“Sciatica” is something I am grateful to have been able to successfully treat hundreds of times since becoming a physical therapist.  Although I make it a rule to never argue over semantics, I so want to start by offering some definitions:

• Sciatica (commonly used definition): When the sciatic nerve experiences increased pressure, causing pain to travel from the buttocks into the upper leg

• What’s good about this definition: it’s famous and partially correct

• What’s not great: it presumes the sciatic nerve is the source of the problem

• Piriformis Syndrome (a physical therapist’s definition):  When the piriformis muscle compresses the sciatic nerve, resulting in pain traveling from the buttocks into the leg

• What’s good about the definition: it more accurately describes the situation

• What’s not great: bad public relations- most people have never heard of piriformis syndrome… until now

• Summary of these two definitions: Sciatica and Piriformis Syndrome are used to describe the same thing.  From here on out I’m going to refer to this condition as “Piriformis Syndrome.”

Anatomy:

The sciatic nerve runs from the base of the spine, under the glutes, and down the back of the thigh.  During this path, it typically runs underneath the piriformis muscle.  (Interesting factoid: In 10% of people it actually pierces through the piriformis muscle instead of traveling underneath.)  The Sciatic nerve provides sensation and motor control to the back of the leg.

The source of the problem:

The piriformis muscle is fairly small, and can easily become overworked if the surrounding muscles are under-active.  For example, if the glute muscles aren’t working as much as they should, often the piriformis muscle picks up the slack.  Over time the piriformis can become overly tight from this extra work which in turn can cause irritation of the sciatic nerve.

What’s the solution?

As always, quality physical therapy isn’t one-size-fits-all, but generally speaking I use a three pronged approach:

1. Hands on manual therapy to decrease the symptoms as quickly as possible

2. Stretch the piriformis muscle to alleviate the compression it’s placing on the sciatic nerve (I usually provide passive stretching to my clients during their visits, and make sure they are confident and comfortable continuing at home between appointments)

3. Strengthen the muscles around the piriformis, so it can stop overworking

Whether you adopt the name “piriformis syndrome” or stick with “sciatica,” what’s important is that you don’t choose to stick with the symptoms.  Reach out to Bespoke Physical Therapy, or your local, trusted physical therapist to start addressing the cause(s) and improving your quality of life ASAP!