Piriformis Syndrome Pain (Deep Gluteal Pain): Shut It Down in 3 Seconds at 95% Certainty, Textbook Theories Irrelevant

Piriformis Syndrome (PS), or its new name - Deep gluteal pain (DGP), is a pain deep in the hip. Currently, there are many known causes of sciatic nerve entrapment that have nothing to do with PS, which is actually a subtype of Deep Gluteal Pain (DGP) (Carro LP et al, 2016).

Treatments for PS: Nothing Truly Works

PS is a disorder falling into musculoskeletal category. For musculoskeletal conditions in general, modern medicine provides no solutions which are more effective and less harmful than placebo or no treatments.

The terminology and clinical description of piriformis syndrome (PS) was established in as early as in 1940s (Black SB, 2018). In the last 80 years, many conservative and surgical treatments have been recommended for PS or DGS treatment. However, evidence supporting superiority of one treatment over another is lacking (Hopayian K et al, 2023).

The recommended treatments include physical therapy, lifestyle modification, NSAIDS and muscle relaxants, and the avoidance of recognized contributory activities.

In 2023, researchers from Cypus and Iran (Hopayian K et al, 2023) published their systematic review on the effectiveness of treatments. Thirteen studies with 508 patients were included, eight RCTs with 336 patients and 5 case series with 172 patients.

The treatments used in those RCTs included:

• Physiotherapy, intramuscular infiltration, and surgery.
• The physiotherapy modalities included tissue mobilisation and selective strengthening of specific muscle groups.

The review found that overall quality of evidence was low. The authors concluded (Hopayian K et al, 2023): Given the low quality of evidence, no single conservative treatment can be recommended over another.

That is, if we ask "which treatment is the best?" The answer is: None. In medicine, when you have a lot of "solutions" but no single one is superior to another, that means none works.

Let's take a look at a PS sufferer's experience with all the treatments she had tried.

A PS Sufferer's Hopeless Cry

Joletta Belton is a writer, researcher, nature lover. She writes about her experiences of how to live with constant chronic pain, pain at hip and leg, unable to walk, the end point nowhere in sight (https://mycuppajo.substack.com/) . Here is her voice:

• Everything … You Name, I Tried

I went through:

physical therapy,

cortisone injections,

surgery, 

more physical therapy, 

yoga, 

massages, 

Acupuncture,

chiropractors, 

posture-based movement therapy, 

changing my diet, 

mindfulness training…

you name, I tried it.

With each new therapist, each new treatment, each new attempt I was desperate for it to work, desperate for me to be fixed. ...But the pain would always come back. Often times less, but always back. And sometimes worse.

The above is a case showing how modern medicine miserably failed in dealing with PS or DGP.

A Healing Art Eradicates Any Pain in A Breeze

While a simple pain in the hip defeated the modern medicine world, few healthcare practitioners today are aware that there was a healing art 2000 years ago in China which could instantly knock out or greatly relieve any pain or abnormal sensation on the body including hip pain. The magic intervention ancient Chinese doctors used to treat diseases was needle therapy. I call it Neijing acupuncture.

With Neijing Acupuncture, DGS pain relief and permanent cure is just a breeze: Upon a needle insertion far away from the hip, the pain at deep hip will subside or even disappear in 3 seconds. You can expect this must happen just as certain as you expect sunrise will happen every morning, or a falling apple from a tree must move downward and hit the ground in 3 seconds. To know more about the power of Neijing acupuncture, read A Falling Apple Must Hit The Ground in 3 Seconds - Healing Power of A Magic Bullet: Observation vs Explanation in Medicine .

The key to eradicate any pain in a breeze lies in where and how precisely apply the stimulation from the intervention on the body.

Hip Is A Big Body Part, Where Is The Pain?

First, we need to identify the precise location of the pain. In DGS’s case, the pain is in deep hip tissues. In my 6 years of clinic observation, the worst spot of deep hip pain with radiating pain to the back of thigh is most often located beneath the edge of lower 1/3 sacrum bone (Figure 1).

Where to Insert Needles for Hip Pain? Not The Hip!

