education would profoundly improve the treatment of pain and lower much of its cost. And it's not too late for physicians already in practice to learn about trigger points and myofascial pain and put the knowledge to good use. They will find this book a quick and practical introduction to the magnificent work of Travell and Simons and this neglected branch of medicine. Hopefully, many will be encouraged to go to Travell and Simons' Trigger Point Manual for a deeper scientific understanding and for even greater benefit to their practice. A large segment of the public needs help and encouragement in learning how to deal with their trigger point-induced pain. No one is better positioned to provide this help than the medical community. The medical profession is not unaware of the deficiencies of current methods of treating pain. Doctors hurt too. Many of them worry like the rest of us about the relentless popping of pills, and many experience frustration with their inability to offer better solutions to their patients. Trigger point therapy, whether self-applied or administered by a professional, has the potential to truly revolutionize pain treatment throughout the world. ============================================================================= Sciatica, Piriformis Syndrome, PIRIFORMIS TRIGGER POINTS Link Sciatic Nerve Impingement, Erectile Dysfunction, Buttocks Pain, Rectal Pain, Anal Pain, Leg Pain, Tingling in Legs According to Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual, myofascial trigger points (tiny contraction knots) in overworked gluteus minimus and piriformis muscles in the buttocks are actually the most frequent cause of sciatica. Referred Symptoms Symptoms of sciatica include aching pain, numbness, tingling, burning and hypersensitivity in your low back, buttocks, hips, and down your legs into your ankles and feet. Simple aching pain in these areas usually is referred from gluteus minimus trigger points. Piriformis trigger points, by keeping the muscles tight and rock hard, can cause actual sciatic nerve compression. Pain from piriformis trigger points is harsher and more electric than pain from gluteus minimus trigger points and is felt in the back of the thigh, the calf, and the sole of the foot. There may also be other abnormal sensations, such as numbness, tingling, burning, or hypersensitivity, in any of these areas. Piriformis Syndrome A piriformis muscle that is shortened and swollen by trigger points can also compress numerous other nerves and blood vessels coming out of the pelvis. This can result in a sense of swelling in the buttocks, leg, calf, and foot. In addition, a tight piriformis muscle can impinge upon the pudendal nerve, causing impotence in males and pain in the groin, genitals, or rectal area of either gender. Piriformis muscles that compress gluteal nerves and blood vessels are believed to be responsible for gluteal muscle atrophy, wherein one or both buttocks waste away. For decades, the medical profession has known this particular group of sciatic symptoms as "piriformis syndrome," although the cause of the piriformis enlargement was never really understood. Surgical release of the piriformis muscle for the treatment of sciatica was once a common treatment. Amazingly, this operation is still performed by surgeons who are unaware of the effects of myofascial trigger points. Misdiagnosis: In the medical world, sciatica is routinely assumed to be caused by pressure on the sciatic nerve as a result of a compressed disk or other spinal abnormality. Surgery on the spine in a search for the cause of presumed sciatic nerve impingement is very common, even though it regularly fails to erase sciatic symptoms. Doctors Travell and Simons believe that traditional medical solutions for sciatica and piriformis syndrome is needlessly expensive and have an unacceptably high rate of failure. Trigger points should be at the top of the list during any examination for pain, numbness and other abnormal sensations in the hips and legs. Wider recognition of the myofascial causes of sciatica could eliminate many unnecessary surgical operations. Self-Treatment: Myofascial Pain and Dysfunction: The Trigger Point Manual You don't have to wait for the medical community to abandon antiquated methods and catch up with trigger point science. You can take care of your own trigger points. In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies has simplified Travell and Simons' extensive research into myofascial pain and made it accessible to the layman. His innovative methods of self-applied trigger point massage will get rid of the numbness, tingling and aching pain of sciatica and piriformis syndrome when trigger points are the cause. To learn more, please visit the homepage. Law Firms For Medical Negligence Emerson. Clinical negligence, medical negligence and medical malpractice all relate to the same thing; i.e. when insufficient or inadequate care has been given from a health care professional to a patient, resulting in an injury or death. 1846983 Lillie Rosenbaum Combs, s/k/a Lillie M. Combs v CW 10/26/1999 Fellow, Royal Pharmaceutical Society of G.B. Lay Privy Council Appointee General Chiropractic Council. Chairman GCC Education Committee, Professional Conduct Committee. Accreditation team Leader RPSGB. Chairman, British Sjogren's Syndrome Association. Independent Member, Prescription Medicine Code of Practice Authority Appeal Board. Pharmacist member RPSGB Investigating Committee. 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