Monthly Archives :

    September 2017

    Do you have Piriformis Syndrome? Dr. Cameron MacEwen of Foxboro, MA says probably NOT!

     

    If I hear one more person tell me they have piriformis syndrome, I might just jump!!!!  Seriously though, piriformis syndrome is an actual condition but according to medical research it is exceedingly rare and commonly over diagnosed by clinicians, fitness professionals, trainers, coaches, and therapists. Of course the internet would have everybody convinced that they suffer the malady. This results in patients and practitioners focusing on treating the piriformis and missing the correct diagnosis and treatment.

    Piriformis syndrome was originally described by Dr. Yeoman in 1928 as a “sciatica like” symptom caused by compression of the sciatic nerve by the piriformis muscle. At the time this was an “advance” in identifying the cause of sciatica. It was theorized the the piriformis muscle compressed the sciatic nerve causing pain or abnormal sensation in the buttock, hamstring, or posterior thigh, or leg. Since then diagnostic technology (MRI, ultrasound, EMG) and the scientific method (research) have provided very little support for the frequency of the diagnosis of piriformis syndrome. M. Read (2002) states that the common theme in the literature is that piriformis syndrome is not a common problem.

    I think that sciatica, gluteal and buttock pain is common and that there are many parts of the body other than the piriformis muscle that can cause it. So we ask, what is the pain generator? What is the diagnosis? What is actually causing the pain in the buttock and/or sciatic like symptoms? There are at least ten anatomical structures that alone or combined can produce the symptoms. To name just a few: spinal joint dysfunction, disc derangement, lumbar and pelvic ligaments, sacroiliac joint dysfunction, spinal stenosis, facet joint inflammation, myofascial trigger points in the thoracic and lumbar region, and postural strain. The piriformis muscle is not alone in the gluteal region either. The obturator internus and gemelli muscles, the gluteal muscles, and tensor fascia lata are all muscles that may generate pain or refer pain to the area. Knowledge and familiarity with these possible pain generators is vital in sorting out and arriving at an accurate diagnosis so that the correct treatment can be provided.

    So does piriformis syndrome exist? The answer is yes, but it is just not that common and it is way over utilized as a working and treating diagnosis. What’s worse is that the proper diagnosis and treatment is missed and the patient suffers while the health care business chugs along without a care. All too often in our health care system (or business as it seems to have become), the art of sorting out and arriving at a proper diagnosis is elusive. I can’t count the number of patients I see that have undergone million dollar workups and testing without receiving an accurate diagnosis and treatment. In any case, I truly love the art of sorting out these kind of problems and providing relief. There is no greater satisfaction than relieving my patients’ pain and suffering, so I look forward to treating your buttock and leg pain, whatever is causing it.

    Yours in health,
    Dr. Cameron MacEwen

    Understanding Spinal Stenosis

    Spinal stenosis is a narrowing of the spaces or canals within your spine, which can put pressure on the spinal cord and/or nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.

    Some people with spinal stenosis may not have symptoms. Others may experience back or neck pain, arm or leg pain, tingling, numbness and muscle weakness. It is a progressive condition with symptoms worsening over time.

    Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. Sometimes acute injuries to discs or spinal joints can cause swelling and pressure on the nerves or spinal cord.

    Types of spinal stenosis

    The types of spinal stenosis are classified according to where on the spine the condition occurs. It is possible to have more than one type. The two main types of spinal stenosis are:

    • Cervical stenosis. This condition causes narrowing in the part of the spine in your neck.
    • Lumbar stenosis. This condition causes narrowing in the part of the spine in your lower back. It is the most common form of spinal stenosis.

    Dr. MacEwen of Tritown Chiropractic Offices will ask you about your signs and symptoms, discuss your medical history, and conduct a physical examination to diagnose spinal stenosis. He may also order special imaging tests to help pinpoint the cause of your signs and symptoms.

    Symptoms

    Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. An acute injury can make spinal stenosis more apparent. Symptoms vary depending on the location of the stenosis and which nerves are affected.

    In the neck (cervical spine)

    • Numbness or tingling in a hand, arm, foot or leg
    • Weakness in a hand, arm, foot or leg
    • Problems with walking and balance
    • Neck pain

    In the lower back (lumbar spine)

    • Numbness or tingling in a foot or leg
    • Weakness in a foot or leg
    • Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
    • Back pain

    Causes

    The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord and nerve roots.

    Some people are born with a small spinal canal, but most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include:

    • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
    • Herniated disks. The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk’s exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
    • Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
    • Postural abnormalities. Abnormal posture and spinal curvature can cause buckling of ligaments, joint capsules, or spinal discs to press on the nerves.
    • Tumors. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
    • Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.

    Risk factors

    Most people with spinal stenosis are over the age of 50. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. These include trauma, congenital spinal deformity such as scoliosis, and a genetic disease affecting bone and muscle development throughout the body. Spinal imaging can differentiate these causes.

    Complications

    Rarely, untreated severe spinal stenosis may progress and cause permanent:

    • Numbness
    • Weakness
    • Balance problems
    • Incontinence
    • Paralysis

    Imaging tests

    These tests may include:

    • X-rays. An X-ray of your back can reveal bony changes, such as bone spurs that may be narrowing the space within the spinal canal. Each X-ray involves a small exposure to radiation.
    • Magnetic resonance imaging (MRI). An MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine. The test can detect damage to your disks and ligaments, as well as the presence of tumors. Most important, it can show where the nerves in the spinal cord are being pressured.
    • CT or CT myelogram. If you can’t have an MRI, your doctor may recommend computerized tomography (CT), a test that combines X-ray images taken from many different angles to produce detailed, cross-sectional images of your body. In a CT myelogram, the CT scan is conducted after a contrast dye is injected. The dye outlines the spinal cord and nerves, and it can reveal herniated disks, bone spurs and tumors.

    Treatment

    Treatment for spinal stenosis depends on the severity of symptoms. Dr. MacEwen will sort out what is causing your symptoms and decide what action to take in your case. Most cases respond very well to conservative, non-invasive, drug free treatment. As always, the safest, non-invasive treatments should be tried first as these most often resolve the problem and have far less risk associated with them. If you are considering surgery please follow the advice of the best spine surgeons and that is try all conservative measures before having surgery. Dr. MacEwen is trusted by the medical community and will work with top specialists to treat your problem.

    Dr. MacEwen in Foxboro Massachusetts will utilize state of the art diagnostic and treatment modalities to diagnose and treat your condition including but not limited to:

    • X-ray
    • MRI scanning
    • CT scanning
    • EMG
    • Therapeutic exercise and postural rehabilitation
    • Skilled spinal manipulation
    • Non-surgical spinal decompression
    • Graston™ soft tissue mobilization
    • Trigger point therapy and massage
    • Pain reducing modalities such as interferential stimulation and therapeutic ultrasound

    Whatever is the cause of your back or neck pain, sciatica, leg or arm weakness, Dr. MacEwen has helped many people with the same symptoms get better and live their lives to the fullest again.

    Call 508-698-0688 for a consultation, or email us at info@tritownchiropractic.com

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