Sciatica – How to recognize and treat it?
The pear-shaped muscle is the structure located in the gluteal area responsible for external rotation, abduction and straightening of the thigh. It also belongs to the hip joint stabilizers. Due to its course (from the pelvic surface of the sacrum to the greater trochanter of the femur), excessive muscle tension may provoke the symptom of sciatica.
What is the relationship between the sciatic nerve (sciatica) and the piriform muscle?
Under standard anatomical conditions, the sciatic nerve emerges from the greater sciatic foramen located slightly below the piriformis muscle. There are cases, however, when one of the branches of the sciatic nerve passes through the muscle itself. In this situation, any increased tension causes pressure on the nerve and, consequently, the symptoms of sciatica.
The causes of the piriformis syndrome are not clear-cut. They can be found in increased muscle tension, poor blood supply to the muscle (temporary or resulting from errors in the anatomy of blood vessels), permanent compression (in the case of office workers), inflammation or trauma in the buttock area.
A well-conducted interview with a doctor becomes the key in the diagnosis of these two diseases.
Sciatica and the symptoms of piriformis syndrome are almost identical – pain radiating from the buttock along the back surface of the lower limb.
It is worth emphasizing that the discomfort caused by the pear-shaped muscle will increase during the movements for which this muscle is responsible, and the structure itself will be significantly tense in the palpation examination.
The situation is slightly different in the case of sciatica, when the patient locates pain also in the lumbar spine, increased muscle tension outside the gluteal area also appears in the area of the back, and the forward bend causes some problems.
The passive straight leg elevation in the supine position will be positive for both sciatica and piriformis syndrome. For the elimination of doubts, attention should be paid to the position of the patient’s feet in a supine position. The foot on the side of the symptoms resulting from muscle dysfunction will position itself in external rotation, which is not observed in the case of nerve ailments.
Therapists are most likely to choose techniques that bring quick and long-lasting effects. It is often recommended: self-therapy in the form of rolling, dry needling, soft tissue therapy or manual therapy. Each of the techniques is aimed at loosening the tense structures, restoring the proper mobility of the hip girdle and, consequently, relieving pain. Patient education in the matter of prophylaxis is discussed directly during the visit and includes properly selected exercises, tips on work ergonomics and presentation of the consequences of ignoring the emerging problem.
If you notice any disturbing pain symptoms, see a qualified physical therapist in order to make an appropriate diagnosis and start treatment as soon as possible.