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Posts Tagged ‘back pain’

Technically speaking a “sprain” and a “strain” are two different types of injuries. A sprain refers to damage of a ligament, while a strain implies damage to a muscle and its tendon. An easy way to remember this is that a strain, has the letter “t” in the word, as does “tendon”. And tendons attach to muscles, not ligaments. Regardless, I’m going to lump the two together because most injuries involve damage, or result in dysfunction, in both a muscle (and its tendon) and a ligament.

Very often a patient will ask whether their pain is stemming from a muscle, tendon, ligament, nerve, disc, or joint. And my answer is often, “all of the above”. Because the body is so interconnected, an injury often does involve all of the above. That said, identifying the “pain generator” or primary tissue involved in causing the pain is something that can (and should) be done by the treating doctor. However, in order to fully resolve a patient’s pain, and return them to optimal function, it’s not uncommon to have to “fix” all of the above. The reason for this is because muscles (and their attached tendons) move bones, ligaments stabilize joints (as they attach bone-to-bone), and joints affect nerve function. When these structures are directly (or indirectly) affecting the spine, spinal discs may become involved. That said, I’ll now discuss the triad of a sprain/strain injury as it relates to muscle dysfunction. I’m going to speak of muscle dysfunction in particular, because if the muscles are not “fixed”, none of the other structures will get “fixed”.

With any injury, or even chronic pain (which may result from an old imperceivable injury) there is always muscle dysfunction. One muscle will become inhibited (or “weak” in lay terms), its antagonist (or muscle and with the opposing action) will become dysfunctional due to shortening of its overlying connective tissue or fascia, and its synergist (or muscle with the same or similar function) will become hypertonic or over-contracted. This is why I use the word “triad”.

First, I’ll discuss the inhibited muscle which is also the one I look to identify first in the triad. This is the muscle that can’t properly perform its function due to an injury (or micro-trauma) to the muscle or its tendon’s attachment to the bone. This is typically due to overstretching or over-contracting from a force that it can’t withstand. The result of this is that it cannot properly contract in its everyday function, which results in subsequent compensations. Those compensations have to do with the other two major muscle dysfunctions.

Next, the antagonist to the inhibited muscle will typically become shortened. The entire muscle can become shortened, but very often it’s the fascia (or overlying connective tissue) that shortens or becomes “knotted” and becomes the major problem. This is the typical “knot”, or more appropriately termed “trigger point” in a muscle that we often feel compelled to stretch or (hopefully) have someone else knead or massage. The eventual result of this type of muscle dysfunction is that after it becomes stretched through normal movement or deliberate stretching, it then becomes inhibited for a brief period of time. This will eventually lead to more joint instability.

Lastly, the synergist to the inhibited muscle becomes hypertonic or overcontracted. That is, the nervous system “directs” the muscle to overcontract or work harder, as it now has to take on the job of the inhibited (synergist) muscle in addition to performing its own function. This will also typically result in a “knot”or trigger point. However, this trigger point doesn’t usually respond (from a functional standpoint, though perhaps it may provide the person temporary pain relief) to stretching. It will need to be shortened (usually with pressure applied to the trigger point) in order to return to normal function. This type of muscle dysfunction will cause the muscle to become inhibited after it is contracted, leading to joint instability.

So, to rehash; a sprain/strain injury almost always involves a triad of muscle dysfunction. That is, one primary muscle is inhibited, while its antagonist becomes (“fascially”) shortened, and its synergist becomes hypertonic or over-contracted. Additionally, the adept practitioner will realize that the patient usually experiences pain in the synergist or over-contracted muscle. Or, the patient will complain of a tight muscle that will not relent to continued stretching. The reason for this is that the primary problem is the injured/inhibited muscle, which creates the subsequent compensations in the antagonist and synergist muscles. Thus, stretching (or focusing on) the compensatory muscles is usually futile or only provides transient relief. Specific muscle tests by the practitioner will uncover the primary cause of the problem and resulting pain and dysfunction.

