PIRIFORMIS SYNDROME

Pain down the back of the leg is usually simply called ’sciatica’, but an important cause of similar pain is ‘piriformis syndrome’.
It often starts with a heavy fall onto the buttock or a long run or walk, but one of the commonest causes is sitting on a long car journey.
Pain down the back of the leg as far as the back of the knee is the commonest complaint, but patients often complain as well of;

• Pain on sitting or standing or lying for longer than 20 minutes
  
•  Pins and needles spreading from the buttock to the back of the thigh
  
• Pain is eased by walking but gets worse with no movement
  
• Pain sometimes radiates to the front of the pelvis, abdomen and groin
  
• Pain on opening bowels
  
• There may be bladder disturbances or pain on intercourse
  

Piriformis syndrome may also be a major factor in Restless Legs Syndrome and releasing spasm in this muscle may make a substantial difference to RLS. 
​Our treatment approach is subtly different for this pain pattern compared with sciatic pain.

Some people also suffer from a condition called ​Plantar Fasciitis, ‘Policeman’s Heel’ 
This painful condition can cause severe pain when you put your feet to the ground first thing in the morning. 
As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting. 
It has usually been described as due to inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).  (Think of the plantar fascia as being like a piece of bike inner tube - tough and elastic - forming part of the springing mechanism of the foot. It helps to maintain the arch of the foot and reduce shock loading to the legs and body as you walk.)  
X-rays of the foot can be misleading because 1 in 10 of the population have ‘heel spurs’. These are often  pointed out as the cause of the pain, but there is no evidence that heel spurs do cause heel pain.
Mainstream treatments include steroid injections into the heel but these can be really painful and often help only for a few months. Shock wave therapy is painless but has mixed success. 
The osteopathic approach of ‘positional release manipulation’ which is aimed at reducing tension in the taut plantar fascia is often helpful and this can be taught online as a self- treatment. Combined with Electrical stimulation this can often be successful in treating a very troublesome problem for many. 
Plantar fasciitis is the third commonest musculoskeletal injury in runners, affecting 5-10% of them. In ultra marathon runners that rises to about 11%. To reduce the risk of developing the condition, careful choice of running shoes with good internal support is very important as is a training programme that increases your distances gradually without suddenly increasing your mileage. But if you do run into trouble we may be able to get you up and running again.