Sciatica and piriformis syndrome are among the most painful conditions orthopaedic patients experience. Stabbing and shooting pain in the lower back, buttocks, and legs can make standing, sitting, and even sleeping extremely uncomfortable and get in the way of daily activities. Both sciatica and piriformis syndrome involve your sciatic nerve. The longest nerve in your body runs through your lower back and buttocks to the back of your thigh, heel, and foot. When it gets pinched or compressed, the pain can be hard to take. Fortunately, there are excellent treatment options, with a robust physical therapy plan at the top of the list.
What Is Sciatica?
Sciatica is a condition that occurs when the sciatic nerve roots on the lower vertebrae of your back become pinched or compressed. There are several primary causes:
- A herniated disc in the lower back: when a disc bulges out, it can put painful pressure on the sciatic nerve. Sciatica can also result from leaking acids or proteins from damaged discs that irritate the nerves.
- A bone spur on the spine (often related to osteoarthritis) can pinch the sciatic nerve.
- Spinal stenosis: a narrowing of the openings in the spine (usually from age-related wear and tear and/or osteoarthritis) can put pressure on sciatic nerve roots.
What Is Piriformis Syndrome?
The sciatic nerve runs through your pelvis, passing underneath the piriformis muscle, which runs from the lower back to the thigh. Your piriformis muscle can become swollen from injury, overuse, or the way you sit or stand. It puts pressure on the sciatic nerve, causing pain in the hip, buttock, or leg on one side of the body.
How Can I Tell If It’s Sciatica or Piriformis Syndrome?
Sciatica and piriformis syndrome have many of the same symptoms, including:
- Pain in the lower back, buttock, and leg (usually on just one side)
- Pins and needles or burning sensation in the back or legs
- Numbness in the lower back, buttock, legs, or feet
- Pain that gets worse when you move or stop moving
- Pain that flares up with sitting or standing for long periods.
Your orthopaedist will conduct tests to determine whether your pain is caused by compression by a disc or bone spur in the spine (sciatica) or pressure from the piriformis muscle. Diagnostic tools include spinal x-rays, MRI, and CT scans as needed.
How Can I Prevent Sciatic Nerve Pain?
The Mayo Clinic offers several essential tips for preventing sciatic nerve pain:
- Exercise regularly and focus on keeping your core strong to protect your back.
- Maintain good posture while sitting and choose a chair with good back support.
- Use good body mechanics when you stand, walk or lift.
Additional strategies include:
- Take Vitamin B12 supplements to support nerve health.
- Work with your primary care doctor to lose weight if you are overweight or obese. Extra weight puts pressure on the spine and can lead to nerve compression.
- Get physical therapy if you are injured: sciatica and piriformis syndrome often result from past injuries.
- Avoid tobacco use or work with your provider to quit tobacco products. According to the Cleveland Clinic, nicotine in tobacco can damage spinal tissue, weaken bones, and speed the wearing down of vertebral disks.
What Are Treatment Options For Sciatica and Piriformis Syndrome?
In some cases (especially when a ruptured disc is involved), your orthopaedist may recommend surgery for sciatic nerve pain. However, surgery is usually not the best option when you have a piriformis syndrome diagnosis. With piriformis injuries, we almost always find that physical therapy does the most good. Some of the most effective treatments include:
- Stretching exercises with a focus on the hip and core
- Ultrasound treatment
- Heat and cold therapy
- Manipulative therapy and massage from your physical therapist
- Dry needling is particularly effective in treating piriformis syndrome. This treatment involves placing tiny unmedicated needles into myofascial trigger points in the muscle. It reduces swelling in the piriformis muscle and relieves pressure on the sciatic nerve.
At Countryside Orthopaedics, we start each sciatic nerve pain treatment with a thorough diagnosis by our top team of physicians and physician assistants. If needed, we’ll explore surgical options. But our preferred option is generally a personalized physical therapy plan. Our stellar physical therapy team works to relieve your pain while building strength and preventing future injuries. We have plenty of tools in our toolbox, including highly effective stretching exercises and innovative therapies like dry needling. Time after time, today’s physical therapy options are nothing short of a miracle for so many of our patients working to break free from the pain of sciatica and piriformis syndrome.