“Piriformis syndrome” is caused by an entrapment (pinching) of the sciatic nerve as it exits the back of the pelvis, deep within the buttock. The sciatic nerve typically exits the back of the pelvis immediately below a muscle, called the piriformis muscle, deep within the buttock. In rare situations, the nerve actually passes right through the piriformis muscle. For various reasons, the piriformis muscle can go into spasm and entrap or pinch the sciatic nerve. This will result in pain along the back of the thigh and knee, with further pain and/or numbness extending as far down as the sole of the foot, called “sciatica”.
Piriformis syndrome can result in “sciatica”. These same sciatica symptoms feel very similar to that of a herniated disk. A herniated disk typically pinches directly on one of the five nerves that eventually make up the sciatic nerve. Because the resulting symptoms of both of these problems are very similar (pain, numbness and tingling below the knee and into the foot), it is not hard to misdiagnose what is actually going on if you don’t look for both potential causes.
Specific diagnostic tests performed by your chiropractor are what distinguish a herniated disk from piriformis syndrome. In simple terms, with piriformis syndrome your chiropractor will not find many positive test results that indicate that the lumbar spine is involved. More often, the acute pain or tenderness is localized to the buttock and hip, while the low back appears quite normal.
Many weekend athletes and people who spend long hours sitting are prone to this syndrome. The athlete’s cause is primarily due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture or tightening of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion.
Any treatment plan must include stretching of the gluteal or buttock muscles as well as stretching of the piriformis muscles. Your chiropractor or health care practitioner can help you by instructing you on the proper stretches to perform. Many Chiropractors may also perform some form of deep tissue massage to the piriformis muscle in the gluteal region in order to relax these muscles. A series of spinal and hip joint adjustments may also be required to relieve your symptoms.
If you are currently diagnosed with a disk herniation but are wondering if the symptoms you are experiencing may at least be partially from piriformis syndrome, call my office for an appointment to have it checked thoroughly. It is always a good idea to rule out other possible causes of your sciatica before simply having surgery.