The sciatic nerve is the longest and widest nerve in the human body. They originate in the low back from 5 lumbar nerve roots and travel through the buttock and down the leg. Compression or irritation of this nerve is called sciatica and can cause symptoms such as pain within the sciatic nerve distribution.
In piriformis syndrome the piriformis muscle in the buttock is responsible for the pressure placed on sciatic nerve. In primary piriformis syndrome there is anatomical differences of the nerve or muscle that result in symptoms where in secondary piriformis syndrome tightness, swelling or trauma to the muscle and nerves is responsible for symptoms.
To diagnose piriformis syndrome, it is important other intervertebral disc and neurological problems are ruled out.
Avoid aggravating activities (e.g. extended running, walking, lunging etc.). This can give a strained or in spasm piriformis muscle the opportunity to repair and relax. This may in turn decrease 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 injuring the buttock region may be useful. This can reduce inflammation and therefore 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 yield some positive results in regards to symptoms reduction in piriformis syndrome. This aims to decrease tension in the buttock region (including the piriformis muscle) to decrease pressure placed on the sciatic nerve by muscular structures. Check out our video on how to stretch the region.
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.
Some sources even recommend the use of Transcutaneous Electrical Nerve Stimulation (TENS) in 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 of 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 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.
By Sydney CBD Osteopath Dr Abbey Davidson