At my Gold Coast acupuncture clinic we routinely see patients experiencing buttock, hip and leg pain. Although these are common symptoms, it is sometimes complicated to differentiate between the various origins of this pain. Many structures, including the lumbar spine, lower back muscles, sacroiliac joints, gluteal muscles and hip joints can generate pain in these areas. A condition that has received greater attention in recent years is Piriformis Syndrome, also referred to as Deep Gluteal Syndrome. The Deep Gluteals, which includes Piriformis, are a group of muscles located between the sacrum and the hip, underneath the larger gluteal muscles that form the buttock. This condition has stimulated interest among health professionals because of its tendency to create sciatic symptoms. In any case, the muscle pain associated with the Deep Gluteals/ Piriformis is commonly located in the buttocks, hip and upper leg. On occasion it gets described to me from a patient as a high hamstring strain. Furthermore, if the Deep Gluteals/ Piriformis impinge the Sciatic Nerve it can cause neuralgia; pain, numbness, tingling and burning sometimes down the entire length of the back of the leg. Pain is often better for moving around but can be aggravated by any sustained activity or an uncomfortable position.
It is more common for the Deep Gluteal/ Piriformis muscles to cause muscle pain rather than leg neuralgia. If there is neuralgia, it should be investigated to differentiate it from nerve impingement in the lumbar spine. Once the Deep Gluteals/ Piriformis are identified as the cause of buttock, hip and leg pain, or leg neuralgia, they can be easily treated. Results are often quickly forthcoming. Acupuncture, moxibustion, massage and herbal medicine can all be utilised in the treatment of this condition. In most cases we take advantage of the side-lying position and needle deeply into the hip and buttock. By using moxibustion in addition to needling, we enhance the ability of acupuncture needles to soften indurated muscle tissue and relieve pain/ neuralgia. As this particular problem is associated with stiffness of the hip, I often treat the entire side of the leg (Illiotibial Band and Peroneals) to help give a sense of freedom in certain hip movements. The main treatment points are often followed up with massage. When there is leg neuralgia and the patient is very uncomfortable I also utilise Chinese herbal medicine to ensure continuity of treatment.
In Traditional East Asian Medicine we often associate this condition with excessive physical activity or labour. At my Gold Coast acupuncture clinic typical cases of this condition are active middle aged people who go on long walks/ hikes, particularly up and down stairs. Additionally, people who are constantly getting up and down from the floor or working on uneven ground seem to also routinely suffer this condition. There are more variations than the common causes mentioned above, which is why this Piriformis Syndrome should be kept in mind for all cases of buttock, hip and leg pain and leg neuralgia.
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