Dear readers, this week’s question comes from Ashley from Alberta, who is interested in learning what I can recommend for piriformis syndrome, as her doctor is recommending a series of cortisone shots and she’s concerned about drugs as a first line treatment. Is there anything more natural she can do, and will it have an impact?
Piriformis Syndrome
Piriformis syndrome is a giant pain in the butt. No really, it is! It’s a condition in which the sciatic nerve is compressed by the piriformis muscle, which is buried deep inside the glutes (see here). Symptoms vary and can include localized pain and numbness in the lower back and buttocks, as well as referred (nerve pain) and or aching and numbness down the leg. It’s often one sided and quite frequently there is a worsening of symptoms when sitting, standing from sitting, or running. It can be misdiagnosed as a disc problem or sciatica, as there’s no definitive, standardized test and how the glutes function directly impacts our lower back.
Causes include tears due to injury, overuse, and tight hip flexors or hamstrings that naturally occur from sitting too much. When we exercise after sitting for prolonged periods, our supporting muscles are not activated and injuries can occur. As such, it’s a very common injury as we age if we are sedentary or if we push ourselves too hard in exercise without strengthening or activating certain muscle groups first.
The best information I have found online about evaluating and treating piriformis syndrome with movement are here and here. The second is an online program created to target the issue specifically, created by Coach Sofia. Osteopaths are well equipped to help you determine if this may be playing a role in your pain and to help you learn movements to activate, strengthen and support muscles that may not be doing their job such that the piriformis is over exerted and inflamed.
Like most soft tissue injuries, piriformis syndrome takes a long time to fully heal — much longer than a broken bone. With soft tissue injuries we are prone to develop a chronic problem because we don’t fully let it heal before straining it again, or we don’t stick to corrective therapies long enough to allow it to fully heal. It can take a year to a year and a half or more to fully heal soft tissue damage.
Complete healing of these injuries requires not only resting the damaged tissue or muscles but also strengthening the muscles that support it and addressing underlying movements, overuse, or laxity that created the problem in the first place. Additionally — and this is what many people miss — soft tissue injuries are directly related to the level of inflammation in the body overall. I’ll explain why and it’s directly related to what we put into our mouths.
Today we’re going to focus on what you can do for piriformis syndrome from a nutritional perspective. This can be applied to any soft tissue injury and is invaluable if you really want to address the root cause of tissue damage or chronic inflammation and facilitate healing in the body.
Inflammation 101
Inflammation is part of the body’s natural healing design and happens in response to injury or perceived injury. It can be both acute and chronic. Acute inflammation is identifiable by the redness, swelling, and heat that often accompany an injury. These happen because blood cells rush to the area like first responders to assess and address the injury. They flood the area with oxygen, nutrients, clotting factors, natural pain killers and more. Together, these factors speed healing. Think about it. They immobilize a damaged area (like in frozen shoulder) until the tissue is repaired. The pain we feel even helps us. It’s a signal to us to use the injured area less. It’s all part of the amazing design of our bodies to self-heal!
Chronic inflammation is a lower grade response than this. It can be systemic but typically shows up in flares that can either be localized in one area or systemic. If it’s localized, you’ll see it in the colon, the joints, the tendons, the sinuses, etc. If it’s systemic it will show up as an autoimmune condition. If your diagnosis ends with ‘itis’ it relates directly to inflammation. Think bursitis, arthritis, sinusitis, colitis, blepharitis, otitis, etc. And if you have pain and stiffness or impaired function anywhere it’s a safe bet you have some level of chronic inflammation.
Piriformis syndrome is irritation/ inflammation of the piriformis muscle.
In cases of chronic inflammation, the toxins in our diet can be provoking the body to stay in a low-grade inflamed state. They damage the gut and create malabsorption that triggers the immune system to a smaller, but more continual degree. Let’s talk about an anti-inflammatory diet to address this.
