Please understand that Sciatica is not a condition, it is a symptom of a condition and Piriformis Syndrome is only one of the 4 conditions that can cause Sciatica which is the pain you feel going down your leg.
Piriformis Syndrome causes Sciatica by irritating the Sciatic nerve as the nerve passes through the hip on the way down to the foot. It is true that the Sciatic nerve can run in 4 different ways past the Piriformis muscle and if you ask me, its not that important as to your ability to get relief so please do not worry about it.
The two most likely causes of Piriformis Syndrome are when the Piriformis muscle is tight and inflamed and continuously irritates the Sciatic nerve or the position of the pelvis is incorrect. When your pelvis is not in the proper position the path of the Sciatic nerve is going to have abnormal contact with the Piriformis muscle and thus be irritated and cause pain.
I mentioned that there are two main causes of Piriformis Syndrome. However, the true secret is knowing that there is always a combination of factors and for most people the frustration comes when you think you are doing the right thing but in fact, you are only doing half of the things necessary in order to get relief. Failure to address both the tight Piriformis muscle and then the abnormal position of the pelvis is going to lead to frustration and prolonged suffering.
By Steven Hefferon, CMT PTA
Are You Struggling with Piriformis Syndrome Pain?
If you have read any of my work you know I like to tell stories, I think they help me connect with you as the reader and my hope it that you can relate to my situation even though it may not be exactly the same.
Well in 2002, my wife and I adopted a 10 day old baby girl and in most cases, you have about 6 to 9 months before the baby starts to get into mischief. It’s at that point that you have to put up the baby gates to keep a safe area for the baby to explore.
In my case it was not the baby that was the problem but a 2 year old Golden Retriever. He just has an over active desire to nurture Baby Jessica and I guess I had not watched enough episodes of the “Dog Whisperer” to know how to control the behavior. So we put up the baby gates early to keep the dog and baby separated.
What does this have to do with Piriformis Syndrome? Everything, because our bodies are great at adapting to our environment and when our environment changes so do our bodies. I’m going to give you my story but I ask you as you read through this to think about what your story is, how has your environment changed?
What Changed in You?
In order to get to the root of your Piriformis Syndrome you will need to think about how things have changed for you over the years or how your life has been for the last number of years or even decades. What repetitive movements have you been doing?
What I’m looking for you to identify are your daily Habits, Patterns, Postures, Positioning and/or the things you do all day long, that over time will cause a tight Piriformis Muscle or your position of your Pelvis to get out of its proper position.
What Changed in Me?
In my case, we put up two baby gates, one going into the kitchen and one at the bottom of the staircase. In both cases, it was easier for me to just lift my leg up and step over the gate instead of having to open it and walk through. Well I stepped over the gate with the same leg each and every time for months and months.
Well, like I said, it took months and months for me to start to feel the pain in my butt, which then went into the back of my leg. What is worse it took me a long time for me to figure out why I was getting the Sciatic pain? Unknowingly I kept lifting my leg over the gate even when I was in pain in part because I just did not put the two together or because it made life easier.
Every time I lifted my leg up I was putting my body through a motion that caused the muscle in my hips and lower back to develop in a way that strengthened them and pulled my pelvis into an abnormal position. Again that abnormal position of the pelvis caused the path of the nerve to have abnormal contact with the nerve, thus the pain.
Where I really felt it was when I had to push my lawn mower. Every step was murder and what made it even worse was that I had to turn my feet outwards in order to push off with my big toe so I had more power. Its the external rotation that caused the Piriformis muscle to get even tighter.
What Do You Need to Look For?
Ok in the absence of trauma to the area, you need to be looking for receptive motions that put your foot into external rotation or your toes in an outward position. One test you can do is to get on the floor and lay on your back and relax your legs to see which way your feet rotate. You can just look down at your feet as you sit and read this and see which way your feet are rotated. My bet is that in both cases your toes are rotated outward, and that means your Piriformis muscle is tight and that is bad.
The second factor is the position of your pelvis. Now the abnormal position of the pelvis is much harder to identify on your self but there are some motions that you can identify with. One common motion is getting in and out of a car. You will do it thousands of times in year and you will do it the same way every time. Another common motions is standing and weight shifting on to one foot while waiting in line or holding a baby on your hips.
These all cause a shift in the use of your core muscle and over time you will develop what are called muscle imbalances and those muscle imbalances will develop in to what are called postural Dysfunctions. It’s those postural dysfunctions that cause your Piriformis Syndrome and thus you will feel Sciatica or pain down your leg.
Can It Really Be That Simple?
Of course there can be differing circumstances and variations to everyone’s body type and body development but at the core, and I mean at the root of the problem, the more imbalanced you are the more likely you are going to have pain. If you fail to identify these environment factors the harder it will be to get lasting relief.
Yes, your case is different from mine. It may have been around for years and you could have tried everything to get rid of it and today you find that you are still in pain.
That does not mean you can forget anything I just said, because I bet that none of your health care professionals have addressed your daily life as deeply as it needs to be addressed in order to get relief. Or, more importantly they have not looked at your body as a whole and addressed your muscle imbalances or postural dysfunctions to develop a plan to get you the relief you want.
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Updated: May 12,2011