Piriformis Syndrome or True Sciatica?

Sciatica seems to be the go-to diagnosis provided by a doctor, family member, friend or personal trainer, when someone complains of lower back, hip, or butt pain.  Once diagnosed by your doctor, you may be lucky enough to receive treatment by a Physical Therapist (if your insurance and busy lifestyle allow).  You should be aware of the possible sources of your pain, whether you receive professional attention for your condition or not. 

The sciatic nerve originates from Lumbar Spine, segment L4-5.  As the nerve exits the vertebral foramen, it may be compressed due to inflammation or irritation of the respective lumbar discs.  The bulging disc presses on the L4-5 nerve roots, which causes radiating symptoms down the back of the leg and into the calf, following the path shown in the picture.  Most frequently, the disc will bulge postero-lateral to the left or the right.  If it bulges to the left and presses on the nerve root, you will feel the symptoms down the back of the left leg.  If it bulges right, you will feel the pain in the right leg.  Although this is called Sciatica, it should be treated like any other bulging disc…initially with lumbar extension and neutral activities (avoiding trunk flexion) and trunk stabilization. 

Piriformis Syndrome is often misdiagnosed as Sciatica.  However, the source of the symptoms is not a bulging disc, but is more peripheral at the Piriformis Muscle. 

                     

Due to increased activity level, such as running, the Piriformis Muscle, located at the posterior hip, tightens and compresses the sciatic nerve which runs between the two portions of the muscle.  This causes pain which is mostly felt in the hip/butt region, occasionally travelling down the leg as in Sciatica.  All the lumbar extension activities in the world will do little to reduce the pain.  While sciatica symptoms worsen upon trunk flexion, Piriformis Syndrome symptoms are less affected by this movement.  Acting as a hip abductor and external rotator, a beneficial treatment for Piriformis Syndrome is stretching.  Rest by backing off the causative activity is also a good idea initially.   Besides stretching the piriformis muscle, trigger point work and deep massage may also be helpful.  Below are three progressive levels of self-administering soft tissue mobilization to the Piriformis.

   

    

      

Place a tennis ball at the tender area of your butt where your piriformis muscle is (upper lateral quadrant of your glute).  The least aggressive is lying flat on your back with the ball placed at the muscle.  Place your weight on the ball and either remain still, or gently rock your hips left and right, rolling the muscle over the ball.  Progress to bending the knee on the affected side and slightly dropping the knee towards the other leg (intermal rotation).  This may expose the piriformis more to the surface.  Lastly, progress by bending the unaffected knee, crossing the affected leg’s ankle over the unaffected side’s knee and sitting on the ball.  This applies more body weight to the ball, creating deeper pressure to the muscle.  The figure four position also stretches the Piriformis while it is being massaged.   This is aggressive and not the most pleasant sensations, so go easy.

Click HERE for a video explaining a Piriformis Stretch from the Herniated Disc, Bulging Disc and Spinal Stenosis DVD at www.strengthondemand.com