This is not to say that only the primary (inhibited) muscle needs to be addressed. Often, the compensatory muscle dysfunction needs treatment, and there will almost always be a spinal and/or extremity joint that needs to be adjusted to allow for proper range of motion and continued muscle balance. Ligament and spinal discs (which are composed of ligamentous tissue) may also need specific attention.

As with any condition, each patient needs to be evaluated and treated as the individual they are, which yields the best results in resolving a patient’s pain and restoring them to optimal function.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Pain is one of the most common reasons that people visit my office for treatment. That said, I thought I’d write a little bit on the topic.

Interestingly, pain doesn’t occur where you “feel” it or believe it to exist. In fact, pain really isn’t a “thing”. Pain is a perception triggered by the activation of certain areas in the brain. These “pain centers” (the neurology can get quite complex, so I’ll keep it simple) in the brain receive signals from specific nerves that have pain receptors (nociceptors) on them. So in the case of low back pain, for instance, the nociceptors harbored in the spinal joints, muscles, etc. get stimulated which then send nerve transmissions to be interpreted by the brain as pain. It’s because of this reason that “nerve blocks” work; basically blocking the signal to the brain. Now, what do we do about pain (other than a nerve block)?

Well, that of course depends on the type of pain you’re talking about. You see, nociceptors can get stimulated in different ways. Specifically, they respond to mechanical forces, inflammatory chemicals, and temperature changes.

As far as mechanical forces go; compression or stretching of a nerve(s) causes the stimulation of nociceptors, and results in the perception of pain. This can be caused by any number of structural imbalances, whether acute or chronic. The treatment for this type of “pain” stimulation is to balance muscle and joint function in order to eliminate the compression or stretching of the nociceptor. Furthermore, balancing muscle and joint function results in the stimulation of nerves that harbor mechanoreceptors (sensitive to light touch, vibration, position-sense, etc.) which actually act to: a) directly block the transmission of nociceptor signals to the brain, and b) travel faster to the brain in order to allow for the perception of something other than pain. By the way, “a” and “b” are the reason we rub an area of pain in order to relieve it.

Chemical pain, on the other hand, results from the stimulation of nociceptors via various inflammatory mediators/chemicals. So why do inflammatory mediators get released? Simple, because of tissue damage. This can certainly result from a structural abnormality that causes damage; in addition to a “chemical assault” that results in inflammation such as a food allergen or sensitivity, infection, toxin, or nutritional deficiency. All of the above can (and usually do) cause an inflammatory reaction. The chemicals involved include the likes of histamine, prostaglandins, thromboxanes, leukotrienes, etc.. As a result, these chemicals need to be kept at bay in order to prevent pain from being perceived. This is the reason why you may still sometimes feel pain after a chiropractic treatment. The treatment is designed to balance the structural components of dysfunction, however if there are still inflammatory chemicals circulating in response to tissue damage, the pain will persist. Once the healing begins, the pain should diminish and ultimately resolve. Chemical mediators of pain can be controlled by balancing muscle and joint function in order to prevent further damage, in addition to being controlled by nutritional substances that assist in healing and reducing inflammation.

Thermal or temperature-related pain… To relieve this…take your hand off the stove and don’t play with matches!

This idea of mechanical and chemical-mediated pain can be of extreme importance in diagnosis. Let me explain. If the pain experienced can be fully relieved by holding your body in a certain position, then your pain is solely caused by mechanical insults. However, if there is no position you can get into that relieves the pain, your problem most definitely has an inflammatory chemical component to it. And of course, if a certain position relieves some of the pain but not all of it, then there is both a mechanical and chemical component involved (this is most often the case). Whenever there is a chemical component to the pain, your doctor needs to have methods that can easily determine why you are inflamed. Remember, this can be the result of the normal repair process from structural damage, a chemical toxin, a food allergen or sensitivity, and/or a nutritional deficiency.

