Piriformis from the Runner’s Angle

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piriformis-syndrome-sciatic-nervePiriformis-muscle-anatomy

Etymology

The word “piriformis” comes from Latin and means “pear shaped”.  The word “syndrome” comes from the Greek word “sun-” meaning “together” and “dramein” which means “to run”.

A syndrome is a number of symptoms altogether that are characteristic of a specific condition or disorder.  Commonly referred to as “wallet sciatica” or “fat wallet syndrome” because the condition worsens up on sitting!

Definition

Piriformis is the name of a flat pyramidal muscle partially located in the pelvic region and in the back of the hip joint. It starts at the lower spine, in the gluteal region, and from the anterior part of the sacrum. It connects with the thighbone (near the femur) and is parallel to the posterior margin of the gluteus medius. It is innervated by some sacral nerves and it helps the hip to rotate and the leg to turn outward. The most important aspect of its location is that it is very close and almost perpendicular to the great sciatic notch, a thick and long nerve in the body.

It is a neuromuscular disorder which is associated with the sciatic nerve. When the piriformis muscle presses the sciatic nerve it causes pain, tingling, and dullness in the hip/ buttocks. It can limit one’s mobility if not treated and is linked to the sciatic nerve. Often, the piriformis syndrome is mistakenly taken for sciatica or other similar conditions. It can be diagnosed only by exclusion, and its treatment, such as stretching, exercises, and even surgery, can require some time.

Symptoms

Someone who has piriformis syndrome will usually feel tingling, numbness, pain in their pelvic area especially while being active or while sitting.  The most common symptoms of piriformis syndromes involve:

  • Acute tenderness or numbness or tingling in the buttock and in the gluteal area that could extend to the leg
  • Pain in the posterior side of the thigh, calf, and foot that might be mistaken for sciatica
  • Increased pain due a long period of time sitting
  • Discomfort caused by running or walking on stairs and inclined superfices (reduces when lying down on the back)
  • Limited mobility in the hip.

Causes

The most common cause of the piriformis syndrome is a trauma, an injury to the buttock area and/or some micro traumas resulted from continuous stress over the piriformis muscle. Prolonged periods of inactivity such as sitting on hard surfaces can create minor stress. If the piriformis muscle is overused or injured, it can start to spasm or it can shorten, compressing the sciatic nerve. This condition is referred to as a nerve entrapment or entrapment neuropathy and is known to be linked to sciatica symptoms induced by the piriformis muscle rather than originated from a spinal disc rotation or some spinal roots.

  • A cause of the piriformis syndrome is the abnormal development of the piriformis muscle within the sciatic nerve, which occurs in 17% of the entire population.
  • The abnormal largeness (hypertrophy) of the piriformis muscle and the abnormal minuteness (atrophy) have been linked to the piriformis syndrome.
  • People who perform forward-moving activities, such as running and bicycling, are more prone to develop this syndrome, specifically if they do not stretch properly. In fact, repeated forward movements that are not balanced by lateral movements can cause the hip abductors to become weak and the adductors to stiffen. As a result of this, the piriformis muscle has to shorten, contract and stress.
  • The inflammation of a nearby structure such as the sacroiliac joint or hip and small herniations in a spinal disc could combine with that, causing the compression of the sciatic nerve and the convulsions of the piriformis muscle. There is still a very limited amount of evidence to back up the hypothesis that there is a particular connection between the strength or weakness of some hip muscles and sciatic nerve pain concentrated nearby the piriformis muscle.
  • Usually, the syndrome occurs to those who are not physically active, thus the sports-related explanation is not convincing in most cases.
  • The spasms of the piriformis muscle can affect another nerve that controls the muscles of the bowel and bladder, the pudendal nerve. If this nerve entrapped, it could cause tingling and numbness, urinary and fecal incontinence.
  • Piriformis syndrome may also be correlated to direct injury to the piriformis muscle (a fall, a knife wound).

