Sciatic Nerve: Sciatica: Identify Pain: Spine: Shooting Pain
Piriformis Syndrome or "Sciatica"
The piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called "sciatica", often goes down the glutes, back of the thigh, and/or into the lower back. Clients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats. The piriformis muscle assists in abducting and laterally rotating the thigh. In other words, while balancing on the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling. This is the action of the right piriformis muscle.
Stretching the muscle often duplicates the pain, so take it easy. To do the piriformis stretch, sit tall in a chair without arms, cross your right leg, flexed at roughly 45 degrees, across your left leg (much like one would do when reading a newspaper) left leg being stationary in touch with the floor at 90 degrees. This adducts and flexes the hip. In this position, grasp just above the right ankle with the left hand, and rotate the ankle outwards. Simply lean forward with ease. This applies internal rotation to the hip and completes the stretch.
Anatomically, the piriformis muscle lies deep to the gluteal muscles. It originates from the sacral spine and attaches to the greater trochanter of the femur, which is the rounded portion of bone on the outside top of the thigh. The sciatic nerve usually passes underneath the piriformis muscle, but in a small percentage of the general population, it travels through the muscle. It is thought that acute or chronic injury causes swelling of the muscle and irritates the sciatic nerve, resulting in sciatica. Clients with an abnormal course of the nerve through the muscle are particularly predisposed to this condition.
The piriformis syndrome is diagnosed primarily on the basis of symptoms and on the physical exam. There are no tests that accurately confirm the diagnosis, but X-rays, MRI, and nerve conduction tests may be necessary to exclude other diseases. Some of the other causes of sciatica include disease in the lumbar spine (e.g. disc herniation), chronic hamstring tendinitis, and fibrous adhesions of other muscles around the sciatic nerve. Please see your doctor for the most responsible diagnosis and treatment available.
Once properly diagnosed, treatment is undertaken in a stepwise approach. Initially, progressive piriformis stretching is employed, starting with 5 seconds of sustained stretch and gradually working up to 60 seconds. This is repeated several times throughout the day. It is important that any abnormal biomechanical problems, such as overpronation of the foot or other coexisting conditions, are treated. This stretching can be combined with physical therapy modalities such as ultrasound. If these fail, then injections of a corticosteroid into the piriformis muscle may be tried. Finally, surgical exploration may be undertaken as a last resort. Again, your doctor will set the best course for treatment or management of your specific condition.