Sciatica and the Piriformis Muscle
Sciatica is a common complaint among many people who seek physiotherapy care, however I am finding that many people are not aware of what true sciatica is. People often come to the clinic with symptoms felt mostly in their buttocks, call it sciatica, and wonder why exercises they googled online haven’t worked! But after assessment, it turns out to be something else such as glute muscle trigger points, SI joint pain or hip tightness. It is important to understand the pathway of the sciatic nerve to know if the symptoms are truly coming from the nerve itself.
The sciatic nerve is made up of a bundle of nerves from the back and pelvis area that run along the back of the leg to the foot. The sciatic nerve supplies the muscles of the back of the leg, inner thigh, calf and deep foot. It also supplies sensation to the skin of these areas. “True” sciatica will cause pain, weakness, numbness or tingling from the back, all the way to the foot.
Often times because the sciatic nerve runs under or through the piriformis muscle, if this muscle becomes shortened due to poor posture or overuse injury, it will compress the nerve. As such, it is very important that this muscle is released, and stretched to relieve pressure from the nerve. Then we often focus on strengthening this tight short muscle, to make sure it can keep up with the demands placed on it throughout the day.
There are several manual therapy and soft tissue techniques to treat the piriformis muscle. A treatment modality that is very effective is dry needling. Dry needling uses an acupuncture size needle inserted directly into the trigger point, eliciting a twitch response and releasing the muscle.
I often describe it as a deep tissue massage in two seconds! It is fast and effective.
Another exercise I often prescribe is a neural mobility exercise, which encourages movement of the sciatic nerve through the pathway that is restricted. An example would be, sitting upright at the edge of a chair with your affected leg straight out in front of you. Keeping your leg straight bring your foot upwards while looking towards the ceiling at the same time. Hold for 2-3 seconds, then complete the opposite movements, tuck your chin, keep your leg straight but point your toes. You should feel symptoms come on and then be relieved. Complete 10-15x as symptoms arise. Relief should be felt afterwards.
If you are someone with a not so pleasant symptom in your buttocks, wondering if it’s sciatica or if it is something else, physiotherapy is a great place to start. We are currently accepting new patients and would love to help you get back to your normal life, symptom free!