By Sydney CBD Osteopath Dr Abbey Davidson
The sciatic nerve is the longest and widest nerve in the human body. It originates in the low back from 5 lumbar nerve roots and travels through the buttock and down the leg. Compression or irritation of this nerve is known as Sciatica, and this compression can cause pain and other symptoms within the sciatic nerve distribution.
In piriformis syndrome, the piriformis muscle in the buttock is responsible for the pressure placed on sciatic nerve causing compression or irritation. There are two different types of piriformis syndrome: Primary, in which there is an anatomical difference in the nerves or muscle which causes the symptoms; and Secondary, in which the symptoms are caused by tightness, swelling or trauma to the muscles or nerves.
To diagnose piriformis syndrome, it is important other intervertebral disc and neurological problems are ruled out first.
What are the signs & symptoms of Piriformis Syndrome
You may be suffering from Piriformis Syndrome if you are experiencing the following symptoms:
- Low back or buttock pain
- Pain referring pain down posterior thigh, calf and/or foot (sciatica)
- Increased pain with prolonged sitting, walking or running
- Aggravation with rising from a seated to standing position
- Decreased hip range of motion
- Weakness in the effected leg
What can I do ‘right now’ to help with Piriformis Syndrome?
If you are experiencing the symptoms above, it is important to avoid aggravating activities (eg. extended running, walking, lunging etc.) so as to give the piriformis muscle the time to repair and relax. By doing this, you may be able to decrease the pressure on the sciatic nerve and reduce your symptoms.
If your symptoms have come on after trauma to the piriformis region, Ice application within 48 hours of the injury may be useful. This can reduce inflammation and therefore reduce pressure placed on the nerve. Heat pack application after 48 hours or in more chronic cases can promote blood flow and relaxation of the piriformis muscle which may help in reduction of your symptoms.
Stretching can also provide some positive results in regards to symptom reduction for piriformis syndrome. Stretching aims to decrease tension in the buttock region (including the piriformis muscle) to decrease pressure placed on the sciatic nerve by muscular structures. Some sources even recommend the use of Transcutaneous Electrical Nerve Stimulation (TENS) in Piriformis Syndrome. A health professional such as a physiotherapist, chiropractor or osteopath would be able to provide advice on both of these therapies.
You may also consider using a Magnesium supplement. Magnesium promotes muscle relaxation and repair which may be useful in those with chronically tight muscle and in particular piriformis muscles. Ask your pharmacist or health practitioner about how magnesium and other supplements may be useful in your case.
When should I see a health-professional for Piriformis Syndrome?
- Worsening nerve symptoms/pain
- Inability to participate in normal walking/running distances
- Inability to perform normal everyday activities
- Bowel bladder symptoms
What can your health professional do to help with Piriformis Syndrome?
Your health professional will question the history of your complaint to establish a timeline and rule out other possible conditions. Your diagnosis will be made using a combination of case history, orthopaedic assessment and neurological assessment.
In terms of treatment for sciatic pain, research shows similar outcomes long-term for both surgical and conservative treatments. We therefore advocate for the trial of conservative therapies such as osteopathy, remedial massage, chiropractic and physiotherapy before considering surgical options. In rare and more chronic cases, surgery may be required.
Hands on treatment is aimed at decreasing muscular tension, improving the sciatic nerve path and decreasing inflammation in the buttock region. This will be complemented with an at home stretching routine and lifestyle changes to decrease pressure applied on the effected nerve.
For more information on Piriformis Syndrome, check out the video below or click here
For more information on other conditions in the Lumbopelvic region, click on the following links below:
- Lumbopelvic Pain and Complaints
- Disc Lesions
- Canal Stenosis
- Sacroiliac Joint (SIJ) Sprain
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