Sciatica / Piriformis Syndrome

The sciatic nerve is the largest nerve in the body – sometimes measuring three-quarters of an inch in diameter.  It is formed by the spinal nerves of L-4 through S-3.  The nerve passes between the ischial tuberosity and greater trochanter, and extends down the posterior thigh.  Distally, it branches into the tibial and peroneal nerves.  Because the sciatic nerve runs deep to the piriformis, there is considerable potential for the piriformis to compress or entrap the nerve.  In general, the sciatic nerve is difficult to isolate in the gluteal region.  

   

What is the difference between sciatica and piriformis syndrome?  Some individuals have stated that they are actually the same thing but the underlying causes of the two conditions are different.   Sciatica refers to irritation of the sciatic nerve that arises from nerve roots in the lumbar spine.  The most common cause of sciatic nerve irritation or “true” sciatica is compression of one or more of its component nerve roots due to disc herniation or spinal denegation in the lower lumbar region.  Sciatica usually begins in the buttock area and, depending on the severity of the underlying nerve compression and inflammation, may extend down the entire leg to the ankle and foot.  Piriformis syndrome becomes the go-to diagnosis when sciatica is present with no discernible spinal cause.   

Piriformis Syndrome is sometimes called false sciatica, because instead of actual nerve irritation, it is caused by referral pain.   These are tight knots of contraction in the piriformis muscle which attaches to the upper femur bone and then runs across the back of the pelvis to the outside edge of the sacrum.  The symptoms of piriformis syndrome are very similar and may be indistinguishable from true sciatica. 

In some cases, piriformis syndrome may cause true sciatic nerve irritation, as the sciatic nerve may run underneath or even through the middle of the piriformis, so contraction of the piriformis may produce sufficient compression of the sciatic nerve to produce actual nerve symptoms.  This is one of the main sources of confusion when it comes to distinguishing true sciatica from piriformis syndrome. So you see, it is difficult even for Doctors to come to a clean diagnosis on this since a lot of the symptoms are common to both conditions.

One of the fixes for this type of problem would be gentle foam rolling or ball release.  Depending on how deep you would need to go would determine which method to use.  In addition, employ dynamic rest.  Let pain be your guide and back off immediately if you do anything that hurts.  An anti-inflammatory like ibuprofen or naproxen can help with the swelling.  As pain allows, try to gradually open up your hips by stretching your hip flexors and rotators.  In addition, don’t forget your psoas muscle (front) and the quadratus lumborum (back).  You need space in both these areas in order to ward off the spasms that accompany this type of condition.  Accompany all of this with deep, rhythmic breathing to relax the body.