Your friend may have told you, you probably have piriformis syndrome and your mom maybe diagnosed you with sciatica. I am going to bring some clarity to each diagnosis and give you some self-help tips. Before we clarify each diagnosis, it is nice to know a little about the sciatic nerve.The sciatic nerve is a bundle of little nerves that are composed of nerve roots from L4-S3 ,meaning the nerves that leave the spine below Lumbar Vertebrae Number 4 to Sacral Vertebrae Number 3. As the nerve leaves the spine, it travels underneath the gluteal musculature.
The sciatic nerve traditionally travels underneath the piriformis muscle, where it is protected and safe from compression. However, in some folks the nerve actually pierces the muscle and goes right through the muscle and in others, it runs on top of the muscle. This means that if your anatomy is such that the nerve pierces the muscle or lays on top of the muscle the nerve is more exposed and susceptible to compression.
The nerve then travels down the back side of the leg. This is some very basic anatomy just to give a little background on what can happen with each diagnosis. Sciatica is a diagnosis that is defined as your sciatic nerve being impinged or injured at some place along the nerve. The sciatic nerve can be injured or compressed at the level of the lumbar spine, through a disc herniation or simply through degenerative changes in the lumbar spine.
There is also a possibility that through pregnancy as the ligaments become more lax, there is more mobility and shearing that can happen through all the pelvic joints, including the sacrum, increasing the likelihood that the sciatic nerve could get irritated. The sciatic nerve can also be affected at the level of the piriformis muscle. Piriformis syndrome is compression of the sciatic nerves but that compression is happening as it runs by (though, under or over) the piriformis, in the buttock. Piriformis syndrome often causes leg pain and pain is frequently worse with sitting.Piriformis syndrome can also begin in pregnancy because as the pelvis is widening the piriformis muscle can stretch, this stretch can cause compression of the sciatic nerve.
So sciatica or piriformis syndrome, it can be hard to tell? You probably could care less by now what it’s called, you just want some relief. As you can see, it could be difficult to tell where exactly the pain in your butt or leg is coming from and to accurately determine the root cause of your pain it is important you work with a Doctor of Physical Therapy who specializes in the pelvis pain.They can run some simple tests to identify where your symptoms are coming from. They can also safely guide you back to doing the things you love to do without the nagging “pain in the butt.”
Treatment options are going to vary in your physical therapy experience because the therapist could identify other dysfunctions that are contributing to the symptoms. Overall, much of what will be needed to stop this pain will be increasing your core muscle strength. When I say core muscle strength, I am talking about how the transverse abdominis, multifidi, pelvic floor, diagram and hip muscles are coordinating to help stabilize your spine and pelvis. It’s important that these are the muscles that are activated and coordinated to help reduce the pressure on your skeleton and keep you out of diapers.
The first step to start healing your back is see a Pelvic Expert physical therapist and one thing that they should teach you is to learn how to activate your transverse abdominis muscle. This muscle lies between the two hip bones.
Here is an Example: Isometric Transverse Abdominis Contractions: Lay on your backPlace yours hands on the inside of your hip bonesImagine that the muscles underneath your fingers are being pulled together horizontally by a wire. You should feel a gentle firming and slight lift underneath your fingers. You should not feel a bulge or anything pushing your fingers out from inside your hips. You should not move or shift your spine or pelvis. Your pelvis should not flatten to the ground underneath it.
MEDICAL DISCLAIMER: All information in this newsletter is intended for instruction and informational purposes only. The authors are not responsible for any harm or injury that may result. Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied on this website.