Sciatica is a partial diagnosis: it tells us that the sciatic nerve is irritated, but on its own it doesn’t tell us where the problem is. Piriformis syndrome is a form of sciatica, in which the nerve is irritated by the piriformis: a deep gluteal muscle.
Anatomy & Risk Factors
We’re all constructed slightly differently, and some people have a sciatic nerve that runs straight through their piriformis muscle. For others, the two might just run close to each other. If the muscle tenses up and causes symptoms in the sciatic nerve, it can become a vicious cycle: the symptoms cause the muscle to tense further to protect the area, and symptoms become worse.
Onset might follow new demands on the piriformis, such as starting a new exercise or increasing the frequency, intensity, or duration of an existing routine. Symptoms may not develop instantly, so be aware of any changes made in the week or so before their onset that could be relevant.
Sometimes these things start for no apparent reason, but we will still endeavour to work out the factors at play. Maybe there’s another area working in an unusual way that has had an impact on the way the hip moves. This in turn could cause the muscle to overwork and irritate the nerve.
Symptoms of Piriformis Syndrome
The symptoms are largely the same as sciatica caused by anything else:
pain (often shooting) from the buttock, down the back of the thigh and into the calf or shin.
pins and needles or tingling in the same area
weakness on some movements of the affected leg
In addition to these points, there may also be:
an increase in symptoms when taking the leg backwards, or turning it out
tenderness and reproduction of symptoms when applying pressure or stretch to the muscle
Take note of the things you can do that make your pains better or worse. Some people prefer a warm bath or a cool compress, and some cases get better with exercise and worse with rest, or vice versa. Keeping a pain diary can be useful if you struggle to draw these connections off the top off your head.
Managing Piriformis Syndrome
When nerves are irritated, it usually takes a while for them to settle down after the stimulus is removed. Therefore, giving a general prognosis can be difficult- but it may be easier to manage the root cause of piriformis syndrome than other causes of sciatica.
Treatment will likely involve massage and exercises to relax the gluteal muscles. It may also be appropriate to work on desensitising the nerve itself, especially if symptoms have been present for a while.
Exercises may initially focus on relaxing the muscle and getting the body used to moving properly again. Over time, and depending on the details of your case, they may be more focused on strengthening the glutes so that they no longer have to work so hard and become tense. If your onset was sport related, there may be additional advice we can give for adapting your form or other details of your training.
Make an appointment for your sciatica/piriformis syndrome here
