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Sciatica or Piriformis syndrome?

If you have ever experienced pain, tingling, and/or numbness along your sciatic nerve, then you’ve likely heard the terms sciatica and piriformis syndrome. These two terms can sometimes be used interchangeably, but are piriformis syndrome and sciatica the same thing?


First, let's take a quick look at the definition of sciatica.

Sciatica is not a medical diagnosis, but rather refers to general pain, tingling, and/or numbness felt along your sciatic nerve. The technical term for sciatica is lumbar radiculopathy, which helps us understand that sciatica symptoms are caused by a problem in your lumbar spine (lower back).


In contrast, piriformis syndrome refers only to when your piriformis muscle irritates your sciatic nerve. Additionally, your piriformis muscle is not located in your lumbar spine, but rather in your buttock. Therefore, piriformis syndrome is not the same thing as sciatica (lumbar radiculopathy).


Because of this, your treatment plan needs to address the cause of whatever is irritating or compressing your sciatic nerve (or nerve roots).


**So, your treatment plan for your piriformis syndrome may differ significantly from a treatment plan for someone suffering from sciatica from a lumbar spine problem (like a lumbar herniated disc). Moreover, you may actually make your symptoms worse if you perform a stretch intended for piriformis syndrome if you have a lumbar herniated disc. Therefore, it is essential to have the underlying cause of the pain, tingling, and/or numbness along your sciatic nerve properly diagnosed.**


The sciatic nerve


The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm of the piriformis muscle.


credits to NFPT.com

Piriformis syndrome


Piriformis syndrome is an uncommon disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body (causes turn out!). This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs -- in short, in almost every motion of the hips and legs.


photo credits to www.lukenorland.co.uk

Piriformis Syndrome Signs and Symptoms.

Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, which can happen while sitting in a car seat or running. Pain may also be triggered while climbing stairs, applying pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica are not due to piriformis syndrome.


Piriformis Syndrome Diagnosis

There is no definitive test for piriformis syndrome. In many cases, there is a history of trauma to the area, repetitive, vigorous activity such as long-distance running, or prolonged sitting. Diagnosis of piriformis syndrome is made by the patient’s report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In some cases, a contracted or tender piriformis muscle can be found on physical exam. Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.


Treatment

If pain is caused by sitting or certain activities, try to avoid positions that trigger pain. Rest, ice, and heat may help relieve symptoms. A doctor or physical therapist can suggest a program of exercises and stretches to help reduce sciatic nerve compression, pilates is a great option to build strength and stretch muscles. The osteopathic manipulative treatment has been used to help relieve pain and increase range of motion.

Some health care providers may recommend anti-inflammatory medications, muscle relaxants, or injections with a corticosteroid or anesthetic. Other therapies such as iontophoresis, which uses a mild electric current, and injection with botulinum toxin (botox) have been tried by some doctors.


Surgery may be recommended as a last resort.


Prevention of Piriformis Syndrome

Since piriformis syndrome is usually caused by sports or movement that repeatedly stresses the piriformis muscle, such as running or lunging, prevention is often related to good form if you’re thinking this is the case for you, it’s worth having your gait analyzed by your team, coach, physio, instructor or an orthoped. Avoid running or exercising on hills or uneven surfaces. Warm-up properly before activity and increase the intensity gradually. Use good posture while running, walking, or exercising. If pain occurs, stop the activity and rest until the pain subsides. See a health care provider as needed.



Sciatica


Sciatica usually starts with a herniated disk in your lumbar (lower) spine. Your vertebrae (the bones that make up your spine) are separated and cushioned by flat, flexible, round disks of connective tissue. When a disk gets worn down -- either because of an injury or just years of use -- its soft center can begin to push out from the hard outer ring.

When a disk herniates, it might put pressure on the nerves around it and this can cause a lot of pain when that happens to be the sciatic nerve. Bone spurs and spinal stenosis (narrowing) can also put pressure on the sciatic nerve in the lower back. When that happens, it can cause a lot of problems all the way down the nerve.

The most distinctive sign of sciatica is pain that radiates from your lower back into the back or side or your legs. It can range from a mild ache to sharp, severe pain. You can also get numbness, tingling, and weakness in your leg or foot.


  • Age. Most people who get sciatica are between 30 and 50 years old.

  • Weight. Extra pounds can put pressure on your spine, which means people who are overweight and pregnant women have a greater chance of getting a herniated disk.

  • Diabetes can cause nerve damage.

  • Your job. Lots of heavy lifting -- or prolonged sitting -- can damage disks.


Treatment

Most people with sciatica get better in a few weeks without surgery. Over-the-counter pain relievers like ibuprofen (Advil) and naproxen sodium (Aleve) can help relieve pain, although they should be only a short-term solution.

Your doctor might also recommend putting cold packs on your lower back for a couple of days and then switching to hot packs for a few days after that. There are also lots of good stretches for lower-back and sciatic pain relief in both physiotherapy and Pilates.


Your first instinct might be to rest and take it easy when you have sciatica, but it’s actually more important to keep moving. If you sit still, the nerve will continue to be irritated in that spot. Staying in motion will reduce inflammation.


If home remedies don’t work, your doctor will probably prescribe a stronger medication, like anti-inflammatories or muscle relaxants. You might also try steroid injections, physical therapy, acupuncture, or chiropractic care.

If your pain lasts for more than 3 months, it might be time for surgery. See your doctor immediately if your sciatica causes severe pain and weakness, numbness, and loss of bladder or bowel function.


 

I hope this helps clear up some of your Sciatica and Piriformis syndrome questions

have a marvelous day.




Katya MacDonald.

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