 

Diagnosis

The doctor will need to physically examine the patient and will need some diagnostic tests and the patient’s medical history to diagnose him/her with the piriformis syndrome. One can be diagnosed with the piriformis syndrome only if other possible conditions, such as lumbar disc herniation or sacroiliac joint dysfunction, are excluded.

Here are some aspects the doctor will take into consideration when diagnosing the piriformis syndrome.

Physical exam

In the physical exam, there will be the examination of the hip and the legs while in motion to understand whether there is a nerve connected to the pain or no. Usually, any sort of movement that involves hips and legs will create pain, tenderness, and numbness in the lower back, in the lower extremity, and around the buttock area. Some physical tests include the stretching of the piriformis muscles and other muscles to compress the sciatic nerve and confirm the piriformis syndrome:

  • Freiberg test

The patient lays supine and the doctor internally rotates the extended tight and hip by stretching the piriformis muscle and compressing the sciatic nerve. The doctor pushes the flexed leg, by the knee, towards the opposite shoulder, stretching the anterior part of the leg. If pain occurs in the buttocks, then the test results positive.

  • Pace test

This range of motion (ROM) exam involves lying on the side without any pain, even when the doctor moves the hip and leg around. Pain usually indicates piriformis syndrome.

  • Patrick’s test or FABER test (for Flexion, ABduction, and External Rotation)

The examination is performed by having the tested leg flexed.  If the pain is anteriorly, it suggests some kind of a hip joint disorder on the same side. If the pain is obtained on the contralateral side posteriorly around the sacroiliac joint, then it suggests of pain mediated by dysfunction in that joint.

Patrick's-test-faber-test-piriformis

  • FAIR test (flexion, adduction, internal rotation)

The patient is lying sideways on the unaffected side: the opposite hip is flexed at around 60 degrees and the knee between 60-90 degrees. The doctor then stabilizes the hip and applies downward pressure to the knee to internally rotate and adduct the hip. This stretches the piriformis muscle while compressing the sciatic nerve. Pain indicates a positive result.

  • Lasègue

This range of motion (ROM) exam involves flexing the hip at a 90-degree angle while lying supine. If pain occurs while flexing the patient’s knee straight, then it’s a positive sign for piriformis syndrome.

straight-leg-test-lasegue-piriformis

  • Sciatic Notch Palpation

This direct palpation exam involves the doctor pressing and releasing his finger directly on the patient’s sciatic notch. Pain will result positive for the piriformis syndrome.

  • Sensory Evaluation

This palpation exam involves evaluating the leg’s sensibility to touch. Decreased sensibility might indicate the presence of piriformis syndrome. Increased sensation indicates something else.

  • Muscle Evaluation

A gluteal imbalance will usually indicate piriformis syndrome. So, the doctor will check if the gluteal muscle on the affected side has tightened, weakened or atrophied. A muscular imbalance may indicate the syndrome.

Medical history

The doctor will look for the in-depth review of the patient’s symptoms:

  • The positions that create or increase pain
  • The activities that create or increase pain
  • The perpetuation of the symptoms and their origin(in case they appeared gradually or right after an injury around the area)
  • The list of treatments that have been tried or taken into consideration
  • The review of conditions that might run in the family such as arthritis
  • This type of syndrome can affect one hip at a time, but both hips can be affected if the patient does not treat themselves.

Diagnostic tests

X-rays, spinal imaging studies, MRIs, and nerve conduction tests will help detect whether the symptoms are caused by similar conditions to the piriformis syndrome or not. The piriformis syndrome can not be detected by X-rays, spinal imaging studies, and nerve conduction tests.  To confirm the source of the symptoms as the piriformis muscle, an injection of nonsteroidal or steroidal anesthetic could be used.

If the piriformis muscle is underneath the other gluteal muscles then it will hurt when compressed, when massaged, when it is used for any activity that causes flexion of the hip, such as prolonged sitting, walking, lifting objects.