Several decades ago, it was found out that the mind cannot be separated from the body (through the field of psychoneuroimmunology). Now, if we were to dismiss the chemical component of pain, we’d basically be trying to separate the body from the body. Hopefully this helps to explain why your doctor may ask you to avoid certain foods, change your diet altogether, and take supplements even though your primary complaint is “physical” pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

some information in this article was sourced from: Chris Astill-Smith, DO, DIBAK – metabolics.com

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It is not uncommon for patients to report that their joint pain becomes exacerbated during stressful times. There are many known, and probably many to be discovered, different reasons for this. For now I’ll focus on one aspect of the stress response which may seem like minutia, however, if it’s your missing link you’ll want to continue reading.

I use the word minutia because I’m going to focus on a particular molecule (really its depletion), sulfate. You may have heard of glucosamine sulfate and even chondroitin sulfate. Add keratan and dermatan sulfate to the list as well – the list of compounds involved (and contained) in the cartilage that cushions your joints. As you may know, one reason for musculoskeletal pain is “wear and tear” to this cartilage. This is especially true in the case of osteoarthritis. However, whether or not you are diagnosed with osteoarthritis, joint pain from cartilage damage and loss – or is it really joint pain from lack of repair – occurs frequently.

Now, back to the stress response. One of the major hormones secreted during stressful times is cortisol. And one of the hallmarks of this hormone is to help stimulate the production of glucose by breaking down fat and protein in order to ready the body to respond to the stressful situation. By the way, this “stressful situation” has been found to be anything from lack of sleep, a food sensitivity or allergy, chronic infections, blood sugar imbalances, musculoskeletal imbalances, and certainly mental/emotional stress as well. Regardless of the source, it’s well known that stress of any kind leads to an increase in cortisol. [In cases of severely depleted individuals with chronic stress, cortisol can get eventually become depleted] In this article I’m not concerned much with the production of cortisol, but rather its clearance or breakdown from the body that may have unpleasant side effects.

Cortisol is a steroid hormone (along with DHEA, testosterone, estrogen, progesterone, etc.) that gets detoxified through specific pathways in the liver. These pathways are known as glucuronidation and sulfation. (That’s about as fancy as I’ll get with words, so no worries from here on.) Note the name of the second detox pathway I mentioned. It’s derived from the word sulfate, because it is the sulfate molecule that is used in this type of detoxification. Now recall those substances mentioned earlier that are components of cartilage. They all end with the word “sulfate” as they also require the sulfate molecule for their structure and function. So, if your body is busy burning through its sulfate to detox the excess cortisol that’s running through your bloodstream; where is the sulfate that helps repair cartilage going to come from? That’s certainly the issue, isn’t it?

Fortunately there are several options. Starting with dietary choices, you can consume foods rich in sulfur. These include garlic, onions, eggs, cauliflower, broccoli, and many others. This may be helpful, though sometimes not sufficient. One major reason (aside from quantity) that relying on food alone may not cut it is if high levels of circulating cortisol has compromised your digestive tract, which it typically does. This may lead to malabsorption of any nutrient(s), and not just sulfur. Another option is to supplement with sulfur, typically in the form known as methyl-sulphonyl-methane (MSM). Whether or not research supports the use of MSM in joint pain and cartilage repair/synthesis, you’re still an individual and may experience varying results (certainly related to your sulfate-dependent detox pathways). Lastly, sulfate can be had from the appropriate metabolism of homocysteine. If you’re unfamiliar with homocysteine, click here to learn more. In order to metabolize homocysteine into sulfate, the body requires certain nutrients especially vitamin B6 and molybdenum.

Please be aware that even though sulfate is critical in relation to stress and joint repair, chances are that your sulfur intake is not the only thing that need adjusting. In order to combat the stress response, I find it critical to support the structural (bones, muscles, etc.), chemical (nutrients, toxins, etc.), and mental/emotional components of a person. A “big picture” (well, truly holistic) approach is often preferred, if not necessary, to overcome the problems associated with any stressors, not the least of which is joint damage and repair. As a generally observed, several other (than sulfate) nutritional factors come to mind: proper collagen formation, healthy blood sugar metabolism, and last but certainly not least, stress management.

