Piriformis Syndrome, Sciatica or Both?

by Celeste Cooper, RN Health Professional

Pain in the body can be sudden and sharp or constant and dull. When pain turns chronic, you’re not sure if you should worry and go to the doctor or go out and get yourself a massage. Sciatica is a type of chronic pain which is characterized by pain, weakness, numbness, or tingling in the leg. The cause of sciatica is often due to an injury or compression of the sciatic nerve. It serves as a symptom of another medical problem and is not a condition on its own so knowing the cause of sciatica is paramount for the right treatment. Pain arising from an inflamed sciatic nerve can occur from low back disease, pelvic injury, lesions pressing on the nerve, piriformis syndrome, or the presence of myofascial trigger points.

What is the sciatic nerve?

The sciatic nerve is the longest and widest nerve in the body and functions as a sensory and motor nerve, meaning it is involved with sensation, strength, and reflex. It relays messages from the lumbar spine (low back), through the pelvis, and down the legs where it branches at the knee to serve the muscles of the lower legs, ankles, and feet.

Low back pain, pelvic problems and the sciatic nerve

When there is a problem in the low back, such as arthritis, degenerative disc disease, spinal nerve impingement, or entrapment of the nerve from any source, it can affect the sciatic nerve. This is because the sciatic nerve is made up of a bundle of nerves, called plexus, involving lower lumbar nerves and nerves of the sacrum, and passes through the buttocks and down the legs. Problems with the lower spine or the sacral plexus can affect the pelvis, genitals, buttocks, and parts of the legs and feet. Treatment of sciatica is to relieve impingement in nerves that affect the sciatic nerve and decrease inflammation that causes pain.

What is piriformis syndrome?

The piriformis is a deep muscle in the buttocks, and when it is dysfunctional, it causes pain. It extends from the side of the tailbone to the top of the thighbone at the hip joint. This tiny, but mighty muscle also passes over the sciatic nerve, and therefore if myofascial trigger points (TrPs) are present, the muscle is shortened, becomes tense, and interferes with movement. It then compresses and irritates the sciatic nerve, causing inflammation, pain and other symptoms.

Unlike most TrPs, those in the piriformis cannot be felt because the muscle is buried under other larger muscles. Therefore, TrP location is dependent on the symptom referral pattern for that TrP. Referred pain can be felt in the sacrum, buttocks, and hip. A tight piriformis muscle can also put pressure on the pudendal nerve, causing pain in the groin, genitals, or rectum, contributing to chronic pelvic pain too. In severe cases, piriformis syndrome, like sciatica from other sources, can cause wasting (atrophy) of muscles in the buttocks. Dysfunction of the piriformis muscle can cause altered gait, guarding, and foot problems. When this happens, secondary TrPs develop in other muscles to compensate for piriformis muscle dysfunction.

Treatment for piriformis syndrome differs from treatment for sciatica, unless it is the cause of sciatic nerve pain. Treatment calls for releasing the knotted pieces of muscle fiber (TrPs). Because the muscle is deep, the safest method is to use manual therapy, such as a tennis ball. Put the ball in a tube sock and sit on it. Roll it around until you find the point of maximum pain or radiating symptoms. Apply pressure at 70-80% for 1-2 minutes. Sit on a couch or soft chair to prevent soft tissue trauma and to allow healing blood flow. Do this several times a day. Once TrPs are released, you can strengthen the muscle. But take care because until the piriformis returns to its normal resting state, strengthening can cause further weakness and more pain. And, always remember if this is chronic, chances are the compensatory muscles also have TrPs that need attention. Though rare, tumors in or around the piriformis muscle can also cause piriformis syndrome, as can scar tissue from trauma. Either may require surgical intervention.

If you benefited from this information or have questions, please leave them in the comments below. I love learning from you. In healing, Celeste

Celeste Cooper, RN
Meet Our Writer
Celeste Cooper, RN

Celeste Cooper, R.N., is a freelance writer focusing on chronic pain and fibromyalgia. She is lead author of Integrative therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and the Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain book series. She enjoys her family, writing and advocating, photography, and nature. Connect with Celeste through Twitter @PainedInkSlayer.