Sometimes sciatica is caused by a tight piriformis muscle. This small muscle is deep in the buttock, but has a close relationship with the sciatic nerve. Everyone’s anatomy is slightly different, so for some people the nerve will just run close to the muscle. For others, the nerve can pass straight through. If the piriformis muscle becomes tight and the nerve is affected by this, you can develop the symptoms of sciatica.
Causes and Symptoms
Piriformis syndrome often starts after a change in exercise. Increasing the intensity or frequency of training can be associated. Sometimes it follows initiating a completely new sport or activity. Running demands a lot of the gluteal muscles, so sports that involve a lot of running might be closer linked to it. Your osteopath will consider whether the root cause is purely an increase in demand on the muscle, or if it might be down to sub-optimal technique or form. Like other forms of sciatica, you can expect:
symptoms in the back of the thigh that may run down the back or side of the calf and into the sole of the foot
pins and needles
numbness
weakness
shooting pain
If your symptoms are related to sport, you might find that they are worse towards the end, or soon after exercise.
Pregnancy can come with symptoms of sciatica, and sometimes this can be blamed on the piriformis muscle. As the bump grows and the centre of gravity moves forwards, the muscles on the back of the body have to work harder. The lower back, buttock, hamstrings, and calf are often affected.
Diagnosing Piriformis Syndrome
Your osteopath will have an idea about your diagnosis when you explain the case history. It may be appropriate to test the nerves in the leg for their reflexes or sensation. They may also need to do some quick tests that can briefly aggravate your symptoms to be sure of the cause. Treatment varies when the nerve is irritated in the buttock rather than the back, which is why it is so important that we know where the problem is coming from.
Management
There are a few ways in which we can take the pressure off the sciatic nerve. Treatment to the piriformis muscle, combined with exercises, may resolve the most simple cases. In more complex ones, we will look further afield. If your symptoms have been present for a long time, we may also want to work to desensitise the nerve itself.
In terms of advice, your osteopath may be able to help with fine tuning your current exercise. Alternatively, they may like for you to see a coach or physical trainer who can help there. We may also like for you to follow a plan of strengthening exercises. These are best suited to cases where the muscles are tight because they are overloaded. We will work with you to devise an exercise plan that suits you, and monitor and adapt it as your symptoms improve.