Hopefully this helped you to understand a bit of how the pathophysiology of the stress response may be affecting your body; and how to help it. Click here to read more on adrenal stress syndrome.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

source – “Degeneration Intervention – Gut, Liver, & Joints” seminar by Walter Schmitt, Jr., DC, DIBAK, DABCN

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If you’ve ever gotten (or given) a massage, you probably noticed that some muscles have painful little lumps or knots in them. They’re sometimes (enjoyably) painful when massaged or prodded; although the worst-case scenario can be constant pain during typical activities of daily living. The technical term for a knot like this has been coined “trigger point” by JFK’s doctor, Dr. Janet Travell.

The typical presentation of symptoms arising from trigger points are painful restricted range of motion and/or dull, aching or sharp muscle pain. Additionally, trigger points can cause referred pain. You may be familiar with the concept that oftentimes when someone gets a heart attack, they will experience pain down their left arm. This is a classic example of referred pain due to (cardiac) muscle damage. The same concept goes for skeletal muscle and/or fascia. I’ve even had instances where patients thought they were having a heart attack, but it was actually referred pain from a trigger point in their chest (pectoral) muscle.

There are basically two types of trigger points. One involves muscle fibers while the other involves fascia, the soft connective tissue that covers every muscle and permeates the entire body. It’s not important for you as a patient to know the difference, however it is for the doctor because the way it’s treated will depend on whether the problem is in the muscle or the fascia.

Trigger points can develop for any number of reasons. Postural distortions very often cause and/or exacerbate trigger points. Another common reason would be a (quick) change in position after being sedentary for a long time. A classic example is someone who is crouched or kneeling while gardening and then suddenly stands up. This commonly results in trigger points in the hip flexor(s) and often leads to low back pain. Theoretically, the muscle is “stuck” in the crouched position and hasn’t adjusted to the standing posture appropriately. This same scenario can take place under any circumstances involving changes in position, especially if they are sudden.

An inhibited or truly weak muscle can also result in trigger points. Typically, the trigger point will be in a synergistic (i.e.: one that performs the same or a similar function to the weak one) and/or the antagonistic (i.e.: a muscle that acts opposite the weak one) muscle. A synergistic muscle would develop trigger point(s) because it has to work harder and make up for the weak one; while an antagonistic muscle can develop trigger points because it tends to shorten and tighten due to a lack of sufficient opposing forces. Typically the former will result in a trigger point in the muscle, and the latter will often involve more of the fascia. This triad of muscle dysfunction is very common in musculoskeletal injuries and pain, and correcting these aberrant muscle patterns and trigger points often makes all the difference between success and failure. Fortunately, treating a person with pain that arises from trigger points is fairly straightforward, simple, and easy to resolve.

If however, a person tends to have trigger points “all” over their body or chronic recurring trigger points, nutritional deficiencies should be considered. In Dr. Travell’s book, “Myofascial Pain and Dysfunction, The Trigger Point Manual”, she mentions inadequacies of vitamins B1, B6, B12, folic acid, and vitamin C; and inadequacies of the minerals calcium, iron, and potassium as potentially aggravating factors. I would add the mineral magnesium to that list as well, because of its ability to act as an anti-spasmodic.

Generally speaking, we all have trigger points in our muscles and/or fascia to some degree. What matters is how much they are contributing to pain and joint dysfunction.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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In a previous article, I wrote about the importance of protein and how much one should consume on a daily basis. Now I’m going to be a bit more specific.

The most abundant protein in the body is collagen. Also, collagen makes up about ninety-percent of connective tissue. This is important for a number of reasons, not the least, musculoskeletal health. If “musculoskeletal health” seems vague, think: degenerative joint disease, degenerative (spinal) disc disease, disc herniations (or “slipped” discs), tendonitis/osis, osteoporosis, sprains and strains, etc.. Collagen essentially provides the tensile strength of tissues. If you don’t have enough collagen or your collagen is “weak” or poorly formed, you’ll be susceptible to injuries and all types of musculoskeletal disorders; among other problems that I’ll touch on briefly as well.

There are twenty-nine types of collagen throughout the human body. Collagen is a major component in many tissues, especially bone, cartilage (including intervertebral discs), tendons, ligaments, muscles, skin, blood vessels, lung tissue, and even the cornea of the eye. Now you can see how the integrity of your collagen is so vital to the functioning of your body. Remember, structure determines function, and collagen is a major part of your structure. So now let’s discuss how to make and maintain strong collagen.