For this specifically localized hip pain, the next step is to determine where to insert needles. Although the pain is at hip, in order to eradicate the pain and the radiating pain in 3 seconds, your needle must be inserted far away from the hip! The further, the more magic effect in shutting down the pain.

There are multiple locations on distal limbs where you can find a pea-sized painful spot where upon a needle insertion, the deep hip pain and together with accompanied radiating pain will instantly subside or even disappear (permanent cure requires 3 to 20 treatments depending on the severity of initial condition).

One of the most convenient options is to insert a needle on the hand opposite to the location of the hip pain, that is, if hip pain is on right hip, you will insert the needle on left hand.

Identify The Pressure Tender Spot on The Hand

Compared to the size of a nociceptive nerve ending which produces action potential for the brain to perceive as pain, the hand is a huge body part. So where to insert needles on the hand?

To instantly reduce even eradicate DGP together with radiating pain, there are again multiple spots on the hand for needle insertion. The most convenient spot is the one located at dorsal side of hand (opposite the palm) at the wrist.

In this very small region, you can identify a small (about 2 mm in diameter) and very painful spot at the proximal end of the joint between lunate bone and triquetrum bone (Figure 2), by firmly pressing using the tip of your thumb. Make sure your needle (0.18 x 15mm) must exactly hit the most painful points on the bones, either on lunate side or on triquetrum side, which ever is more painful. If not sure, you may simply stick 3 needles to cover this spot.

In Neijing Acupuncture, No Clinician Can Fail

With the procedure described above, PS or DGP can be instantly shut down or reduced by at least 80% by inserting a needle at this spot on the hand (to get 100% reduction in a few seconds, multiple needles at second optional spot is needed).

I could expect this instant PS pain relief phenomenon will happen again and again at 99% certainty just similar to that I can expect the sunrise will happen every morning.

(There is around 0.5 % chances you can fail. That is when the patient has received nerve blocking injection, cortisol short, or TrP deep dry needling treatments, all of which were applied to the hip).

Also note, the reduced hip pain can come back after a few days or even only after a few hours depending on the initial severity of the condition. But with each treatment, the pain will come back at less and less level. Permanent cure can be achieved in 3 to 20 treatment at once or twice per week, again depending on the initial severity of the condition.

One Thing Is Unfortunate

But unfortunately, this clinical phenomenon of PS pain instant relief can not be explained by any available textbook theories such as trigger point theory, tight muscle theory, weak muscle theory, poor posture theory, spine subluxation theory, meridian theory, acupoint TCM formula theory, any other types of biomechanical dysfunction theories, or metaphysical or spiritual theories ...

Outside these cozy and safe echo chambers made of textbook theories, it is an unknown dark world! For many clinicians who have been extensively trained by textbooks, few would dare to take any risk.

Yet, Science Not Advance in Cozy Echo Chambers

Textbooks, particularly the most popular ones, are written by experts, big names or gurus. “Science is the belief in the ignorance of experts…The experts who are leading you may be wrong...” Says Richard Feynman, Quantum Physicist. Science does not move forward if we blindly accept everything of what we see, hear or read (including this post). Instead, we need to keep thinking, testing and retesting.

Science does not advance in cozy echo chambers. The knowledge and skills of medical professionals will not grow in cozy echo chambers either.

To know more about why echo chambers prevent science from advance, read this: The No. 1 Stupidity in Medicine: Buckets Full of Holes; Nothing Would Ever Be Settled .

References

Carro LP et al. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J. 2016 Dec 21;6(3):384-396.

Black SB, From Piriformis Syndrome to Deep Gluteal Syndrome. Spotlight Topic: Pain | September 2018, practicalneurology.com

Joletta Belton, https://mycuppajo.substack.com/

Hopayian K et al, A systematic review of conservative and surgical treatments for deep gluteal syndrome. J Bodyw Mov Ther. 2023 Oct;36:244-250.

#piriformesyndrome #deepglutealpain #dgp #hippain #modernmedicine #acupuncture #huandineijing #painrelief #hereticthinking #echochambers