Sciatica or a Pain in the Piriformis?
What is sciatica?
Sciatica is often defined as: “a term used to describe nerve pain in the leg that is caused by irritation and/or compression of the sciatic nerve”. The compression or irritation can be caused by several factors and is likely to result in inflammation, pain and possible numbness which, has a direct impact on your mobility and feeling in your leg.
Where is my Sciatic Nerve?
The Sciatic Nerve originates in the lower back, radiates deep into the buttock and travels down the leg. It is your body’s longest nerve as well as being one of the most important. There is a diagram at the end which shows you more clearly.
Sciatica can manifest itself from a mild ache to a sharp or excruciating pain, with some people explaining it feels like a jolt or an electric shock. Usually, it only occurs down one side and it can radiate from your lower back (lumbar area) to your buttock and then extend down the back of the thigh and calf. A strong feeling of discomfort can be felt almost anywhere along the nerve pathway and make doing simplest of functions such as washing, dressing, and bending from the lower back difficult as well as compromising actions such as walking. Other symptoms which may present include:
Numbness, burning, or weakness in your legs or feet along your sciatic nerve pathway, which may create a loss of feeling or movement in severe cases – at this point please got to A&E!
Sensation of pins and needles in your toes or feet
A tightness type pulling pain down the back of the leg as well as intense pain shooting down the leg in short bursts.
Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae. The most common ways to cause these injuries is by lifting, working in prolonged flexed position, poor posture or extended sitting times. Rarely, the nerve is compressed by a tumor or damaged by a disease such as diabetes and as a safety note – if you have back and leg pain accompanied by bladder or bowel dysfunction, numbness in your genitals or a total loss of the ability move your foot – you must proceed to A&E. These symptoms happen to very small percentage of people with disc issues, but it is important to make you aware not scare you!
What is Piriformis Syndrome?
Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, shortens, tightens and in some cases, spasms resulting in pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain). It is important to note that this only in severe cases – which is where the similarities lie with sciatica, however, this is not true sciatica. The cause of the pain is the piriformis muscle being compressed with primary symptoms of localised buttock pain which in turn puts strain on the sciatic nerve causing secondary symptoms.
Where is my Piriformis muscle?
The piriformis muscle is a small muscle located deep in the buttock - behind the gluteus maximus connecting to the upper surface of the femur. Its main function is to assist in hip rotation and turning the leg and foot outward. The diagram below indicates it more specifically.
In the majority of circumstances piriformis syndrome is commonly reported from sporting activities such as running, hill walking, horse riding and forms of gym-based exercise – typically it may be due to poor technique, imbalances within local muscle groups or a sudden change in the amount of exercise that is being undertaken. Another common cause is compression which is due to sitting on hard seating or in a poor position. However, it is also believed that piriformis syndrome can be because of other structures such as the sacroiliac joint or hip being irritated.
Most commonly, patients describe acute tenderness in the buttock at the location of the muscle, which can extend into the larger buttock area and tends to get worse after prolonged sitting, walking, or running. The patient may feel some relief for lying down on their back and by doing some stretches. Other symptoms may include:
A dull ache in the buttock
Pain down the back of the thigh, calf, and foot (sciatica)
Pain when walking upstairs or inclines
Reduced range of motion of the hip joint
You’re in pain and you think it is either sciatica or piriformis syndrome, what do you do?
Book in to see a healthcare professional or injury specialist. Do not rely on Dr Google! Each injury and person are different and gaining the best diagnosis will then give you the best treatment plan.
Will the treatment hurt and what will you do?
Treating sciatica and piriformis syndrome do not differ too much, in that the emphasis will be placed on soft tissue techniques and massage to the affected areas to help reduce tightness and tension. Regarding pain, every person has a different threshold and as a therapist it is important to work within that threshold, we are not here to hurt you!
How long until I get better?
The question everyone would love to know the definitive answer to. As mentioned previously every person and every injury is different and everyone’s healing time differs. However, as a norm and from a very generic perspective you would be looking at getting and feeling better between 4- 6 weeks.
The main difference between piriformis syndrome and sciatica is that piriformis syndrome is mostly buttock pain and in worse cases some leg pain. Sciatica is typified with lower back pain, buttock pain and leg pain which follows the nerve path down the back of the leg. piriformis syndrome is often mistaken for sciatica. While both conditions interfere with sciatic nerve function, sciatica results from spinal dysfunction such as a herniated disc or spinal stenosis. Piriformis syndrome, on the other hand, occurs when the piriformis muscle, located deep in the buttock, compresses and can affect the sciatic nerve.
Prevention is key in stopping the injury getting worse or even happening in the first place. Both problems come with a careful approach to exercise, new activities, and postural positions. With the key areas to strengthen being the lower back and glute muscles to make your body more robust. This can also be helped by stretching with the exercises below giving you a helping hand.
If you are struggling with Sciatica or Piriformis Syndrome and would like to have a chat or book an appointment, please click the CONTACT SAM link below. But in the meantime have a go at these stretches.
Here are a selection of simple exercises that you can try to start managing your symptoms of sciatica and piriformis syndrome.
Knee Hugs – lie on your back and gentle hug either one or both of your knees towards your chest – go as far as your symptoms allow – the goal will be to gain full range of movement. This exercise helps you to maintain the lower backs range of movement in bending / flexion.
Lumbar Twists – In a crook lying position, keep your knees together, take your knees to each side as far as they will go. This rotates the lower back, mobilising the facet joints of the back and loosening the lower back muscles.
Pigeon Stretch – Using the arm of the sofa or a bed, bend you knee and bring it up onto the bed or arm of the sofa. Make sure the leg is bent at the knee (so it looks like half of a cross legged position). Keeping your standing leg straight slowly lower your chest towards the sofa or the bed. Go to the point you feel a stretch but do not go to the point of pain. Hold this position for 20 seconds and take a deep breath in and as you exhale lower yourself further, again holding for 20 seconds, repeat again for a 3 stretch but hold for 30 seconds. Slowly then stand up and put your leg back down. Remember to stay within your pain threshold.
Seated Sciatic Nerve Glider – in a chair, sit up with good posture into extension. With the affected leg, pull your toes towards you and gently straighten the leg and then bend it again. This must be performed slowly and should look like you are performing a slow kick with your toes pointed up. Do not kick fast as this can aggravate the nerve and make things worse. Aim to perform this exercise until the leg becomes a bit achy then rest. This exercise can be performed throughout the day when needed.
Piriformis Stretch – relaxing the piriformis can help to reduce pressure on the sciatic nerve which can add to your leg pain. Lie on your back and pull your knee in to your chest on the side that is affected and point it diagonally over your opposite shoulder and hold for 20-30 seconds. This will target the small glute muscle which can commonly be compressing the sciatic nerve. Repeat as many times as you need to.
Mobility Ball / Foam Roller – targeting any of the sore areas with mobility or roller tools is recommended. A foam roller to the back can ease tension, a mobility tool into the piriformis or sciatic nerve can help to alleviate pain levels. You will feel some discomfort in the tissue but after you finish it should feel like a relief from pain. These tools can help to relax the tight tissue such as the piriformis and reduce nerve pain
Do not partake if they cause pain and do not push your body further than your pain threshold as there is a chance that if you do you will cause yourself more damage. You should feel a stretching session but at no point should this be painful beyond reasonable means.