Sciatica or Piriformis Syndrome? Either way, it’s a pain in the butt…

What is sciatica?

A term commonly associated with pain, numbness, weakness and tingling in the regions of the buttocks, lower back and backs of the legs.

What causes sciatica?

Many causes are sited for sciatica, and with it there have been many definitions of this name. The debate to reach a single definition continues. The term ‘sciatica’ is defined by the UK’s National Health Service (NHS) as “any sort of pain caused by irritation or compression of the sciatic nerve”. The NHS mainly attribute sciatica to compression of the sciatic nerve from disc bulges/herniation, and structural damage or abnormalities in the region of the vertebrae.

What’s piriformis syndrome… and how can I get one?

‘Piriformis Syndrome’ is a hotly debated topic. I’m not ready to delve into the political minefield here (see the links below if you want to see for yourself), but I feel it really deserves a mention when the topic of sciatica arises. That’s because, after ruling out disc bulges and the other causes listed above, it is highly likely to be associated with symptoms of sciatic nerve compression. The piriformis is a small muscle located in the deep gluteal region (in the buttocks). It’s responsible for rotation of the hip and if overworked, or weak can become ‘upregulated’ (i.e.: go into spasm). This powerful little muscle can compress the sciatic nerve that passes underneath, over or through it (this varies from person to person) and causes sciatica symptoms in the lower back, gluteal region and legs. I often find this condition to be common in clients who spend a fair portion of their time in or moving through hip rotation, for example: those who drive long distance for their work, frequently climb in and out of cars, or have a desk-based job.

Assessing and treating piriformis syndrome

There are tests that can be performed in-clinic to rule out sciatic compression from the nerve root (i.e.: disc bulges, spinal stenosis, etc). Once these have been ruled out then deep tissue treatment can be applied to the piriformis muscle, such as trigger point therapy, can often result in immediate relief of symptoms! Self-applied trigger point therapy and muscle energy techniques can also be used to treat and regulate the piriformis and avoid sciatic nerve compression.

I am curious to know how you have dealt with piriformis syndrome – it is very common in my clinic. I often find that other clinicians prescribe stretches but from my experience I have found strengthening the gluteal muscles including piriformis is the most effective route. Have you ever been diagnosed with either sciatica or piriformis syndrome? What treatments were you offered, and were they effective?

Please feel welcome to comment below.

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