Differentiation of symptoms between Piriformis syndrome and herniated disc.
Hello,
Background:
- Disc herniation L4/5 treated conservatively in 2007
- persistent blockage of the sacroiliac joint (SIJ) in 2012
- Disc herniation L4/5 in 2014 with paralysis of the right foot extensor => nucleotomy. Since then symptom-free
- in May 2021 (increased training volume due to marathon preparation) pain in the buttocks / piriformis => increased stretching of the back of the leg, prescription from the orthopedist for manual therapy. After three weeks of manual therapy, symptoms resolved
- in August 2021 further increase in training volume for marathon at the end of September (running since 2009 / marathons since 2011)
last run 10km on 31.08 without complaints.
Since 01.09. (for 3.5 weeks) very strong pain in the left leg. Starting again in the piriformis, additionally on the outside of the thigh. Pain increasingly spreading over two weeks, later involving the entire quadriceps. Occasionally strong pain at the muscle insertions around the knee, occasional cramping of the muscles on the shin. There are no sensory or motor deficits.
Orthopedist orders MRI lumbar spine => disc herniation L3/4 left.
Orthopedist orders MRI hip => unremarkable.
The manual therapy for loosening the leg muscles feels good (2-3 times a week), unfortunately the effect does not last long and the muscles quickly harden again.
After two weeks of a tendency towards worsening, now for over a week there has been stagnation at a low level.
Mobility in the back is slightly restricted, but not nearly as bad as in 2014. Without the MRI of the disc herniation, I would say: limitation out of fear + not stretched for weeks (out of caution).
Since I have no back pain and the leg pain does not radiate but feels like specific strong muscle pain, I suspect that the problem may not necessarily or at least not solely be attributed to the irritation of the nerve root L3/4, but rather another pain source (irritation of the sciatic nerve in the piriformis area) may be present.
Can this be differentiated neurologically? Or can the described symptoms be solely attributed to the disc herniation L3/4?
Thank you for your response.
