Piriformis Syndrome, Sciatica or Both?

Piriformis Syndrome, Sciatica or Both?

Sciatica is a type of chronic pain which is characterized by pain, weakness, numbness, or tingling in the leg.

The cause of sciatica is often due to an injury or compression of the sciatic nerve.

It serves as a symptom of another medical problem and is not a condition on its own so knowing the cause of sciatica is paramount for the right treatment

Pain arising from an inflamed sciatic nerve can occur from low back disease, pelvic injury, lesions pressing on the nerve, piriformis syndrome, or the presence of myofascial trigger points.  

What is the sciatic nerve?

The sciatic nerve is the longest and widest nerve in the body and functions as a sensory and motor nerve, meaning it is involved with sensation, strength, and reflex.

It relays messages from the lumbar spine (low back), through the pelvis, and down the legs where it branches at the knee to serve the muscles of the lower legs, ankles, and feet.

Low back pain, pelvic problems and the sciatic nerve

When there is a problem in the low back, such as arthritis, degenerative disc disease, spinal nerve impingement, or entrapment of the nerve from any source, it can affect the sciatic nerve.

This is because the sciatic nerve is made up of a bundle of nerves, called plexus, involving lower lumbar nerves and nerves of the sacrum, and passes through the buttocks and down the legs.

Problems with the lower spine or the sacral plexus can affect the pelvis, genitals, buttocks, and parts of the legs and feet.

Treatment of sciatica is to relieve impingement in nerves that affect the sciatic nerve and decrease inflammation that causes pain.

I have to wonder how treatments focusing on the psychosocial aspects of pain (instead of the biological) will deal with such mechanically initiated pain.

What is piriformis syndrome?

The piriformis is a deep muscle in the buttocks, and when it is dysfunctional, it causes pain.  It extends from the side of the tailbone to the top of the thighbone at the hip joint.

This tiny, but mighty muscle also passes over the sciatic nerve, and therefore if myofascial trigger points (TrPs) are present, the muscle is shortened, becomes tense, and interferes with movement. It then compresses and irritates the sciatic nerve, causing inflammation, pain and other symptoms.

In severe cases, piriformis syndrome, like sciatica from other sources, can cause wasting (atrophy) of muscles in the buttocks.

I suffered from this and my neurologist pointed out that it was also causing atrophy of a muscle at the outside top of my foot.

Dysfunction of the piriformis muscle can cause altered gait, guarding, and foot problems. When this happens, secondary TrPs develop in other muscles to compensate for piriformis muscle dysfunction.

Treatment for piriformis syndrome differs from treatment for sciatica, unless it is the cause of sciatic nerve pain.

Treatment calls for releasing the knotted pieces of muscle fiber (TrPs).

Because the muscle is deep, the safest method is to use manual therapy, such as a tennis ball.

Put the ball in a tube sock and sit on it. Roll it around until you find the point of maximum pain or radiating symptoms. Apply pressure at 70-80% for 1-2 minutes

Sit on a couch or soft chair to prevent soft tissue trauma and to allow healing blood flow. Do this several times a day. Once TrPs are released, you can strengthen the muscle.  

Everything I did to the piriformis muscle using these techniques only aggravated the sciatic nerve and increased my pain even more, not just at the moment but also as a continuous higher pain level.

When there is a mechanical problem causing pressure on the nerve, it is only increased by these techniques. Perhaps such treatment would work better if the sciatic nerve isn’t growing *through* the piriformis muscle, as turned out to be in my case.

Sometimes it seems as though the recent unquestioning focus on the psychosocial aspects of pain (instead of the biological) would treat a broken bone as a  psychosocial problem and suggest mindfulness as a treatment.

Just to be clear, I’m in awe of the powers of the mind and how our thinking can affect so many aspects of our physical existence. My personal “goal” is to

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