Mary, You seem to have figured it out all I can not agree with you more.
After botox my pelvis was clearly unstable. My pelvis was let loose as well as
my sciatica. Now I have pain around the piriformis muscle not the muscle itself;
there are six other(external,outward) rotators of the hip, and priformis is the
main mover. But only piriformis is entangled with sciatica the others are just
muscle pain and after sciatica pain it is minor. Ref:An illustrated guide to
Muscles& Clinical Massage Theraphy. Presented by the pain &posture clinic.
http://danke.com/orthodoc/pirif.html

Piriformis syndrome is a by-product of pelvis misalignment, and/or pelvis is
misaligned after an injury to piriformis. If it is not diagnosed before the
occuring of piriformis tendonitis, when direct tenderness is found in the region
of the piriformis tendon over the buttoct
region,(www.drpribut.com/sports/piriformis.html) the piriformis may be
hypertrophied. (As we all know the main problem that it is not diagnosed till
all the side effects are out there!) Then aligning the pelvis, massage and
physical theraphy are not enough to stop piriformis disturbing the sciatica
sometimes. This is at least what I believe happened in my case.

I am hoping that Botox will lessen the tone of my overused piriformis muscle
and I will try to get my body aligned and tense muscles relaxed during this
period. Before when my piriformis was tight (and my sciatica was tight) I had
too much pain even to be manipulated properly.
I agree there are many side effects and I was told not to even exercise by my
osteopath at the moment he says we do not want it out of place more. He also
told me he wished I had found him before the botox injection, he does not
approve it. By the way he is an homeopath, too. It is the first time I have a
doctor who realy listens and tries to heal all my body.

I had read many research papers on Treatment of Piriformis Syndrome with Botox
and actually asked for the injection myself. My pain doctor had applied a
cortisone injection instead of botox to my piriformis in June, he was reluctant
to apply botox before making sure the piriformis muscle was the main reason of
my pain. I agree with you it is not the best solution, but it is better then
the surgery if you can not handle the pain anymore. It also should be done
knowing everything about it. There is an article(ref1); a research on 50
patients who underwent botox injection of the piriformis muscle. I am in the
5th week and my sciatica is not tight as before, I can sit without being scared
now; after 6 weeks I will see more influence. If there has not been occurance of
any fibroids, scars or I do not know what other harm; I might be having
permanent relief rather than the temporary one I have now with neural theraphy.
If I still have sciatica pain in after 18 weeks and after all this effort I have
to consider surgery; actually I am so scared of the surgery I am making all I
can to get well now. I do not agree with having continuous botox injections, but
it could be given a try once if you started considering surgery like me.
Sciatica nerve does not have as much healing chance as the muscles.

Ref1:http://advancedspine.net/Articles/Piriformis-VsNCT
Medi-Dx 7000 V-sNCT a valuable aide in Piriformis muscle syndrome diagnosis

Ref2: The Internet Journal of Anesthesiology TM
ISSN: 1092-406X Treatment of Piriformis Syndrome with Botox
Ref3: Botulinum Toxin in Pain Management(www.emedicine.com)
Last Updated: September 1, 2004
Side effects

Since the mechanism of action of BTX-A is so specific, side effects are
uncommon and systemic effects rare. Flulike syndrome has been reported, but it
is generally short-lived. Other side effects have been reported, but they are
not necessarily a result of BTX-A treatment. They include muscle soreness,
headaches, light-headedness, fever, chills, hypertension, weakness, diarrhea,
and abdominal pain.

Muscular weakness, the predominant and desirable effect of botulinum toxin
injection, also may be considered an undesirable side effect when weakness
occurs in an unintended area or when weakness is greater than intended.
Clinicians must understand the functional consequences of unintended weakness
caused by botulinum toxin injection. While overweakening the muscles that curl
the toes may have few, if any, undesirable consequences, spread of toxin into
the muscles that control swallowing, which can occur when injecting muscles near
the larynx (eg, proximal part of the sternocleidomastoid muscle), may result in
difficulty swallowing. Patients, therefore, should be informed of the potential
for either too much weakness in the area injected or weakness in nearby muscles.








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