A diagnosis of “sciatica” can be quite alarming. But the title is just part of the picture, your osteopath also wants to know what structures are causing the nerve irritation. One possible cause of sciatica is piriformis syndrome, where the piriformis muscle irritates or compresses the nerve as it passes through or near the buttock muscles.
What is Sciatica?
Sciatica is the collection of symptoms caused by irritation of the sciatic nerve. These typically include a sharp, shooting pain, pins and needles, numbness. Importantly, it’s only sciatica if it’s the sciatic nerve that’s involved. The image above shows its course from the lower back to the foot. So you can’t have sciatica in the front of your thigh, or your arm. You can have the same symptoms, but it gets a different name as a different nerve is involved.
What Is the Piriformis Muscle?
The piriformis is a small muscle deep within the buttock. It connects the sacrum to the upper part of the thigh bone and helps to rotate and stabilise the hip. The sciatic nerve normally passes underneath the piriformis, although for some people, part of the nerve passes through the muscle itself. This means that changes in the muscle can affect the nerve in those cases.
Tension in the piriformis can potentially irritate the sciatic nerve. This may produce pain in the buttock, sometimes extending down the back of the thigh or further into the leg.
Symptoms of Piriformis Syndrome
Beyond the symptoms of sciatica listed above, piriformis syndrome may also cause deep buttock pain, discomfort with prolonged sitting, and pain walking uphill or up stairs. Symptoms may be exacerbated by hip movements that involve the muscle.
Sitting can be particularly uncomfortable because the piriformis is compressed between the hip and the surface you are sitting on. Symptoms can vary a lot, but this irritation can exacerbate the leg symptoms, causing more shooting pains in the leg on sitting.
What Causes Piriformis Syndrome?
Often the cause is something subtle that develops gradually. Repetitive activities or a change in routine, like spending an unusually long time driving, could play a role. There isn’t always an obvious injury.
Runners, cyclists, and people whose sports require frequent changes of direction may be more susceptible. A sudden increase in training volume can also be enough to provoke symptoms. The piriformis may also become overworked if other muscles around the hip aren’t functioning efficiently. Weakness, restricted movement, or previous injury elsewhere in the lower limb can therefore contribute to the problem.
How Can Osteopathy Help?
Before starting treatment, Barnes will work to find out why the area is overloaded. He will assess the lower back, pelvis, hip, and lower limb along with the muscle itself. Sciatica symptoms can be investigated in clinic regardless of which structure might be causing them. With this information, Barnes can work on improving movement locally and beyond to reduce the demand placed on the piriformis and reduce pain. Where appropriate, you will be given exercises to strengthen or stretch relevant muscles.
If sport is contributing to the problem, completely stopping activity is rarely the answer. Adjusting training volume, intensity, technique, or recovery time may allow you to remain active while the area settles. Your osteopath can give you tailored advice specific to your presentation.
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