Diagnostic modalities such as CT scan, MRI, ultrasound, and EMG are the best to exclude other conditions.

The magnetic resonance neurography, which is a medical imaging method, can reveal the inflammation of the sciatic nerve when compressed by the piriformis muscle. Neurography is a used to see if a patient has a split sciatic nerve or a split piriformis muscle, while image-guided injections can test and confirm the diagnosis if they relax the piriformis muscle. These injections are often performed on an open MRI scanner or other 3D image guidance. Blind injections, fluoroscopic guided injections, ultrasound, or EMG guidance often work but have drawbacks.

Treatment

As soon as the patient is diagnosed with the piriformis syndrome, the doctor will recommend the best treatment.

The injection of a local anesthetic can help and bring some relief, but the syndrome can limit one’s mobility, thus has to be treated as soon as possible. Stretching exercises, myofascial release, massage, physical therapy, soft tissue mobilization, hip joint mobilization,  stretching techniques, and strengthening of the muscles are all conservative treatment methods to cure the piriformis syndrome, although in some rare cases the only way to cure the condition is a surgical procedure.

There are multiple ways to treat piriformis syndrome. Here are some of the methods.

Stretching

Most cases of piriformis syndrome can be treated with some regular stretching exercise of the piriformis muscle every a couple of hours of walking.

The exercises carefully and progressively target the piriformis muscle but include the stretching of other muscles such as the hamstrings and hip extensor muscles to improve the range motion. The doctor will eventually recommend the patient to keep away from activities such as rowing, lifting, running, and bicycling.

Applying pressure perpendicularly to the muscle can be a useful manual stretch method to relax the piriformis muscle.

Here are some stretches you can do at home:

1. Piriformis stretch. Just lie on your back with your knees bent, then pull one of your knees towards the opposite shoulder and hold. Let the muscles stretch and breathe, then repeat with the other knee. Hold for 5 seconds then progressively try and hold up to 30 seconds. This exercise is meant to be repeated three times a day.

2.Piriformis stretch. Lie on your back with your knees bent, then place the ankle of one leg on the knee of the opposite leg. Bring the ankle as close to the chest as you can and hold. While you breathe you will feel the stretch in your glutes and hamstring. Don’t forget to repeat with the other leg. Hold for 5 seconds then progressively try and hold up to 30 seconds. This exercise is meant to be repeated three times a day.

piriformis-stretch

3. Hamstring stretch. Sit on the ground with your legs forward. Bend one leg and place its foot on the thigh of the other. Slowly bend at the hip and try and reach the toes of the leg that is not bent. You should be able to feel the stretch in the hamstrings, in the back and sides. This exercise is quite important because it can help alleviate any type of sciatic pain. Hold for 5 seconds then progressively try and hold up to 30 seconds. This exercise is meant to be repeated three times a day.

4. Hamstring stretch. With your legs straight, lay down on your back. You can use a rolled towel around the ankle to pull one leg up. You should be able to feel a gentle stretch in the back of the thigh. Hold for 5 seconds then progressively try and hold up to 30 seconds. This exercise is meant to be repeated three times a day.

piriformis-hamstring-stretch

5. Side stretch. Lay on your side and pull the upper leg toward your chest so that the bent knee touches the ground. Rotate your torso to the opposite side so that the shoulders touches the ground. You should be able to feel it in your back and your outer thigh. Hold for 5 seconds then progressively try and hold up to 30 seconds. This exercise is meant to be repeated three times a day.

Strengthening and physical therapy

Strengthening some muscles such as the gluteus maximus, gluteus medius, and biceps femoris can help diminish the stress on the piriformis muscle, thus reducing the pressure exerted on the sciatic nerve and, as a consequence, decreasing the pain.

A patient with piriformis syndrome was completely treated, according to one study, with physical therapy that included the strengthening the hip abductors, external rotators, and extensors. The first step involved some bodyweight exercises (isolating the muscle), exercises with weights, and ballistic exercises (plyometrics).

