If you’ve ever spent any time with Grandpa, or watched any movie with Don Rickles, you’ve probably heard him complain about his sciatica. Sciatica is a radiating pain running along the path of the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg.
Typically, sciatica affects only one side of the body, and is most commonly caused by a herniated disk, bone spur on the spine or spinal stenosis (narrowing of the spine) which causes compression on part of the nerve. This compression causes inflammation, pain and often some numbness in the affected leg. Sciatica is not, however, the only cause of sciatic pain.
Piriformis Syndrome is a neuromuscular condition that affects the proximal sciatic nerve due to contracture or tightness of the piriformis muscle. Piriformis is a flat shaped muscle originating at the sacral vertebrae and attaching to the femur bone. The disorder affects females twice more than males. The condition is also known as ‘wallet sciatica’ as the syndrome may be caused from sitting with wallet on the affected side’s rear pocket.
Most commonly, patients complain of a dull ache in the buttock, pain down the back of the thigh, calf and foot, pain when walking on an incline, and pain after sitting for prolonged periods. People who sit at work for long periods of time are susceptible to developing this condition. Runners and bicyclists who engage in forward-moving activities are also vulnerable to developing this, especially if they do not engage in lateral stretching and strengthening exercises.
Disproportionately week hip abductors with tight adductors can also put more strain on the piriformis leading to its shortening and resultant sciatica as the nerve passes through the muscle. People who sit for long periods of time often develop tight hip flexors leading to reciprocal inhibition of gluteal muscles. The function of these gluteal muscles would be taken over by the piriformis leading again to its shortening resulting in the syndrome. Patients with ‘flat foot’ are also candidates for developing this syndrome.
Stretching the piriformis muscle is almost always necessary to relieve the pain along the sciatic nerve and it can be done in different positions. Myofascial release, massage, avoidance of contributory activities should be taken into consideration as part of treatment protocol. Rest is usually recommended. A two to three week break from sports and activities that cause pain can also be helpful.
Strengthening the hip abductors, extensors and external rotators is also an important part of treatment. Also, don’t sit on your wallet.
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