These case summaries are examples of real people treated here at the clinic (names changed for privacy). They are not an exhaustive study of the whole condition, merely an opportunity for you to see the sort of things that we have been able to help with in the past, and how we may be able to help you if you’re suffering a similar condition.
“The leg pain is at a point where it’s now affecting my ability to work and enjoy life.”
Elle, a 49 yr old hairdresser, presented to the clinic with a 2 week history of constant right sided lower back pain travelling down the leg to the outside aspect of her knee, “like sciatica”. She was unaware as to what could have caused this and stated the only injury she could think of was “when she did her back in whilst moving last year”. She mentioned that the pain and discomfort is very different to what she felt then.
Elle described the pain as a sharp stabbing like pain that occasionally changed between that and a deep ache. Severity of pain was 6-7/10 and she reported that the symptoms were worsening over the last week or so. Elle stated this was severely impacting her work life and she was even unable to work on several occasions over the last week or so. Elle also stated her sleep was being disrupted and she often woke in pain during the night.
Symptoms were worse when sitting or standing for long periods of time and strong pain killers (Panadol rapid) and anti-inflammatories (Voltaren) offered relief, however she didn’t like constantly taking them.
Examination: All safety tests and neural tension tests were negative – ruling out serious pathology and any disc lesions. Lower limb deep tendon reflexes were also normal. Palpation revealed very tight and tender lumbar paraspinal muscles worse on the right side. Both buttocks were also very tight and tender and when the right side was stimulated it reproduced the exact sensation Elle has been experiencing. Further orthopaedic testing revealed significant piriformis (a muscle deep in the buttock area) shortening with associated gluteal tightness with a pain referral into the right thigh and towards the knee.
Elle was diagnosed with right sided piriformis syndrome with referral of pain into right thigh and leg. Elle also has associated muscle tightness of the gluteal and hamstring muscles, much worse on the right side.
A 2-3/week treatment plan for 4-6 weeks was advised and progression would rely upon responsiveness. Re-assessment after the initial treatment period would determine future treatments.
Initial treatment consisted of releasing the tight lower back and buttock muscles with massage and muscle release techniques focusing on the right side. These were initially quite uncomfortable reproducing the exact sensation Elle was experiencing. Straight after these procedures Elle felt a great sense of relief and commented that she feels “ lighter and much looser”.
Gentle lumbar and sacro-iliac chiropractic adjustments were performed on both sides however focusing on the right SIJ (sacro-iliac joint) region. Lower and mid thoracic chiropractic adjustments were also performed. There was an immediate improvement in ROM and the patient felt a “release of pressure” . Elle was shown and advised to stretch her hamstrings and buttocks both sides 3 times a day for a minimum of 30 seconds each stretch.
Upon presentation for follow up treatment, the patient felt slightly “bruised and tender” however noted that she did get some relief and didn’t need to take as many pain killers for several days. However, she did state the symptoms returned and are still currently giving her discomfort. She was complaint to stretching although stated that she didn’t do them as much as she should have.
Treatment was continued 3 times a week focused at relieving muscle tightness of the right sided buttock muscles (piriformis and gluteals) and maintaining mid to lower back and sacro-iliac movement. Gentle chiropractic adjustments were continued aimed at providing and maintaining movement through the thoracic, lumbar and sacro-iliac joints. Elle continued to do her stretches and stated that they were getting much easier to perform. Elle reported that after every treatment she was slowly improving and could work for much longer without discomfort. She also was no longer waking at night in pain.
After 2 weeks the stabbing and shooting pain was gone with only a “niggly” buttock pain remaining. Elle was able to work and sleep without discomfort and was even able to go dancing over the weekend. After 3 weeks of treatment the patient was completely symptom free and only felt discomfort when her gluteals were palpated and released.
4 weeks into the treatment plan, Elle reported that all symptoms had resolved and she has returned to work as normal. Elle was very happy to be symptom free and stated she was even able to walk her dog and function without significant discomfort and pain. Treatment was continued for several weeks with the goal or maintaining these positive changes and ensuring the symptoms had not returned. Elle continues to come on for maintenance treatments with the goal of maintaining function and preventing this issue from returning. She also had a foot scan and found that there were some issues in her feet affecting the alignment of her hips & pelvis, so she was fitted with a pair of Foot Levelers custom-made orthotics to correct this and minimise the risk of further recurrence of the injury.
By Dr Grant Colombo (chiropractor), May 2017