This study of a single individual, therefore it does not provide enough evidence to confirm that physical therapy can work in all cases.

Another study has been conducted with the participation of 14 piriformis syndrome patients. The rehabilitation program included physical therapy, low doses of muscle relaxants and pain relief medication. It appeared that this rehabilitation program was successful as far as reducing nerve and muscle pain, but it does not provide much evidence (because of the limited number of participants and the absence of the control group) to determine if this sort of rehabilitation program helped treat the piriformis syndrome or if the piriformis syndrome dissipated on its own.

A personal custom exercise and stretch program can be created for every patient by certified health practitioner such as a physical therapist, physiatrist, chiropractor while taking into consideration the symptoms of the patient.

Massage

A certified specialist or a physical therapist can perform a deep massage on the affected area to increase blood flow and to reduce muscle spasm.

Electrotherapy

Electrotherapy is a transcutaneous electrical nerve stimulation (TENS) or interferential current stimulator (IFC) applied to the buttock. This method can help decrease muscle spasm due to the piriformis muscle.

Electrotherapy-piriformis-syndrome

Ice and heat

Ice can be applied to reduce pain by decreasing inflammation thus diminishing the pressure exerted on the sciatic nerve. This is a fast way to help the patient find quick relief after doing an activity that might cause pain. The application of ice can be combined with massage: lie on your stomach in a comfortable position and have someone massage the affected area with an ice pack for twenty minutes while being careful at ice burns. Repeat every time you need relief from pain, every couple of hours.

Heat, on the other hand, may also temporarily limit the muscular pain and help the muscle to become more flexible. Heat can be alternated to cold: lie on your stomach in a comfortable position and place a heating pad for twenty minutes while being careful at heat burns. Repeat every time you need relief from pain, every couple of hours.

Painkillers or drugs

Non-steroidal anti-inflammatory drugs and/or muscle relaxants can provide symptom relief.

drugs-piriformis

 

Glucosamine and nonsteroidal anti-inflammatory drugs (NSAIDs):

  • Ibuprofen and similar products

Eating a fiber-rich meal is recommended before taking since Ibuprofen might cause, in some cases, bleeding of the gastrointestinal apparatus. Carefully check the leaflet. Naproxen can raise the probability of stomach ulcers.

Steroid medication and local anesthetics:

If the pain progresses your doctor may prescribe you some injections to reduce inflammation.

Methyl salicylate-based rubs

Methyl salicylate aka. oil of wintergreen or wintergreen oil is an organic ester, naturally produced by many species of plants, particularly wintergreens. It is also synthetically produced and can be found in different brands such as Ben-gay, Tiger Balm, and others.

Piriformis injections

Acute pain and spasm can be reduced with the help of a direct local anesthetic and/or corticosteroid injection into the piriformis muscle.

Corticosteroids are manufactured from the adrenal cortex and are a group of steroid hormones. They’re usually made in the lab, artificially. Corticosteroids need to be discussed with your doctor, as they need to be prescribed. Injections may be given near the Achilles tendon.

Botox injection

A muscle weakening agent, botulinum toxin injection (e.g. Botox®) could be used for a perpetual type of spasm of the piriformis muscle that doesn’t stop with anesthetic/corticosteroid injections. It can help to reduce pain by decreasing tension in the piriformis thus diminishing the pressure exerted on the sciatic nerve.

Surgery

In some rare cases, surgery is the only way to get rid of the pain. The surgery for piriformis syndrome is often successful and effective. In 2005 it was proven that the new surgical method with minimal access is useful and successful in most cases.

Epidemiology

The piriformis syndrome can be mistaken for other disorders and conditions because of its symptoms that can be very similar (back pain, quadriceps pain, lower leg pain, and buttock pain), different definitions, survey/examination techniques, and when the general population is surveyed or not. Epidemiology is affected by the ambiguity of the diagnosis and treatment due to lack of unanimity of the group.

