Piriformis sciatica, or piriformis syndrome as it is often called, refers to nerve pain or a deep aching sensation in the buttock. This syndrome can be difficult to differentiate from other possible causes of sciatica pain, making it difficult to diagnose. Treatment for a pinched sciatica nerve can take time and complete relief is not guaranteed.
"treatment usually begins with"
Sciatica home treatment usually begins with gentle piriformis stretching while avoiding any activities that may strain the piriformis muscle. More general holistic pain management techniques such as, yoga and meditation, may also be useful.
Gluteal Strain And Sciatica Stretches
Understanding piriformis sciatica requires understanding the piriformis anatomy and its relationship to the sciatic nerve.
The sciatica nerve pain of piriformis syndrome may radiate down into the thigh and calf, or up into the low back. People often complain of a severe ache, similar to a toothache.
There may be associated numbness or tingling in the lower leg, foot, or toes. The problem is that there are many other possible causes of sciatica that can produce the same symptoms.
"similar to a toothache"
The exact cause of this sciatica pain is not always 100% clear. Some authorities believe that the pain is caused by the piriformis muscle putting pressure on the sciatic nerve.
While others contend that we don’t really know what is causing the symptoms. They believe that after you have excluded all of the other possible causes, you can conclude that piriformis sciatica or piriformis syndrome, is the diagnosis.
"is enough to exacerbate a flare-up"
Symptoms can develop in a variety of situations. Inadequate stretching and warming up prior to exercise, or advancing your exercise program too quickly, or beginning a new exercise program, have all been known to cause symptoms.
In some people, just vigorous walking or exercising on uneven ground is enough to exacerbate a flare-up of sciatica nerve pain.
"caused by irritation of the sciatic nerve"
Sciatica is pain caused by irritation of the sciatic nerve. The sciatic nerve is the largest nerve in the body, approximately the same diameter as your index finger. It is formed by several nerve roots after they exit the lumbar spine.
Image thanks to Anatomist90 via Wikimedia Commons
The nerve then exits the posterior pelvis and passes under the piriformis muscle, before proceeding along the posterior thigh. It has been reported that in 15% of the population, the sciatic nerve passes through the piriformis muscle, rather than passing under it.
"compromising the blood supply to the nerve"
Along its course, there are several locations where the sciatic nerve can be irritated, causing pain, numbness, and other problems. This irritation is usually caused by pressure from adjacent structures, compromising the blood supply to the nerve.
This can be caused by several different problems including a herniated lumbar disc causing herniated disc sciatica, spinal stenosis causing radiculopathy, or spondylolisthesis, to mention a few. The pain and other sensations may be felt anywhere from the buttock to the toes.
"increased stress on the piriformis"
The piriformis muscle is one of the many muscles on the hip and buttock; it assists in external rotation of the hip. Because it is rather small, compared to the other hip muscles, it is easily strained. Some theorize that this can occur when the large muscle groups, such as the gluteus and hamstrings, are weak and place increased stress on the piriformis.
Because the sciatic nerve passes under or through the piriformis, when the piriformis is tight or in spasm this places increased pressure on the nerve, resulting in sciatica nerve pain and other symptoms.
"there is no gold standard"
While conditions like pelvic stress fractures, bulging discs, and other musculoskeletal complaints may be diagnosed with imaging studies, there is no gold standard widely accepted study to objectively diagnose piriformis sciatica.
Imaging studies such as x-ray, magnetic resonance imaging, and computed tomography can be useful to rule out other possible causes of the pain. But, a diagnosis of piriformis sciatica often relies on the subjective experience of the examiner.