An anti-inflammatory diet
An anti-inflammatory diet removes those foods that are most inflammatory to the body. As such, many diets can be said to be anti-inflammatory, including a raw food vegan diet. However, only a few also focus on the most natural, nutrient dense replacements. These include the carnivore diet, the Paleo or Primal diet, and a very low carb or ketogenic version of the same.
The key inflammatory foods in our diets today are:
- processed and take out foods
- wheat and gluten
- vegetable and seed oils
- sugar and sugar byproducts
- corn and corn byproducts
- soy and soy byproducts
- and for some, dairy (this often happens because of gluten or glyphosate induced gut damage to the junctions in the intestines and can be repaired over time with guidance)
I recommend the Paleo/Primal diet or a keto version of this for healing most health issues. Why? It not only removes the most inflammatory foods, but it uniquely focuses on replacing those with the foods with the greatest nutrients. Essentially, a Paleo diet focuses on foods our ancestors would have eaten before the advent of agriculture. Think hunter/gatherer. It focuses on whole meat, fowl, seafood, and eggs as the source of most calories and includes vegetables, fruit, herbs, and nuts and seeds. Condiments that are natural and unsweetened, like mustard, homemade mayonnaise, vinegar, or horseradish are allowed on this diet. I, and many others, also recommend all natural fermented foods to support a healthy gut biome. All traditional cultures included fermented foods of some sort.
The Paelo diet doesn’t remove foods simply because they are new and what’s old is best. They remove them because there is evidence that these foods are very inflammatory, hard to digest, and subpar for human health. Not everyone agrees, but I have seen this borne out in my clinical practice. I started nutrition as a raw food vegetarian. I did a 180 when I realized the damage this did to my health and saw the healing of a Paleo diet. Seeing this benefit over and over again in clients, I no longer recommend processed foods or grains as staples, at all. Grains contain anti-nutrients that make them difficult to digest, but even when they are able to be digested, they contain enough glucose (starch) to fuel insulin and insulin is both highly inflammatory and an arbiter of all manner of disease. If clients prefer a vegetarian version of this diet, I try to persuade them to do it with supplements and including fermented dairy, eggs, and seafood if they can.
In a Paleo diet there is emphasis on sourcing grass-fed ruminants, eggs from free range chickens, and seafood that is sustainably wild sourced. Organic and sustainable agriculture is preferred for veggies, nuts, seeds, and fruit, as the quality of the products are impacted detrimentally by pesticides and depleted soils. Sustainability is essential when considering consuming animal products regularly.
Top anti-inflammatory foods
Additionally, there are foods that are super at helping to reduce inflammation in the body. Fish and seeds that contain omega 3 are great for down-regulating inflammation. These include sardines, salmon, chia, and hemp. If you dislike fish, you can always take a fish oil to get the benefit in concentrated form. Look for a product with high EPA and DHA. DHA is particularly important for brain health.
Apple cider vinegar (unpasteurized) is also a great anti-inflammatory product. It helps us better digest protein in our diets, as well, giving it great benefit when taken with or just before a meal. It can also be rubbed on inflamed joints for relief.
Turmeric root and turmeric powder have potent anti-inflammatory properties, as does fresh ginger root. Including these every day in your diet or adding them as supplements can drastically help inflammation like joint pain, for example. Making tea with fresh ginger and turmeric root with raw honey and apple cider vinegar is exceptional as a remedy for flare ups. Add some cayenne pepper if you can handle it. This is my go-to recipe for acute inflammation! I’ve seen it stop acute gout and rheumatic attacks and reduce pain substantially in just a few days.
What we need to remember is that food isn’t like medicine — it is medicine. We can use it as a first line treatment to reduce inflammation in the body so that any medication or surgical treatment we undertake is both absolutely necessary and more effective because the body has all it needs to help us heal on a deeper level and to prevent the injury from repeating.
Thank you, Ashley, for writing in with your question, I hope you found this helpful. If you have a health issue or question, just send me an email. If you’re looking for more specific health information, check out my website.
Namaste!
Nonie Nutritionist