piriformis question

[joeparz]

Hello everyone

Unfortunately after 6 weeks, my pudendal block officially did nothing.

I saw an orthopedist today to look into my hips to see if they could potentially be adding to the issue.

No labral tears or fractures or anything else.

But he did notice my piroformis was in total spasm. He had me do all these weird movements and each time my pirifromis went nuts.

I have been having pain for a long time in that area and never realized what it was. I also was unable to stretch my left leg because it would me weird nerve senations as if it was stretching a nerve.

Is it possible for the piriformis muscle spasm to be causing my pudendal pain?

I ask because my emg showed no delay at the sacro spinous and sacrotuberous, only at the alcocks canal.

And if i recall correctly where the pudendal nerve comes out with the piriformis muscle is right above the alcocks canal.


Just wondering if i am finally onto maybe getting relief, as nothing else has worked

Thanks a bunch

Joe

[Patty]

Joe has anybody talked to you about botox? I know the urogyn office I go to seems to offer this quite often. I have declined as of today's date but who knows what the future holds.

[Violet M]

Joe, there are some docs who believe the piriformis muscle can impinge on the pudendal nerve. For me, I originally had PN pain and eventually the piriformis muscle went into spasm causing sciatica. I think it could be hard to tell which happens first -- the pudendal pain or the piriformis spasm.

I'm doubtful you can get an accurate diagnosis of where an entrapment is from an EMG -- just based on my experience. Dr. Bautrant and Dr. de Bisschop disagreed where my entrapment was even after I had the EMG. Turned out I was entrapped in more than one place but the EMG wasn't all that accurate for predicting where the entrapment was. It can tell you which muscles respond to electrical stimulation of the nerve though.

Violet

[desperate]

Very easy to figure it out. Get a Chinese Accupuncturist to do dry needling on the piriformis and gluteus maximus. If it spasms while they do it you know you have a piriformis problem. If it doesn't you can stop thinking it's your piriformis. Quite easy. Make sure you get a Chinese Accupuncturist though. A very experienced one. I've gotten dry needling done before and until I found a very experienced one I had no idea what I was missing. Make sure to do your research and take your time finding the best therapists for your body. Dry needle them though ! Painful but the procedure works if it's the piriformis. Some people have entrapments ventral and inferior to the piriformis muscle right before it ventures into the sacrospinous ligament. The dry needling can help those spasms forsure. I'd get dry needling done once a week though. Let me know how it goes !

[desperate]

And I laugh when people mention Botox. That is NOT the answer. Botox would screw things up more. Putting your piriformis on a relaxed state would alter your biomechanics And put stress on your gluteus medius and minimus. This would increase trigger points in those areas as well as the TFL. Whenever you relax a muscle, other muscles compensate to take the load and make problems worSe. The body is a functional unit with each muscle acting on a grEater picture. Look at specific muscles and understand the synergist and antagonist relationship. Not to mention how fascia is responsible for the body. Botox would not be wise in my opinion. Do dry needling Once a week. Stretch the glutes and piriformis and see if it increases your symptoms or reduces them. And then go from there.

-Dom

[Thewozi]

Why is the piriformis in spasm? It's a stabilizer muscle and may be taking on greater load because of another pro Len in the chain. My pirifirmis problems have diminished significantly after a year of weekly dry needling and a Sacro iliac joint stabilization program ala Vicki Sims, PT. I think some (including Vicki) would argue that the piriformis spasm is caused primarily by SI joint dysfunction.

[joeparz]

The problem is that i can't stretch.

If i stretch anything that involves bending over or stretching anything in my hips/lower back i get a feeling like i am stretching the nerve.

It's painful but more uncomfortable than anything.

I have been noticeing that when i press my piriformis muscle into the corner of granite countertop and try to massage it, i actually feel a little bit better for a few minutes. Strange.

I go for the injections in 2 weeks for the piriformis, i figure it can't hurt. They are steroids not botox injections.

If these do not help, and the new physical therapist can't help me within 6-8 months, i am seriously considering surgery with Dr. Conway at this point.

My life is absolutely non existant at this point. I can't work, i can't sit, i can't do anything fun, if i have sex i am in crazy pain for days, i have just about lost every ounce of life at this point.

Getting super depressed and i am at the point of just saying screw it, go for the surgery, can it really get any worse than it already is?

[stephanies]

You can try a massage ball on your piriformis. Either with the ball under you on a bed, against a wall, or even by hand. I suggest a ball that is not too hard and going slow in case it causes a flare or increase in pain.

[ezer]

joeparz, you also said in the past that you are an anxious person and you have fibromyalgia. PNE surgery will certainly not help your fibromyalgia that may get worse. You wrote that pudendal nerve blocks don't work either so that is one more reason not to go that route.
A lot of what you describe in your first posts lines-up with non-bacterial prostatis that is linked to stress. Don't dismiss it.

Patients with abacterial prostatitis/chronic pelvic pain syndrome (CPPS; category III in the 1995 National Institutes of Health prostatitis classification system) have the same symptom complex as those with chronic bacterial prostatitis. The chief symptom reported by patients with abacterial prostatitis/CPPS is pain. Genitourinary symptoms include perineal, penile tip, testicular, rectal, lower abdominal, or back pain.
Patients can also have irritative or obstructive urologic symptoms such as frequency, urgency, dysuria, decreased force of the urinary stream, nocturia, and incontinence. Other symptoms are a clear urethral discharge, ejaculatory pain, hematospermia, and sexual dysfunction.

Many patients with abacterial prostatitis have emotional strife and some psychological difficulties (ie, socially, sexually, or both). Patients should be questioned with regard to their overall social adjustment. Stress level is important because stress is responsible for increased tension of the pelvic floor and the internal urinary sphincter, resulting in the symptoms of prostatitis.

[Violet M]

Ezer, what is the source of that quote?

Violet