A Pain In The Butt - Piriformis Syndrome

One of the most common complaints I hear from clients coming to see me is "My sciatica has flared up because I was....".  When symptoms travel down the legs from either the lower back or the pelvis, there may be a few things going on that are irritating the tissues.  Sciatica is something that a lot of people think that have, but can easily be misdiagnosed.  There are a few questions and assessments that I do to ensure that your massage is treating the source and not just the symptoms.

So what is the sciatica?

The sciatic nerve stems from the base of the spine and branches down to supply the rest of the leg and feet.  The term sciatica refers to irritation or inflammation of the sciatic nerve. When there is added pressure on this nerve, it can cause some discomfort down the leg - the most common being a "sharp/shooting" or "shock" sensation that travels down the entire leg into the foot.  It is predominately caused by an irritation in the soft tissues in the buttock region (such as increased tension or inflammation) that put pressure on the nerve.  But it can also be caused by conditions where the sciatic nerve pierces the gluteal muscles during development, meaning it is aggravated when the tissues are stretched or contracted.

Piriformis Syndrome can be a very similar.  The piriformis muscle is a small, triangular muscle that sits deep in the gluteal region.  The muscles helps with rotating the hip laterally to help turn the foot outward.  The sciatic nerve normally runs below it.  If the piriformis is tight or inflamed, it can put extra pressure on the sciatic nerve, which can cause some of the symptoms listed above. If the piriformis muscle has a trigger point (or a muscle knot), the pain referral pattern travels down the hip into the knee. 

A lot of clients believe that this pain is related to sciatica because it travels, but it may not be aggravating the nerve at all, it could be just the muscle irritation.

There are many ways to treat piriformis syndrome as well as sciatica.  With massage therapy, we first must determine where and more importantly why the structures are irritated.  With the new legislation, in order to do an assessment and/or treatment of the gluteal region, your therapist is now required to retrieve written consent from you prior to commenting.  For more information on this form, please check out my previous blog post here.  If there is inflammation present, we must deal with it first but applying some lymphatic drainage techniques to the area, and possibly applying cryotherapy.  When the muscles are tense, injured or have trigger points, the muscles can be manipulated through deeper massage techniques and stretching.  Hyperthermy can be applied as well.  Home care exercises are also given to help the tissues heal at home.  This could be something as simple as changing a position that you are in that is causing the irritation, simple stretches to loosen up the structures and strengthening exercises to build stability in the hips and lower back.  These are all given on a case-by-case basis as the cause for each case will be different.  

Overall, piriformis syndrome and sciatica can usually be treated without any medical intervention.  For more serious cases, medications/injections and surgery can be recommended to help, but as a Registered Massage Therapist, we would refer you to a doctor in those cases as it would be outside of our scope of practice.

If hope this helped you to clarify the difference between performs syndrome and sciatica!  If it ever happens to you, I hope you'll have a speedy recovery now that you know what you can do.

Thank you for stopping by and I hope you have a great day!

References:

Physio Works - Physiotherapy Brisbane. (n.d.). Retrieved June 7, 2019, from https://physioworks.com.au/injuries-conditions-1/piriformis-syndrome

Piriformis Trigger Point Diagram. (n.d.). Retrieved June 7, 2019, from http://www.triggerpoints.net/muscle/piriformis

Revord, J. P. (n.d.). What Is Piriformis Syndrome? Retrieved June 7, 2019, from https://www.spine-health.com/conditions/sciatica/what-piriformis-syndrome

Sciatica Pictures: Symptoms, Causes, and Treatments. (n.d.). Retrieved June 7, 2019, from https://www.webmd.com/back-pain/ss/slideshow-visual-guide-to-sciatica