It can be an electric tingling sensation when we first experience a pain that shoots from the buttock down the leg. This sensation is the likely result of the sciatic nerve being irritated by something. We often hear about herniated discs in the lower back causing ’sciatica’, the term given to this pain. But, more often it’s caused by something less serious, and easily treatable with massage therapy.
Several things can cause sciatica symptoms, including diseases of the lumbar spine, like herniated discs, chronic hamstring tendonitis or adhesions of the sciatic nerve to the surrounding tissues can cause sciatica. Another common cause, particularly in athletes, is when the piriformis muscle goes into spasm or develops trigger points that press on the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called “sciatica”, often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats.
The piriformis muscle assists in abducting and laterally rotating the thigh. In other words, while balancing on the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling. This is the action of the right piriformis muscle.
A SIMPLE TEST
To see if the piriformis is causing the pain, try stretching it, stretching the muscle often duplicates the pain. To do the piriformis stretch, lie on your back, and flex the right hip and knee. Now, while grasping the right knee with your left hand, pull the knee towards your left shoulder. This adducts and flexes the hip. In this position, grasp just above the right ankle with the right hand, and rotate the ankle outwards. This applies internal rotation to the hip and completes the stretch. Another way to do this stretch is to stand on your left foot and place the right foot on a chair, such that the right knee and hip are flexed at about 90 degrees. Now, using the right hand, press the right knee across towards the left side of the body while keeping the ball of the right foot on the same spot on the chair.
Anatomically, the piriformis muscle lies below to the gluteal muscles. It originates from the sacral spine and attaches to the greater trochanter of the femur, which is the big, bony “bump” on the outside top of the thigh. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle. Often, acute or chronic injury or overuse causes swelling of the muscle and irritates the sciatic nerve, resulting in referred pain. Patients whose nerve passes through the muscle are particularly prone to this condition.
Piriformis syndrome is diagnosed primarily on the basis of symptoms and on the physical exam. There are no tests that accurately confirm the diagnosis, but X-rays, MRI, and nerve conduction tests may be necessary to exclude other diseases. Some of the other causes of sciatica include disease in the lumbar spine (e.g. disc herniation), chronic hamstring tendonitis, and fibrous adhesions of other muscles around the sciatic nerve. However, the risks of seeking treatment with massage therapy are essentially nonexistent. Even in the event that your sciatica is caused by something other than the piriformis, it is most likely contributing to it.
Once properly understood, treatment is undertaken in a stepwise approach. Massage therapy, specifically deep tissue and NMT, is particularly effective at treating piriformis syndrome. A series of sessions consisting of Trigger Point Therapy, stretching the affected muscles and restoring normal range of motion are the first steps towards treatment.
Additionally, we will explore your daily habits that may be causing the issue and teach you some stretches and massage techniques that you can do on your own in between treatments. Initially, progressive piriformis stretching is employed, starting with 5 seconds of sustained stretch and gradually working up to 60 seconds. This is repeated several times throughout the day. It is important that any abnormal biomechanical problems, such as overpronation of the foot or other coexisting conditions, are treated. We may want to coordinate your treatment at Profile Massage with a PT and a physician. During your treatment we will take detailed notes that we can then share with your physicians (at your option), so that they can use that information while pursuing other treatments.
A good sports massage therapist with experience in caring for athletes with piriformis syndrome can help direct appropriate management. With proper diagnosis and treatment, there is no reason to live with sciatic pain.
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