A study revealed that 0.33% of 1293 patients mentioned that they had an episode that could be attributed to piriformis syndrome. An independent study showed that 6% of 750 patients mentioned that they had an episode that could be attributed to piriformis syndrome. Lower back pain incidents were linked to the piriformis syndrome for circa 6% – 8% of all occurrences.

Some other survey on the general population showed that 12.2% – 27% had an incident of piriformis syndrome in their life and 2.2% – 19.5% had an annual incident.

An additional study in 1991- 1994 revealed that the piriformis syndrome was prevailing 75% in Pennsylvania, Connecticut, New York and New Jersey and 20% in the biggest American urban centers; and 5% in North and South America, Europe, Asia, Africa and Australia.

The piriformis syndrome was developed by 17,2% people who had lower back pain.

In 2012, 17.2% of lower back pain patients developed piriformis syndrome. The ordinary price of treatment is $29,070 for a 4 day hospitalizing.

Risk factors

Anyone can develop the piriformis syndrome, although there are some factors that can make one more prone to the development of the condition:

  • Sex

Women are more at risk of developing the piriformis syndrome due to the fact that they tend to have wider quadriceps.  In 2011, 53,3% of a total of 263 patients (between the ages of 45 to 84) who were treated for the piriformis muscle were women. In fact, women are more likely to get the piriformis syndrome due to the hormonal changes along the way, during pregnancy(muscles in the pelvic area, such as the piriformis muscle, stiffen to prepare the area for the birth).

  • Age

The ages at risk are between thirty and forty. Children are usually not affected.

  • Lifestyle

Lifestyle factors and physical activity can make one more or less prone to the trauma. Several people think that being more careful while practicing intense high-impact physical activities, such as wearing padded equipment for protection or adjusting the workplace’s surroundings, can prevent the development of the piriformis syndrome, micro and macro injuries to the piriformis muscle or to the sciatic nerve root, nevertheless, there isn’t any published research to provide evidence to that.

First aid

Although the piriformis syndrome is a condition that is usually developed in time, there could be times when injury or very intense pain can occur during physical activities. The R.I.C.E procedure is a valid way to try and alleviate the pain. Here it is.

R.I.C.E. (Rest Ice Compression Elevation)

Rest is both required in the long and short term. The first thing the subject should do after an episode of intense pain or an injury in the area of the piriformis muscle is to cease all physical activity and to find a comfortable position (for example laying on the back). An injury can require from numerous weeks to various months, and proper rehabilitation is required for a more effective healing process.

Ice to reduce the inflammation and muscle swelling. A big bucket of iced water or some ice cubes wrapped in a cloth are going to reduce some of the most bothersome symptoms. Pain is decreased because the nerve roots are anesthetized and released from the internal muscular pressure. Apply 15-20 minutes once every 30 minutes or so. Avoid direct ice-to-skin contact, preferably cover the ice with a towel.

ice-piriformis

Compression. You can try to gently compress the area with a sports band or similar bands or devices. The compression will reduce pain, inflammation, and discomfort.

Elevation. You can try and lift one leg or both legs to help reduce pain.

Prevention

The piriformis syndrome can be prevented, as some researchers suggest, by taking precautions such as the ones listed bellow.

Warming up before a workout or physical activity

If one starts to practice a high-impact physical activity without warming up they can increase the risk of muscle strains and injury during flexion or circumrotation of the hip. Micro and macro traumas can occur to any muscle, bones, and ligaments. Warming up before a physical activity can decrease the risk of traumas by helping the body, especially the muscles, to progressively ease into the physical activity. Here are some of the best moves to warm up:

  • March on the spot.

Just march around your room for a couple of minutes to make sure your heart gets used to beating faster, to get your heart pumping. Marching is a great way to get ready for any workout or sport.

  • Jump.

