Many people have come away from their GP’s surgery diagnosed with “Sciatica”, with a shopping bag full of pills to help – but is it always true sciatica? I would say more often than not, it isn’t…
Piriformis syndrome (PFS) is a pain and discomfort condition much like sciatica. PFS is where a tight and/or inflamed piriformis muscle compresses the sciatic nerve, the largest nerve in the body. The syndrome can be very persistent and painful. Located deep within the gluteal (buttock) muscles, the piriformis can be extremely misbehaving, causing great discomfort and pain. The sciatic nerve passes directly under the piriformis muscle in most people, however it is thought that in nearly 20% of the population it passes through the piriformis. Tension in the soft tissue of the piriformis, glutes and other related muscles is usually the cause behind the pain. This tension may be caused by incorrect posture, sport activity, or improper exercise, however there are many causes of this problem, which can be from the foot up (foot bio-mechanics) or more localized to the hip itself. People who are overweight, or who spend much of their time sitting (at a desk for example) and then are active on the weekends might be prone to the condition, and it is claimed that people that keep a wallet in their back pocket and sit on it throughout the day are highly susceptible.
Symptoms of PFS include pain, tingling and a numb sensation in your buttock region. You may feel ache in the mid butt area that radiates down the whole of the back of your legs – but more often just one leg.
Treatment; Therapy for piriformis syndrome often begins with loosening of specific, deep and (unfortunately!) uncomfortable muscle. Stretching exercises that are simple to do at home or the office and require no equipment are usually encouraged. If the muscle pain is causing altered walking/running gait, we need to slow down and start rehabilitation before causing additional injury – this might include work to stretch the muscles in the glutes and hips to help relieve the spasm and inflammation. We may also need glute strengthening and to try to maintain or increase flexibility in the hip joints, including the iliopsoas, iliotibial band (ITB) and Tensor Fascia Latae (TFL).
Self Help; Patients may also find relief from ice and heat. Ice can be helpful when the pain starts, or immediately after an activity that causes pain. If pain is persistent during stretching then try using some heat beforehand, as this may be beneficial. The heat also attracts blood to the area which may enhance healing.
Sciatica, or True sciatica, is caused by pressure on the sciatic nerve at the nerve root. The most common cause of pressure is a bulging or herniated disc which compresses the nerve near the lower spine. It is this nerve compression which differentiates it from Piriformis Syndrome, which would be considered a nerve entrapment. If it is suspected that a disc is bulging or herniated, then an MRI is usually needed, but in a high percentage of cases, pain consistent with sciatic symptoms aren’t caused by true sciatica but by chronically tight muscles, such as in PFS, or Trigger Points (a trigger point is an area in a muscle that refers sensation to another part of the body).
Symptoms are very similar to PFS; pain, aching, burning, tingling, numbness, or weakness anywhere along the path of the sciatic nerve. This could be anywhere from the lumbar spine through the buttocks, down the back of the thigh, into two branches in the lower leg. Symptoms may occur anywhere along the nerve, from the lower back as far down as the foot. Finding a comfortable position to sit, stand, lie down can be problematic.
Treatment: It’s important to make the distinction between true sciatica and pain that’s mimicking sciatic symptoms because otherwise we miss the most frequent cause of pain: our muscles. Muscles receive little attention in modern medical school teaching; certainly the most common “treatment” i see nowadays for Sciatic symptoms are Naproxen (anti-inflammatory) and Co-codemol (pain relief). If this does take away the pain, where do we go from there, if structually nothing has changed? Well, we sit and wait til it comes back…..
Spinal manipulation can be very useful in helping to achieve proper structural alignment, however this is greatly enhanced by thorough soft tissue treatment, and on-going exercise therapy. This isn’t necessarily the same as a nice relaxing Swedish style massage before the adjustment. It is very detailed muscular and fascial release work which will not only enable much less force to be needed for the adjustment, but will also make the adjustment last much longer.
Hopefully this is useful; if you are suffering from any of the above symptoms, or know someone that is, please contact me at Dan@DC-InjuryClinic.co.uk.
For more information please visit www.dc-injuryclinic.co.uk