Piriformis Syndrome: A pain in the butt…and leg

Sciatica is term to describe pain that can include any part of your lower extremity from your buttocks all the way down to your toes. It occurs when your sciatic nerve, a very large bundle of nerve fibers that begins in your lower back and travel downward to provide nerve information to your legs and feet.

“Sciatica” is a general or descriptive term and not a specific medical condition, because it can be caused by many primary conditions. In other words, if you have sciatica it is purely a symptom of an underlying condition.

The most common causes of sciatica are:
· Disc bulge or herniation
· Disc degeneration
· Subluxation or misalignment of spinal bones
· Spasm of the Piriformis muscle in the buttocks
· Tumor of the lower spine

Much is written about disc disease, bulges and herniations. Subluxations are also referenced a lot particularly by Doctors of Chiropractic. Tumors are relatively rare. Piriformis muscle spasm is getting more and more attention and in fact is becoming so “popular,” I am beginning to see it becoming “over diagnosed” by many general practitioners of all persuasions.

Therefore, this article will briefly explain what Piriformis syndrome is, how to tell if you actually have it and what can be done about it.

To understand Piriformis syndrome you just first be familiar with two important anatomic structures: The Piriformis muscle and the sciatic nerve.

The Piriformis muscle is located underneath your gluteus maximus muscle. It attaches to the side of the sacrum or tailbone and inserts into the top of the femur or hipbone. It’s purpose or action is to rotate your leg outward. The Piriformis muscles shape varies from person to person.

The largest nerve in the body is the sciatica nerve, which is a bundle of nerves that arises from he spinal cord at about the L4, L5, S1, S2, S3 and S4 levels. I say about because this nerve varies from person to person. Some people have branches that being as high as L2 or L3. Skin sensation and muscle strength of the thigh, lower leg and foot are supplied by the sciatic nerve.

In many people the sciatic nerve passes under the Piriformis muscle and then branches off into two parts to supply different parts of the leg. In others, the nerve may branch before the Piriformis muscle and overlap parts of it and still another variation is where the Piriformis muscle is split in two parts with the sciatic nerve passing between the muscle branches.

In Piriformis syndrome the muscle contracts and thickens due to spasm in response to a strain, injury or chronic postural stress. When it thickens it squeezes the sciatic nerve causing the characteristic pain from the buttocks to the thigh or lower leg.

How to tell if you have Piriformis syndrome:
This is a simple 5-second test that will tell you if your sciatica is caused by your Piriformis muscle. Locate the area of your Piriformis muscle by finding the part of your hip bone on the side of your leg that sticks out. Slide your fingers backwards towards your buttocks 3-4 inches. You should be over the Piriformis. Put firm deep pressure with a thumb or fingers into the buttocks over the Piriformis area. If you have pain only where your fingers are pressing, you have an inflamed Piriformis, but not Piriformis syndrome. Your sciatica is probably caused by one of the other causes mentioned earlier.

If on the other hand, you have localized pain and also experience numbness, tingling and/or pain radiating down your leg, it is likely you have Piriformis syndrome as a cause of your sciatica.

What to do about Piriformis syndrome:
Successful treatment and a good recovery rate are often found with chiropractic manipulation of the sacrum and pelvis along with therapy modalities such as heat, stretching, deep massage, electrical stimulation, etc. The initial goals of treatment are to reduce inflammation around the nerve and reduce spasm of the muscle. Later, stretching and active exercises are employed to keep the muscle relaxed and elongated rather than bunched up.

Chronically recurring Piriformis syndrome may indicate you have a variation of the sciatic nerve and/or Piriformis muscle in which you are predisposed to this problem. Reportedly, 15% of the population has this variation. It may also indicate an underlying disc issue where the nerves are being slightly irritated by the disc bulge and then again by a tight Piriformis muscle. The resultant “double crush” of the nerve causes sciatic pain. Both the disc and the muscle must be treated for complete resolution.

Why the confusion over diagnosis?
Many cases of sciatica, no mater what the underlying cause, present with tightness and tenderness of the buttocks musculature. Often general practitioners, who do not spend the majority of their time focused on this one area of the body, misdiagnose Piriformis tightness and tenderness with the sciatica-causing syndrome. True Piriformis induced sciatica must reproduce leg pain on palpation of the muscle. If not, it is just a tight sore muscle.

For more information on sciatica and it’s many causes and for information on other low back pain related issues, visit http://www.cureforlowerbackpain.com.