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Piriformis Sciatica

Aka. Piriformis Syndrome

In the sports medicine literature, piriformis sciatica is referred to as piriformis syndrome. Sciatica symptoms are usually described as a cramping or aching pain in the buttock and/ or hamstring. It may be described as a sensation where the hamstring muscles feel “tight”. In other cases it presents with pain and paresthesia of the hip, buttock and posterior thigh and leg with sciatic like tingling. Low back pain may or may not be present, but piriformis should be thought of as a cause for low back pain and disc herniation symptoms!

Piriformis syndrome may be aggravated by prolonged sitting, (especially on a wallet) or activity. Also, it may be associated with a direct blow or after surgery due to a build up of scar tissue.
There have also been suggestion that the sciatic symptoms may be a result of chemical irritation (common with the theory that mechanical stress is translated into chemical stress in the sciatic nerve causing pain instead of paresthesia)

The Anatomy:

xpiriformismuscle.jpg.pagespeed.ic.l2Ta_PW3_cThe piriformis muscle is in the back of the pelvis and attaches to the leg to help it externally rotate (turning the foot outwards). It acts very similar to the way the rotator cuff muscles do in the shoulder. The sciatic nerve runs under this muscle, and in rare cases through the muscle, when it gets tight it can press on the nerve causing irritation.

It is thought that the piriformis can impinge on the sciatic nerve and ligaments in the hip. The piriformis muscle, although it most commonly comes out below the piriformis, sometimes (about 15% of the time) splits above the piriformis, and passes on opposite sides of the muscle.

Other Possible Causes of Sciatica Taken from a Study of patients with failed treatment of sciatica on MRI (239 patients). These were given a new diagnosis as follows.

piriformis syndrome (67.8%)
– distal foraminal nerve root entrapment (6%)
– ischial tunnel syndrome (4.7%)
– discogenic pain with referred leg pain (3.4%)
– pudendal nerve entrapment with referred pain (3%)
– distal sciatic entrapment (2.1%)
– sciatic tumor (1.7%)
– lumbosacral plexus entrapment (1.3%)
– unappreciated lateral disc herniation (1.3%)
– nerve root injury due to spinal surgery (1.3%)
– inadequate spinal nerve root decompression (0.8%)
– lumbar stenosis (0.8%)
– sacroiliac joint inflammation (0.8%)
– lumbosacral plexus tumor (0.4%)

This study just shows the wide variety of causes for sciatica symptoms, however the overwhelming majority are due to piriformis syndrome (at 68%), and disc herniations are less than 5%.

Tests:

-The muscle is tender to touch.
– Straight leg raise may aggravate symptoms by stretching the nerve
– Often people describe hamstring pain that is not relieved with regular hamstring stretches
– A tight hip muscle may cause you to ‘toe-out’ when walking
– Hip range of motion may be restricted and painful
– Imaging tests are controversial in most cases. MRI may help to confirm.

Treatment

– Piriformis sciatica very rarely ever requires surgery and should always be treated with hands on therapy first.
– Soft tissue treatment / myofascial release should be non-aggravating of the symptoms and can be directed at the origin of the muscle away from the nerve
– Intermittent Sciatica Stretches of the piriformis muscle (every waking 2 hours)
– Spinal manipulation therapy (chiropractic adjustments) may help with associated sacroiliac dysfunction and provide muscle release
– Nerve Flossing exercises for sciatic nerve pain should also be performed (every waking 2 hours)
– Acupuncture for sciatica is also helpful for reducing symptoms of piriformis sciatica


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