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Is it really sciatica, or could it be piriformis syndrome?

Everything you need to know about a little muscle buried deep in your buttock

When people feel nerve pain down their legs, they can often be quick to self-diagnose with sciatica - however, more often that not, the pain is actually caused by a much lesser known muscle called the piriformis. Diagnosing what's really causing the pain is important, so I thought I'd explain a bit more about this little-known muscle.

Where is the piriformis muscle?

The piriformis muscle is a small muscle located deep in the buttock (behind the gluteus Maximus). It starts at the lower spine and connects to the upper surface of each femur (thighbone). The muscle's function is the external rotation, abduction and extension of the hip joint, and it helps with general stabilisation of the hip (in simple terms, if you move your leg as if you were going to kick a football, the piriformis muscle is playing a role). The piriformis muscle runs diagonally, with the sciatic nerve running vertically directly beneath it, although in some cases the sciatic nerve can actually run through the muscle itself.

What is piriformis syndrome?

Piriformis syndrome is a condition in which the piriformis muscle spasms and causes pain in your buttocks and lower back. The piriformis muscle can also irritate the nearby sciatic nerve, which will cause pain, numbness and tingling along the back of the leg and into the foot. This is very similar in nature to the pain caused by sciatica, which is why it's easy to misdiagnose - but spotting the differences early on means choosing the right treatment, for faster and more effective results.

What causes it?

The exact causes of piriformis syndrome are unknown, and have been known to vary widely. Suspected causes include:

  • Pregnancy - in particular from changing postural and movement patterns
  • Hyper-mobility due to overstretched ligaments
  • Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip
  • Tightening, swelling or bleeding of the muscle, in response to injury or spasm.

This trauma could even be caused by something as simple as keeping your wallet in your back pocket and sitting on it all-day, every-day!

How do you treat it?

Piriformis syndrome can often be eased with manual therapies such as massage and acupuncture. A typical session for piriformis syndrome would consist of both superficial and deep massage focusing on the glutes and piriformis muscles. I would also include some stretching and muscle energy techniques to relax the muscle and make sure it eases up.

Your legs can become quite tight due to overcompensating for the movements that can be brought on by discomfort. For that reason, I tend to finish off with some work on your upper and lower legs. I don’t tend to use needles during a first session, but they may be used on follow up appointments if you are comfortable with them.

I have had great success in easing sciatic pain (brought on by this syndrome) in my clients. It is one of the most satisfying conditions I help people with, as I understand from personal experience just how much the pain can affect day-to-day life. If you are able to receive massage and have no contraindications preventing treatment, I would greatly recommend trying this therapy if you yourself suffer with sciatic pain.

I hope you found this useful - as ever, feel free to contact me if you've any questions, or to discuss your specific case in more detail. Thanks! Jo 😃

PS - I'll be back in a couple of weeks with my next blog, where I'll be demystifying needles! I'll explain how dry needling (acupuncture) works, what electro-acupuncture involves and whether it's like little electric shocks... and how neither are painful, even if you're not a fan of needles!

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