Piriformis Syndrome – The hidden culprit of Sciatic Pain

 Treating piriformis syndrome, by healing the piriformis muscle and surrounding connective tissue properly through massage therapy, PNF stretching, and myofascial release while addressing the underlying behaviors that are causing the sciatic nerve to become aggravated will often times easily alleviate your sciatic and lower back pain giving you rapid relief without the need for surgery or other invasive procedures.

Sciatic lower back pain

Piriformis Pain Syndrome (aka. Sciatic Pain Syndrome) is often wrongly diagnosed as Sciatica. If you are suffering from these symptoms you may be needlessly in pain. Misinformation through misdiagnoses of the chronic condition of sciatica is a highly common mistake. Most often misdiagnosis claims some form of compression of the Sciatic Nerve at the nerve’s roots located in the Lumbar and Sacral regions of the spine. However, more often than not the cause of pain associated with the sciatic nerve occurs lower in the body in the deep layers of muscle within the buttocks region and cannot be treated without treating this area specifically.

Simply put, if the injury is in the buttocks region and you treat the spine, treatments will generally not be successful.

A quick understanding of how nerve damage can be assessed and treated

On a high level, understanding how and where a nerve has been damaged through it’s displays of symptoms within the body is quite simple. The spinal cord and brain make up the Central Nervous System (C.N.S.), once a nerve leaves the spinal chord we are now within the peripheral nervous system (P.N.S.). The C.N.S. is the “power center” for all functions of the body (much like the main fuse box providing power to a house) where a region of the body located in the P.N.S for example: your leg is like a room in the house, where your toes are like lights in the room.

Therefore, we look for the area where normal nerve activity (the lights are on) meets abnormal nerve activity (the lights are off, or flickering). The injury to a nerve can be experienced as sharp or dull pain, numbness, heat, cold, weakness and loss of functionality or a combination of any of these symptoms.  In other words, we look for “where the pain or symptoms begin to show themselves” and we can deduce that just proximal (closer to the spine) from the start of the symptoms is the origin of the dysfunction.

Consequently, if your sciatic pain is felt in the hamstring but not in the buttock region, then we know the injury is in the buttock region, and so forth. 

Often times we can learn the general location of the injury through some mobility tests of the limbs. Sometimes this becomes a bit more challenging to deduce in lower back pain when we start getting closer to the spine with the sciatic nerve, as the nerve root originates in multiple zones of the spine as shown below in figure A1. 

Piriformis Syndrome and the Sciatic Nerve
Piriformis Muscle compresses sciatic nerve

Figure A1. shows how the Sciatic Nerve is formed through each of these nerves from their unique origins of the spinal chord. The Sciatic Nerve is a bundle of nerves receiving it’s nerve bodies from the Lumbar Spine (L4, L5) and the Sacral Foramen (S1, S2, S3, and S4* ).

 Piriformis Syndrome: one of two of the most common causes of Sciatic Pain treatable through massage therapy, PNF stretching and myofascial release.

Piriformis syndrome is probably the most common and treatable lower back pain condition causing the discomfort associated with the sciatic nerve. Perhaps the next dysfunction causing lower back pain and sciatic pain would be the discomfort caused by Iliopsoas Dysfunction and various forms of postural collapse. The piriformis muscle as shown above (figure A2.) causes symptoms often termed as “Sciatica” because of the compression of the Sciatic Nerve that occurs as the Sciatic Nerve passes under (and in some very rare instances through) the piriformis muscle. When the piriformis muscle is inflamed (often experienced as a knot, or large mass in in the deep buttock region; similar to knots often experience in the shoulder, neck or back) this muscle compresses the Sciatic Nerve below causing irritation and inflammation. In turn, this nerve compression and inflammation causes the nerve to malfunction resulting in pain. Much like a kink in a water hose causes water to flow at a lesser rate, once you release the kink the flow of water returns to it’s normal rate. When we release that which compresses a nerve, the electrical signal within the nerve is restored and the pain subsides.

When nerve damage has been prolonged muscle tone, strength, and mobility can suffer causing imbalance in all supporting muscle groups that often times causes eventual pain in other locations of the body, ie. headaches, and upper back pain. 

Aside from the obvious localized pain caused by sciatica and sciatic pain syndrome, migraines are a common side effect of dysfunction located in the lower back! Imblance in one part of the body eventually finds it’s way to other parts of the body.



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