First, you need (to digest and absorb) adequate amounts of protein in order to supply the raw materials. Remember, the building blocks of protein are amino acids. Any amino acids can be used in some areas on the collagen molecule, but the key ones are proline, lysine, and glycine. You shouldn’t have to be concerned with eating large quantities of food that contain these specific amino acids in high levels. Focus on getting an adequate amount of protein from a variety of sources and that should cover your bases. Although, vegetarians and vegans may want to seek out foods high in these amino acids to be sure. And, those with injuries and/or chronic musculoskeletal conditions may want to ensure higher than typical amounts of these amino acids.

Now I’ll discuss the synthesis of collagen. First, in order for your DNA to begin the process (I’ll keep it simple), you need zinc. There is an important zinc-dependent enzyme, DNA polymerase, that allows for the proper function of DNA. This is why zinc is an extremely important mineral in general. The proper function of DNA is an absolute necessity for every cell in your body; especially cell growth.

As mentioned above, the amino acids lysine and proline are necessary. These amino acids then need to be hydroxylated (which means adding an -OH group). For this reaction to occur, you need iron, vitamin C, and alpha-ketoglutarate. Focus on the iron, vitamin C, getting enough protein and you shouldn’t have to worry about the alpha-ketoglutarate (for the most part).

The next step in forming collagen is known as glycosylation (adding glucose basically). This requires available glucose (or galactose) along with vitamin A and manganese. Now don’t go out consuming pure glucose in order make sure this step happens. But do make sure you have good blood sugar metabolism in order to have it available for the cells to use. I have written several articles related to blood sugar. Click here to read my article on “what” to eat, and here to read about “how” to eat.

After glycosylation, pro-collagen is eventually formed which is/are basically chains that are linked with the help of sulfur. So sulfur is essential for collagen formation, but it does have other roles in the body as well. In supplement form, sulfur can be obtained from “MSM” (or methylsulfonylmethane). Additionally, there are “sulfur-amino acids” that can be taken as supplements or gotten from food. These amino acids are cysteine and methionine. Foods that are especially high in sulfur include kale, cabbage, cauliflower, onions, garlic and eggs.

Pro-collagen then requires transport outside of the cells which again requires vitamin A and zinc.

At this point pro-collagen is converted to collagen and then strengthened by cross-linking the fibers (or fibrils) with the help of copper-dependent enzymes. Please note that this enzyme can be inhibited by high levels of the amino acid homocysteine. If you’re not familiar with homocysteine, I have written about it in another article linked here. If homocysteine inhibits this enzyme, the strength of the collagen fibers may be compromised resulting in weak or dysfunctional collagen. This is extremely problematic and may thwart the whole effort. See my article linked above for the “antidotes” to homocysteine. It will “save” more than just your musculoskeletal health.

That essentially covers the formation of collagen. To recap, here is a list of the most important nutrients: protein (esp. the amino acids: proline, lysine, and glycine), zinc, vitamin C, iron, vitamin A, manganese, sulfur, and copper. Don’t forget healthy blood sugar metabolism. And you can also include the nutrients that are necessary to metabolize homocysteine.

Before I finish, I want to touch on another point. Collagen can form adhesions, so to speak. This is the result of excessive cross-linking of collagen. Essentially, when this happens, the fibers don’t glide along one another smoothly. Adhesions can result in decreased range of motion in a joint; and it can be caused by decreased range of motion (usually post-injury or post-surgery). Adhesions in other structures that require collagen (such as blood vessels) may affect their function as well. The key nutrients for preventing this excessive cross-linking (thus aiding in normal cross-linking) are bioflavanoids. In nature, bioflavanoids are found in the white, pithy part of citrus fruits under the rind. They’re also contained in most fruits and vegetables as well as green tea. So in addition to structural treatments designed to increase range of motion, bioflavanoids may be particularly helpful. These can be obtained from supplements as well as food.

