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A Pain in the Butt (Piriformis Syndrome)

If it hurts to touch a point that's at hip height in the middle of one side of your buttocks, you may have Piriformis Syndrome. The sciatic nerve is the longest nerve in your body. It starts on the lower part of your spine, passes through a hole between the piriformis muscle and several other muscles, and goes down the back of your leg to your heel. When you run, the piriformis muscle contracts and squeezes the sciatic nerve. Repeatedly squeezing and relaxing the piriformis muscle can damage the sciatic nerve and cause pain. Your doctor will be able to make an accurate diagnosis by injecting a mixture of xylocaine and corticosteroid drugs directly into the piriformis muscle where it passes over the sciatic nerve. If the pain disappears, you have piriformis syndrome. This injury is thought to be caused by an innate tightness of the piriformis muscle or a structural abnormality in the path of the sciatic nerve. It has not been traced to any specific training errors.

Similar pain may be the result of an injury to bones, muscles, tendons, bursae (pads between the tendons and bones), the hip joint or the sciatic nerve, but there are ways to determine which condition you might be suffering. If you feel most pain when you land after hopping on one leg, you might have an injured hip joint or a stress fracture in your pelvis or upper leg bones. An x-ray will usually reveal a joint injury, but only a bone scan will reveal a stress fracture. If you feel pain in your buttocks, particularly when you touch your toes while keeping your knees straight, you might have a tear in the large muscles or tendons that run down the back of your hips. If you feel pain when you touch a spot that's either on the lowest point of your pelvis (the part that touches a chair when you sit) or at the top of your femur (thigh), you might have injured your bursae (bursitis) or torn the tendons that are attached to bones at these sites. If your back hurts, particularly when you bend backwards, and the pain goes down the back of your leg to below your knees, your sciatic nerve is probably being pinched in your back.

Piriformis syndrome won't ease until you stop running, cycling, or any other activity that caused it. Don't start again until you can do your sport without feeling pain in your buttocks. If it hurts to touch, it hasn't healed. You probably shouldn't do any exercise that causes you to bend at the hip while keeping your knees straight, because this will stretch the sciatic nerve. You might be able to swim, if it isn't painful. Medication doesn't usually alleviate the pain, and even if it does, the pain will return as soon as you stop taking it. When the pain is gone you can resume your regular exercise program, but be aware that this injury tends to recur.


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Dear Dr. Mirkin: What is the nutritional difference between a fresh bean and a cooked dry bean, such as green soy beans (the Japanese edamame) and cooked dried soy beans, or green peas and dried split peas?

"Green" beans, peas and other legumes are picked before they are mature, so they have not yet become fully developed seeds. They contain more water and sugar, and less starch and protein than the mature seeds. As the seed finishes developing the sugars are converted to starch, proteins are formed and water is withdrawn. Both types are good sources of fiber, vitamins, minerals and other nutrients; enjoy a wide variety of them in your diet.


Dear Dr. Mirkin: Can you help us convince our boss that a fitness program at work would be a good investment?

You can quote a study from Oklahoma State University that shows people who exercise regularly are far less likely to miss work than those who are not fit. Your boss might say that this study is irrelevant because sick people can’t exercise because they are sick, so it’s their illness causes them to miss work. However, this study shows a direct relationship between how much you exercise and how much you miss work. Those who exercised 20 minutes one day a week were far less likely to miss work, and those who exercised two days a week were even less likely to miss work (Journal of Occupational and Environmental Medicine, Volume 43, Issue 12, 2001). That’s why many companies pay their employees while they exercise during the work day.


Recipes featuring ripe fresh tomatoes:
Mediterranean Salad
Tomatoes with Pepper Salsa
Tomato-Mint Salad
Tomatoes with Cucumber and Onion
Tomatoes with Basil

List of Diana's Healthful Recipes

June 27th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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