Get a rope or just jump, it will help your body to get used to the imminent workout or sport by making your heart beat faster and warming up the whole body.

  • Dance around.

The most effective and fun way to warm up is to move around to your favorite tune to get you started. Jump, slide, bend, twist your torso, lift your legs etc. Don’t do too intense or sudden moves, you could hurt yourself so be careful! The first moves should be slow then progressively faster.

  • Balance exercises.

Jump on one foot, bend while standing one one foot or try and do a semi-squat on only one foot. Balancing is very important because it prepares your brain for the moves and for the sport you are going to practice.

Swing your legs and arms. This is a great way to warm up and to get your muscles ready for action.

  • Practicing the correct exercise form

If one doesn’t practice the correct form of the exercise, they might end up causing(in some cases irreversible) traumas to the muscles and/or to the bones and ligaments. In fact, having an incorrect form, not only increases the risk of having traumas but it also compromises the whole purpose of the exercise and the result of it.

  • Stretching

While warming up is important before the workout, stretching is important to slowly and progressively stimulate the muscles to decontract, relax and repair, by helping the lactic acid distribute in all the fibers of muscle rather than in one spot.

Here are some stretch moves that can help your muscles relax properly after a workout:

The runner’s stretch. Step forward with one foot and lower your basin so that the knee that’s in front of you is of about 90 degrees. Reach the floor with your fingertips and breathe. Slowly straighten the front leg. Repeat with the other leg. You should be able to feel your hamstrings and your glutes. This stretch should be repeated for about 3-4 times.

The standing side stretch. Stand tall, lift your arms straight, your hands should be holding each other. Exhale while you bend your upper body to a side and then to the other. You should feel it in your sides, your arms, and abdomen.Repeat for about 3-4 times.

The forward hang. Stand tall, interlace your fingers behind your back then straighten your arms. Bend from the waist and bring your straight arms towards your head. You should feel it in your arms, back and also in your legs. Repeat for a couple of times.

The low lunge arch. Step forward with one foot and lower your basin so that the knee that’s beneath you touches the ground. Touch your thumbs and the keep your arms straight while you bring them over your head arching your back. You should feel it in your glutes, arms, thighs, and core. Repeat on the each side for about 3 or 4 times.

The seated back twist. Sit on the floor with your legs straight in front of you. Bend one knee then twist your torso and press the opposite elbow into the outer thigh of the bent leg. You should feel it in your back and core. Repeat for about 3 or 4 times on each side.

The bound angle. Sit on the floor with your legs straight in front of you. Bring you feet together so that the soles of your feet touch and let your knees drop as close to the floor as possible. Bend from the waist and bring your arms in front of you. you should feel it in your back and specifically in your inner thighs and hamstrings. Hold for about eight breaths.

One legged pigeon pose. Sit on your mat. Bring the right leg behind you straight so that your quads are facing the floor. Bring your left leg in front of you and bend it at the knee. The knee should be oriented right in front of and not to the side. Bend at the waist and rest your forehands and elbows on the ground. Hold this position for about 30 seconds. Repeat on the other side. Don’t forget to breathe. This move should be felt in the hamstring and in the hip muscles.

  • Doing strength training

This type of training is very important to ensure that the muscles are strong and used to stress. If it is practiced correctly and if it targets equally all the muscles of the body, it provides protection from traumas, for example in the case of the piriformis muscle, having strong hip adductors and abductors, adjacent muscles and pelvic muscles can reduce the stress on the piriformis muscle, thus reducing the risk of developing the piriformis syndrome. In several cases, it can help treat the piriformis syndrome.

Here are some of the best exercises for the piriformis muscle and for the muscles that are helping it:

Step ups. Hold two dumbells in each hand. Stand tall and step with one the right leg on a bench or some higher surface using one just the right leg to lift your body. Don’t forget to inhale and exhale, don’t hold your breath. Repeat on each leg for about 15 to 20 times. You should feel it in the hamstrings and specifically in the quadriceps.