I’ll give you an example of how helpful bioflavanoids can be, as well as collagen formation in general. A 42-year-old patient who had undergone a double-mastectomy was referred to me for herniated discs in her neck as well as shoulder and rib pain (in addition to hip and knee pain). I surmised that most of her symptoms were a result of scarring and adhesion formation from the surgery (in addition to a lack of regeneration or degeneration of collagen in her neck/discs, hip and knee). The reason I felt this was because she had never injured any of those areas and there was no history of “overuse” as in repetitive sports. The surgery can be considered an injury, but regardless, she didn’t recover well if pain and decreased range of motion persisted.

I treated her structurally to get her muscles, ligaments, joints, and even skin functioning optimally. In thinking about the nutritional component of her pain and realizing this concept of adhesion formation and collagen; I instructed her to take a bioflavanoid supplement containing dried fruits and vegetables; and she also began juicing fresh fruits and vegetables (even better!). I also had her take a specific mineral related to sulfur metabolism. After about one month of treatment she reported “I feel better”, “I finally feel good”. After about two months, she was doing great and reported a “75%” improvement in her neck, shoulder, and rib pain and was able to walk long distances without pain in her hip or knee. This is a significant improvement, especially after undergoing surgery, in addition to chemotherapy and radiation. I recently saw her after a three-to four-week hiatus and she reported that a fair amount of the pain and discomfort had come back. Sure enough, the holiday season and her busy schedule interfered with her juicing and taking the supplements which allowed the adhesions to reform and decrease her range of motion, while increasing her pain. It may be unfortunate that she’s currently relying on supplements to remain pain-free, but it sure beats pain medication. With more time and consistency, she should be fine on a well-rounded, whole-food diet.

In conclusion, the array of nutrients necessary for collagen formation and maintenance helps explain why a well-rounded diet is so important. And remember, collagen is important for more than your musculoskeltal health. It’s absolutely vital for your (cardio)vascular system. Oh right, and something as simple as anemia (iron or folic acid/B12 deficiency) and hypochlorhydia can (and most certainly will) affect your musculoskeletal and cardiovascular health. You see, it does all fit together if you can find the missing pieces.

Also, remember that skin is dependent on collagen (among other things), and without sufficient amounts, wrinkles will result. I wonder if those collagen injections people get could be used for more than just vanity. And when the visual effects wear off, does the body “steal” it from (say) the lips to put it where it’s more important for survival? I hope so.

Source: http://www.metabolics.com/

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Kidney Stones

The passing of kidney stones is reported to be one of the most excruciatingly painful events one can go through. At times, morphine may be necessary to relieve the pain. There are several reasons why kidney stones may form. And fortunately, they may be easily preventable.

First, the most common signs and symptoms that you may have a kidney stone, or be susceptible to forming one are the following:
1) Pain or burning during urination – because the urethra, the tube that carries urine from the bladder outside the body, is getting irritated
2) Cloudy urine (signifying a possible build-up of calcium) or bloody urine
3) Back pain and “flank” or side pain, especially below the ribs – because the ureter, the tube that carries urine from the kidney to the bladder, is getting irritated
4) urgency or an excessive need to urinate
5) feeling nauseous or even vomiting

Most stones are made up of a calcium compound known as calcium oxalate. Therefore, consuming foods high in oxalate can be a main contributor. The main foods to consider in this category are spinach, swiss chard, chocolate, soy, and beer.

Another possible contributor to kidney stones is an excessive intake of vitamin D. Fortunately, this is not very common (as most people are considered to be vitamin D deficient) unless you are taking a supplement. Also, consider long exposure to the sun as something that may cause excessive levels of vitamin D. This is because high blood levels of vitamin D will cause your body to absorb more calcium from the intestines and transport it to the blood. Also, if there is no calcium in the intestines, excess vitamin D will increase blood calcium levels by mobilizing it from the bones. This excessive blood calcium will eventually need to be cleared from the kidneys; and may result in kidney stone formation if it is not cleared properly. If you read my article on bursitis, you may remember that essential fatty acids are necessary to keep calcium in solution or transport it out of the blood and (back) into the soft tissues or bones.

