For years, damaged discs in the lower back or spinal nerve problems have taken the blame as the most common cause of sciatica, a painful condition in which the sciatic nerve in the back of the leg is pinched and pain radiates down the leg. But some of the other causes of sciatica include chronic hamstring tendinitis, fibrous adhesions of other muscles around the sciatic nerve, and Piriformis syndrome, a condition in which a muscle in the buttocks called the piriformis compresses or irritates the sciatic nerve.

Doctors often recommend spinal fusion surgery for spinal problems (associated with sciatica), when the actual problem is piriformis syndrome.

Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called sciatica, often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs or performing squats.

Anatomically, the piriformis muscle lies deep in the gluteal muscles. It originates from the sacral spine and attaches to the greater trochanter of the femur. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle.

Piriformis syndrome can develop when the piriformis muscle becomes tight or spasms and places pressure on the sciatic nerve that runs beneath it. When the piriformis muscle and its tendon are too tight, the sciatic nerve is choked. This may decrease the blood flow to the nerve and irritate the nerve because of pressure. This can cause low back pain and/or pain that radiates to the rear and down the leg (similar to sciatica pain). From a technical standpoint, piriformis syndrome does not cause true sciatica (as sciatica is usually defined as a radiculopathy, or compression of a nerve root as it exits the spine). However, just like sciatica, piriformis syndrome can cause pain, numbness and tingling along the sciatic nerve, which runs down the back of the leg and into the foot.

• Anti-inflammatory medications  to help control pain and inflammation
• Steroid (cortisone) injections 
• Surgery to release the damaged tendon
• Physical therapy

Treating through physical therapy, progressive soft tissue manipulation can result in relaxation of the piriformis muscle. In our practice, this is followed (if indicated) by pelvic manipulation to correct the cause of the piriformis tightness, after which  stretching is employed, starting with five seconds of sustained stretch and gradually working up to 60 seconds. This is repeated several times throughout the day.

It is important that any abnormal biomechanical problems, such as over pronation of the foot or other coexisting conditions, are treated. This stretching can be combined with physical therapy modalities such as ultrasound, heat , ice and medical acupuncture to loosen up the muscle tissue to increase the blood flow to the injured area, starting the healing process by providing access to nutrition and oxygen in the injured area.