Pistol squat. Just squat only using one leg, the other one should be in front of you but not touching the floor. You can use the hovering leg, by touching the ground with it and pushing, to help you squat. Repeat on each leg for about 10 to 15 times. You should feel it in the hamstrings and the glutes. This killer exercise is usually done even by the most advanced without additional weight because it is already really challenging with only the bodyweight.

Walking lunge. Hold dumbells in your hands and step forward with each leg while walking. After just 10 to 15 repetitions for each leg, your legs will shake and feel like they are on fire. Don’t forget to breathe.

Bulgarian lunge. It is similar to the walking lunge except you are not walking and the leg that’s behind you rests on a bench. With some dumbells in your hands, lower yourself until your front knee is a 90-degree angle and then come back to the standing initial position. Repeat 20 times for each leg at a time. You should feel your quads.

Romanian deadlifts. Hold two dumbells or a barbell. Stand tall and bend at the waist while keeping the knees slightly bent. The barbell or dumbells should almost touch the ground. The back should always be flat, not rounded. This exercise targets the hamstrings and the glutes. Repeat 10-15 times and don’t forget to breathe.

Front squats. Hold your weight using your arms, between your neck and your chest, almost resting on your collar bones. Squat and keep your knees a bit wide apart from each other, in a comfortable position. Don’t use too much weight! This exercise is another killer that targets your quads. Repeat the exercise for as many times as you can and don’t forget to breathe.

Squat. This exercise could not be left out of this list. The squat is one of the most complex and effective exercises of all time. It targets the legs (the quads outer and inner thighs and the hamstrings) but it works your back and your overall core too.

  • A good diet and lifestyle

Every condition, disease, and syndrome can be prevented with a good diet and a healthy lifestyle. A plant-based diet helps you healthy and strong, reduces inflammation and prevents all kinds of illnesses such as cardiovascular and organ disease, cancer, and other bone-related conditions etc.

Here are some foods and vitamins that are fundamental to prevent and cure the piriformis syndrome.

Anti-inflammatory foods

Foods such as pineapple, berries, spices like turmeric, and many others are sour even when ripe are anti-inflammatory and help the immune system and healing.

sour-fruits

Vitamin B group

The B vitamins are found green peas, potatoes, whole grain fortified cereals and other foods. This group of vitamins is important for the functions of the brain and for healing. B12 in micrograms (μg) is important for growth and brain functions. Its deficiency can really damage your body in numerous ways. Below there is a table with the daily recommended intake for adults and young people.

Age                            RDA (μg)

0-6 months……………….0.4

7-12 months……………..0.5

1-3 years…………………..0.9

4-8 years…………………..1.2

9-13 years…………………1.8

14+ years………………….2.4

pregnant women………2.6

lactating women……….2.8

Vitamin A

Carrots, dark green leafy vegetables, orange-colored fruits, mangoes, apricots, beta-carotene rich foods like broccoli, apricots, carrots and sweet potatoes are extra important for the reconstruction of the fibers.

Vitamin C

Citrus, yellow vegetables, and many others are a viable source of vitamin C for the bones and absorption of other vitamins.

Vitamin K

Sources such as broccoli and spinach, are very important for the blood and cell and tissue reconstruction.

Water and Sun

Drink lots of water, the adequate quantity is about 1.5 – 3 liters a day. Sun is also important because it is a viable source of Vitamin D that is fundamental for the absorption of Calcium and other minerals and vitamins.

Conclusion

The piriformis syndrome is a condition that can be cured and that does not affect the quality of life in a significant way, apart from the limited mobility that might be caused by it. In any case, a good lifestyle, diet and exercise plan can help prevent and cure the condition. Attend regular therapy sessions and rebuild strength and flexibility in the affected area.

The information in this article should be discussed with your doctor before deciding a rehabilitation strategy.

Sources

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