Another potential problem would be dehydration. Even if you have normal amounts of calcium in the blood, you may not have enough water to dissolve or dilute the calcium. However, bear in mind that if you are processing calcium appropriately, you should not notice signs or symptoms of kidney stones if you become mildly dehydrated from time to time. Here’s an article that talks about my recommendations for daily water intake.

Other less common types of kidney stones may be from a build-up of calcium phosphate, cystine, uric acid; and struvite which is is caused by an infection. No one should have to deal with chronic health conditions, especially chronic kidney stone formation.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

Source: http://www.metabolics.com/

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The piriformis is a muscle that originates from the anterior (or front) part of the sacrum and inserts into the greater trochanter (the large “bump” on the outside of the upper thigh) of the femur. Its action is mainly to externally rotate (or “turn out”) the femur and hip.

The sciatic is a bundle of nerves composed of nerves from the lower spine (~levels L4-S3) and usually runs it course under the piriformis. Interestingly, it is believed that in roughly fifteen percent of the population, the sciatic nerve actually goes through the piriformis muscle.

Piriformis syndrome occurs when the piriformis is overly contracted, shortened, or tight and puts pressure on the sciatic nerve. The result of this is typically (the proverbial) “pain in the butt” and possibly down the back of the thigh, and sometimes pain that radiates into the low back.

Now, the question remains: “Why is the piriformis overcontracted, shortened, or tight in the first place?”. Well, realize that there are basically two muscles that cross and thus stabilize the sacroiliac (or pelvic) joint on either side. These are the gluteus maximus (or buttock muscle) and the piriformis. Typically when I encounter a patient with piriformis syndrome, I find the gluteus maximus to be under-functioning; i.e.: neurologically inhibited. As a result, the piriformis seems to be left to do the job of stabilizing the sacroiliac joint on its own. Obviously, by design, it was meant to have the help of the gluteus maximus muscle, and without it the piriformis may reflexively over-contract or shorten to give the most support possible. The result is then excessive pressure or irritation to the sciatic nerve. Bear in mind that there can certainly be other causes of piriformis tightening or contraction, however the example just mentioned seems to be the norm in what I’ve encountered.

Standard treatment is generally aimed at stretching the piriformis, in addition to deep massage and perhaps anti-inflammatory medication.

Typically, I’ll look to the reasons behind gluteus maximus muscle inhibition if I find that is the major cause of the tight piriformis. This can include pelvic joint dysfunction, ligament laxity in the pelvic joints, lumbar (low back) and sometimes cervical (neck) spine joint dysfunction, lower extremity (hip, knee, ankle, and/or foot) dysfunction, and in some instances nutritional deficiencies.

I aim to address the cause of the piriformis dysfunction in the first place. I have many patients who do not stretch their piriformis and still do not have piriformis syndrome; so we can be certain that the cause of piriformis syndrome is not a lack of stretching. If it was, everyone who didn’t stretch that muscle would have piriformis syndrome. Don’t get me wrong, stretching is often indicated, however my point is that the cause of the tightness needs to be addressed or this problem will generally recur and perhaps cause other complications.

There may also be a problem with an inhibited priformis on the opposite side or inhibited internal hip rotators contributing to or causing the problem. Because of the inter-relatedness of all parts of the body, there can be any number of primary causes for this condition. This article is meant to be a general introduction into the problem, so I’ll leave it there.

All in all, the muscles that support the pelvis should be evaluated for dysfunction. And the alignment and motion of the pelvic joints and lumbar spine need to be restored. Specialized treatment for ligaments, tendons, and fascia (connective tissue) may also be required. A home stretching and strengthening program may be given to help support the treatment, while helping prevent a future recurrence. Nutritional supplements designed to increase healing and reduce inflammation may also be of benefit.

Strangely enough, doctors used to doubt that piriformis syndrome even existed, but that thinking seems to be obsolete now . Dr. Janet Travell, John F. Kennedy’s doctor certainly believed in the occurrence of piriformis syndrome; as she has been reported to say that it was more common than spinal disc herniations (or “slipped disc”) as a cause of back pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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