At Integrative Physical Health, many of our patients seek treatment for lower back pain, and quite a few others seek relief from sciatica; in some cases, they suffer from both conditions. When patients are simultaneously affected by these conditions, quality of life usually takes a dive because they are forced to deal with debilitating pain and discomfort.

Let’s say a patient is diagnosed as emanating from two herniated discs, specifically the L5 and L6, which in turn put pressure on a spinal nerve cluster, thus causing a neuralgia that extended down her gluteal muscle tissue to the sciatic nerve. It would be natural to assume that treating the spinal disc issue would take care of this patient’s sciatica problem, but this is not always the case. When chiropractors assess complaints of sciatica, they know better than to expect a single cause. It is not unusual to learn about patients whose sciatica condition remains even after spinal adjustment alleviates their back pain, and this is when we need to consider piriformis syndrome as the cause.

How Piriformis Syndrome Relates to Sciatica

Sciatica is not always caused by piriformis syndrome. In the aforementioned example of a patient with L5 and L6 issues, treating her two slipped discs may result in her sciatica going away on the spot, but if this does not happen, we should turn our attention to the muscle tissue close to the sciatic nerve. Piriformis syndrome is directly related to muscle tissue; specifically, the muscle that runs from the sacrum to the trochanter, which is part of the intricate attachment of the hip joint to the femur.

If the health professionals who treat our hypothetical patient noticed that her sciatica does not improve after her L5 and L6 discs are treated, they would probably consider piriformis syndrome as a potential cause. The piriformis is one of the various masses of tissue that make up the gluteal muscles. As its name suggests, this muscle is shaped like a pear; its functions include helping in what is known as external thigh rotation, which is involved in body mechanics such as:

• Stability while standing
• Crouching
• Sidestepping
• Squatting
• Kicking
• Balanced walking

The piriformis works through isometric contraction; you can actually feel it in action when you perform a deep squat that involves tightening the buttocks and your core at the same time. Martial arts practitioners condition their piriformis through high roundhouse kick exercises. In approximately 85% of the population, the piriformis is located above the sciatic nerve. Patients whose sciatic nerve runs right through the piriformis are more prone to suffer from sciatica caused by muscle spasms.

The reality of piriformis syndrome is that it can also develop even if your anatomy does not place the sciatic nerve through muscle tissue. If the sacroiliac joint is injured or deformed, the piriformis is bound to tighten and exert pressure down on the sciatic nerve. Patients whose work duties keep them chained to their desks several hours a day can also end up with piriformis syndrome in the long run.

Symptoms of Piriformis Syndrome

We all have bilateral piriformis gluteal muscles, but most of us will not develop piriformis syndrome even if we are in the anatomical 15% of patients whose sciatic nerves run right through the tissue. It is difficult to estimate how many piriformis syndrome patients are asymptomatic; quite a few will only feel temporarily affected after an intense workout session focused on squats.

Invariably, sciatica is the symptom that reveals piriformis syndrome. If you have received an intramuscular gluteal injection of a viscous substance such as penicillin or vitamin B12, then you know what sciatica feels like: A sharp pain that seems to come from deep inside the muscles of the buttocks, and which sometimes makes you laugh because it feels so different. The difference is that injection site pain typically goes away in less than a day; sciatica is a chronic pain condition that gets progressively worse.

Other piriformis syndrome ailments include the following:

• Muscle spasms coming from within the buttocks.
• Pain that travels from the middle of the buttocks all the way down to the ankles.
• Difficulties with walking, crouching, kicking, sidestepping, and squatting.
• Visible edema or a feeling of internal inflammation.
• A feeling of numbness past the buttocks and down your leg, particularly when sitting down or shifting in your seat.

The intensity of sciatica pain caused by piriformis syndrome determines how severe it is. As previously mentioned, you may feel tightness and pain after certain workouts, but you only need to worry about muscle spasms or nerve damage if the pain persists and starts turning from dull to sharp. Once you are not able to comfortably sit down, a chiropractic evaluation should be the first thing on your mind.

When the sciatic nerve runs through the piriformis, anything that causes irritation to the nerve causes irritation to the muscle tissue. This is a true syndrome because of the potentially negative synergy between the muscle and the nerve; in other words, you can suffer from bulging spinal discs that pressure the sciatic nerve, and this will in turn irritate the piriformis.

Piriformis Syndrome is Not Always Chronic

Not all patients will deal with piriformis syndrome on a chronic basis. This condition can also be acute; in fact, it is common among NBA players because of the body mechanics that the game demands when competing at the professional level. Runners of all distances can also suffer from acute piriformis syndrome, which can be alleviated through chiropractic care and physical therapy.

Acute piriformis syndrome will often go away on its own; if not, sports medicine professionals will treat athletes with ice packs, rest, and medications to control inflammation. When this condition happens more than once in a regular NBA season, team doctors will take a closer look at how athletes are moving on the court. Acute piriformis syndrome among athletes can be linked to repetitive strain injuries indicative of improper conditioning; this can be alleviated with both chiropractic care and highly specific physical therapy.

It is more common for patients who are not athletes to suffer from chronic piriformis syndrome than to experience acute episodes. In both cases, chiropractic treatment can certainly help to overcome pain and lack of mobility.

How Chiropractic Professionals Approach Piriformis Syndrome

Similar to other musculoskeletal conditions, piriformis syndrome requires a careful assessment, precise diagnosis, and a treatment plan that can provide conditioning while alleviating pain. Chiropractors start with an observation of subjective and objective clues that can either determine or rule out the syndrome.

We already know that sciatica will always be present, but this does not guarantee that the piriformis is involved. This is the kind of muscle that is not easy to isolate, but it is somewhat palpable; for this reason, some patients will require diagnostic imaging such as x-rays. Chiropractors always look for signs of spinal subluxation or physiological issues that may trigger or exacerbate dormant piriformis syndrome.

When the syndrome is determined to be chronic, chiropractors will consider other factors to formulate the right treatment plan, which may include therapeutic deep tissue massage that directly targets the piriformis; the goal is to stimulate muscle fiber and promote adequate circulation. Patients who have tried to improperly compensate for their diminished mobility and reduced strength may need spinal adjustment sessions. More importantly, however, is the physical therapy plan recommended by chiropractors.

By targeting the piriformis with specific stretching exercises and contractions, Chiropractic patients can turn their chronic conditions around. In the beginning, patients complete guided therapy sessions at the clinic. Later, they are strongly encouraged to complete the exercises at home and with greater frequency. For the most part, these are low-impact exercises that can be gradually increased in terms of intensity in order to make them more effective.

Exercises can be gradually increased in terms of intensity in order to make them more effective. Also, patients can make adjustments to their home exercise program and make an effort to incorporate it into their day-to-day life; however, most people can expect the piriformis to feel more comfortable in a few weeks. This is one of the most important factors because, for many people, it will be months before the first significant decrease in symptoms. During that time, chiropractors are willing to keep patients on the road to better health. Eventually, as patients learn the exercises and find the most comfortable postures, they can progress toward an optimal healthy lifestyle.

Piriformis syndrome is a type of sciatica that is usually attributed to lumbar strain, injury, or surgery in the spine. If you get the right diagnosis and treatment from chiropractors, you are more likely to have a better outcome of sciatica or piriformis syndrome than with the traditional treatments of injections and drugs.