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Viewer Question:

“My physician told me my sciatica was caused by something called piriformis syndrome. I googled it and found a lot of different explanations about what this is, and why it’s causing me pain. Could you help me to understand this a little better? Is there anything I can do about it?”   -Samantha

Well, we should probably start out with some basic anatomy and define a couple of terms…

The piriformis muscle is a short, thick muscle which runs between the sacrum (the broad flat bone at the base of your spine) and the top of the femur. This muscle stabilizes the hip and participates in rotating your hip outward when contracted.

Sciatica is a broad term for pain caused by irritation of the sciatic nerve-associated with the L5-S1 nerve root. While the cause of pain is sometimes easy to identify, pain from this nerve can have several origins, and sometimes diagnostic testing may be required to identify the specific cause of an individuals discomfort.

In most individuals, the piriformis passes over the sciatic nerve (the large nerve which runs down the back of your thigh, and causes sciatica when irritated.) In a small percentage of people, the sciatic nerve actually passes through the piriformis muscle. The space through which the sciatic nerve passes underneath the piriformis is quite small, and when the muscle becomes irritated or goes into spasm, it contracts- thickening it in its center, and constricting the space for the sciatic nerve. This reduction in space often results in irritation to the nerve, causing radiating pain down the leg. This situation is worse for individuals who’s nerve pass through the muscle itself.

Now, in my clinical experience, the longer this irritation is going on- the harder it is to treat. So if this is a new thing for you, get aggressive about taking care of it.

Now- what to do…

First things first- your doctor may have already put you on an anti-inflammatory medication such as ibuprofen. Sometimes this is a good start, as it will reduce the discomfort sufficiently to allow you to adequately stretch the muscle, and for you to have a partner apply a hands-on release of this muscle. Keep in mind, that while the medicine may help reduce your pain, it is only a transient reduction and unless you relieve the underlying cause, your pain will return. I am all about the short term use of medications whenever they are needed.

There is a simple self-stretch which you can do to help elongate and relax the muscle. If, for example, you are trying to release your left piriformis muscle- stand on the floor facing a standard height chair. Place your left foot flat on the seating surface of the chair. While leaning forward towards the chair, use your right hand to pull your left knee to the right. Gradually increase the pull while leaning forward a little farther. Apply steady pressure forward and upon your knee. Do not ‘bounce’ while stretching, as this is one area in particular which can be worsened by ‘ballistic’ type stretching.

One really effective approach for mild to moderate cases it to (carefully) cut a tennis ball in half , and to place one half flat-side-down on a chair, and to sit with the ball right in the ‘meatiest’ portion of the buttocks. This actually applies pressure directly to the center of the piriformis, and can help it to release and come out of spasm.

There are many hands-on techniques which partners can do on each other to help release the piriformis muscle- a couple of which I outline in my book and DVD, but are a little too involved to address here, as there are many techniques leading up to them.

In extreme cases of  piriformis syndrome, the area is so painful and tender, that that it is almost impossible to stretch or apply hands-on techniques. In these cases, more aggressive medical intervention can be required- either in the form of oral medications such as prednisone to help reduce inflammation or injections- either into trigger points in the muscle itself or via an epidural to reduce pain & inflammation along the nerve pathways.

Some people worry that the more aggressive medications are still just a temporary fix. The truth is, these medications can sometimes reduce the pain sufficiently to allow pain-free movement for a while, and help to restore normal body mechanics. This alone can go a long way towards getting rid of the underlying issue. While the pain is reduced, patients can the introduce the more conservative treatment approaches.

Samantha- I hope this helps to clarify things a bit. Thanks so much for your question- please keep me posted on your recovery.

The response to the Pregnancy & Back Pain posts have been great- look for Part 3 next week.

Thank you again for your comments and questions. As always, be well.

-Andy

How nice- to be able to take a nap pretty much anywhere…