BACK PAIN

Knowing the pyramidal syndrome

The pyramidal syndrome is defined as the set of signs and symptoms that originate the compression of the sciatic nerve in its exit from the pelvis through the channel located between the piriformis and superior gemellus muscles. It is a pathology in which the piriformis or piriformis muscle compresses the sciatic nerve due to a contracture, fibrous band or overload, causing tingling and pain in some of the areas through which the nerve passes (buttock and back of the leg).

For this reason, pyramidal syndrome is often confused with sciatica, and is popularly referred to as false sciatica or pseudo-sciatica.

Pyramidal syndrome and sciatica How to distinguish them?

The main difference between both pathologies is found in the causes that provoke them, but their symptoms are similar so it is usual that, without the pertinent diagnostic tests, they generate confusion.

While pyramidal syndrome is caused by compression of the sciatic nerve by the pyramidal muscle, sciatica is caused by compression of the roots of the same nerve in the spine. Generally, sciatica is a consequence of a herniated disc or other degenerative disc processes.

The pain experienced in both pathologies is slightly different. In piriformis syndrome, the pain usually manifests itself when spending long periods of time in a sitting position or when making specific movements such as crossing the legs.

How is the diagnosis of pyramidal syndrome obtained?

Pyramidal syndrome is responsible for more than 65% of cases of chronic non-disc lumbosciatica, or in other words, pain radiating down the leg that does not originate in the vertebral discs.

The diagnosis of pyramidal muscle syndrome is fundamentally clinical, that is, the identification of the pathology is obtained from signs and symptoms, clinical history and physical examination. It is very rare to obtain definitive findings in complementary explorations that, in this case, serve to rule out other pathologies that are usually associated with sciatic pain.

Treatment of pyramidal syndrome

We can differentiate between different types of treatments for pyramidal syndrome, but all of them have as main objective to release the compression of the sciatic nerve.

Preventive: Before performing any activity that involves some physical effort, it is highly recommended to perform warm-up exercises, especially in the lower back. These should be gentle and prolonged. Stretching is the best option to warm up in the case of pyramidal syndrome, since it maintains the flexibility of both muscles and tendons. It is appropriate to establish a routine of about 15 minutes two or three times a day, which should work the gluteal musculature, pyramidal, obturators, hamstrings and lumbar square.

It is also important to stretch after the activity, as this is when the muscle relaxes, and a sudden stop can cause it to contract.

Physiotherapy: Massages performed by professionals can provide relief for pain caused by pyramidal syndrome, as they contribute to the stretching and elongation of the gluteal and pyramidal muscles. They should always be performed under the recommendation and approval of a medical specialist to avoid possible damage.

There are also techniques that consist of acting on the so-called trigger points by means of dry needling. Again, it is important to remember that in no case should these techniques be applied without the recommendation of a medical specialist.

Medical: Pharmacological treatment or other procedures such as infiltrations are an effective method to reduce pain derived from compression of the sciatic nerve causing pyramidal syndrome. There are also effective surgical techniques that can be considered in certain cases in which the pain is severe and does not improve with other treatments.

At MIVI we are experts in the treatment of pain, addressing it through a holistic and multidisciplinary approach, and with a great team of professionals. If you suffer from pain or if you have any questions about our treatments, please contact us.

References

Ruiz-Arranz, J., Alfonso-Venzalá, I., & Villalón-Ogayar, J. (2008). Pyramidal muscle syndrome. Diagnosis and treatment. Presentation of 14 cases. Revista Española de Cirugía Ortopédica y Traumatología, 52(6), 359-365. https://doi.org/10.1016/s1888-4415(08)75586-3.

Fernández De Las Peñas, C., & Dommerholt, J. (2013). Dry needling of trigger points: an evidence-based clinical strategy. Elsevier.

Egea, M. A. (2019). Guia Clínica SoHAH | multidisciplinary manual for the management of chronic groin pain (Spanish Edition). Sociedad Hispanoamericana de Hernia.