Sciatica vs. Piriformis Syndrome
A catch-all term for pain starting in the buttock that travels to the leg is “sciatica.” Sciatica is caused by nerve irritation, either as it exits the spine or when traveling out in the periphery. When a nerve root is pinched within the spine, which typically occurs from a disc herniation, it is called “lumbar radiculopathy” and results in a "sciatic-type" presentation.
As you already know, nerves aren't always pinched when exiting the spine. They can also be compressed outside of the spine.
A collection of nerve roots exiting the spine coalesce to form the sciatic nerve. The sciatic nerve can be pinched by a tight piriformis muscle which also creates a "sciatica-type" presentation similar to that of lumbar radiculopathy, however, in this case it is called “Piriformis Syndrome.”
Essentially what you have is a similar presentation of pain in the buttock traveling into the leg, but with two possible pain-generators: 1) A nerve root that is pinched by a disc herniation vs 2) The sciatic nerve being pinched by a tight piriformis muscle.
It is important to understand this concept as their treatment options differ. Today, we will be focusing on treating Piriformis syndrome.
Piriformis Syndrome–A Pain in the Butt!
The piriformis muscle travels from the sacrum, the wedge-shaped bone at the bottom of your spine that serves as a connection point to your pelvis, to your femur, a bone that articulates with your pelvis to form your hip joint.
Unfortunately, individuals can develop a tight piriformis muscle which clamps down on the sciatic nerve. As you can imagine, nerves hate to be pinched. When this happens, you may experience pain in the buttock traveling along the back portion of your leg. You may also begin to experience, numbness, tingling, and sometimes weakness in the leg. In addition, you might have some tenderness in the buttock region and find it difficult to sit for long periods of time. Activities such as walking or running long distances can also aggravate this pain.
In some instances, the pain can significantly inhibit your day-to-day function stopping you from doing even menial tasks such as household chores or driving for any length of time.
How do you get Piriformis Syndrome?
There are a number of reasons why someone may develop piriformis syndrome.
1) Trauma: Such as slipping on ice and falling on your buttock, from a motor vehicle accident, heavy lifting, or secondary to a sports-related injury.
2) Overuse: Repetitive activities such as jogging, stair-climbing, or when seated for long periods of time at a desk job.
How is it diagnosed?
As with any medical problem, an accurate diagnosis is first made via a good history and physical performed by a medical professional. Tests like an MRI can help to rule out a disc herniation that could be causing lumbar radiculopathy. An EMG, a test which evaluates how well the nerves in your extremities are functioning, can also be considered.
Treatment
Before attempting any of the treatment options below, it’s imperative that you seek the advice of a medical professional so an accurate diagnosis can be made. Now let's look at some treatment options for piriformis syndrome:
1) Activity modification: Avoid activities that cause you to experience pain. This may mean holding off on running for a while and focusing on alternative forms of exercise that do not cause discomfort.
2) Ergonomic changes at work: Consider making changes to your work environment such as purchasing a standing desk or a balance ball chair. Set an alarm on your phone to remind you to stand up and walk around the office for 2-3 minutes every other hour.
3) Adhering to an anti-inflammatory diet:
Eat a diet consisting of anti-inflammatory type foods such as, berries, avocado, broccoli, peppers, and green tea. To learn more about naturally occurring anti-inflammatory agents supplied be Mother Nature, check out this prior post.
4) Non-steroidal anti-inflammatory (NSAID) medications: If approved by your doctor, consider starting an NSAID such as Ibuprofen or Naproxen. It’s important to note that Acetaminophen (which is not an NSAID and goes by the Trade Name, Tylenol) may help with pain, but does not have anti-inflammatory properties. You can also consider over-the-counter topical anti-inflammatory agents like Asperecreme.
5) Physical Therapy and Stretching: Stretches targeted at the piriformis muscle are nicely demonstrated in this video. [1] Yoga therapy can also prove beneficial and is a great way to get a good workout in if you are no longer able to run. Pigeon pose, in particular, is a great way to stretch the piriformis muscle. One can also consider purchasing a foam roller to help massage the gluteal area.
6) Acupuncture and Deep Tissue Massage: There are a few case studies published suggesting that acupuncture may be beneficial in treating piriformis syndrome. Though larger-scale, placebo-controlled trials are needed to further validate this claim, I believe it is a low-risk option that could offer substantial improvement in your pain. [2] Deep tissue massage may also be beneficial.
7) TENS Unit: Another low-risk treatment option to consider would be a transcutaneous electrical nerve stimulator (TENS unit). A TENS unit is an external device with electrodes that adhere to the skin. It works by sending electrical impulses to the muscle that is believed to stop painful signals from being transmitted to the brain and can be purchased for less than $40.
8) Ultrasound-guided Piriformis Injection: If more conservative treatment options fail to provide you with the pain relief, you should talk with your doctor about receiving an ultrasound-guided piriformis injection. Typically, this injection utilizes a combination of numbing medicine and steroid which is delivered at the site of pain generation via image guidance and can offer significant improvement in your symptoms. [3]
Prevention is Key
Although there are a number of options for treating piriformis syndrome should it arise, prevention is always the best medicine. Make sure you are stretching appropriately before exercise, creating a work environment that is nurturing for your body, eating a diet that is chalk full of anti-inflammatory foods, and limiting repetitive activities that may cause you to develop piriformis syndrome.
References:
Gu, H. (2010). Acupuncture treatment for piriformis syndrome following lumbar diskectomy. Medical Acupuncture, 22(3), 203-206.
Smith, J., Hurdle, M. F., Locketz, A. J., & Wisniewski, S. J. (2006). Ultrasound-guided piriformis injection: technique description and verification. Archives of physical medicine and rehabilitation, 87(12), 1664-1667.