Sciatic pain into the buttock caused by Piriformis Syndrome
Sciatic pain is a burning sensation into the buttock along the hamstring and down into the outside calf muscle and foot. However there is a strong need to differentiate between sciatica caused by disc bulging in the lower back and that caused by piriformis syndrome. Piriformis syndrome involves the piriformis muscle of the hip becoming very tight and hence compressing the sciatic nerve that runs underneath the sciatic nerve (see illustration). It is a common injury in activities that involve constant twisting and turning movements such as field sports and also in Long Distance Runners. If there is no aggravation of symptoms with coughing or bending the spine forward then the lower spine disc bulging can be ruled out as a cause of pain.
Signs & Symptoms
Burning sensation into the buttock travelling down the back of the leg and into the ankle.
Possible groin pain.
Restricted pelvic and lower back movement
An abnormal walking gait, patient doesn’t strike the ground with their heel but instead strike the ground during walking with their mid foot.
The stride of the patient becomes shorter and sometimes a bent knee posture when walking can be noted in order to prevent stretching the sciatic nerve.
Feet turned outwards indicated tight piriformis
Pain is aggravated by prolonged sitting, standing and walking.
Causes of piriformis syndrome;
Piriformis muscle is compensation for a weak gluteal medius muscle that stabilizes the Hip joint.
Excessive tightness in the Hip Flexor muscles
Leg length difference
Treatment & management
As stated earlier, it is extremely important that the root-cause of the sciatic nerve pain is correctly diagnosed as being the Piriformis muscle compression and not a lower back disc protrusion. The early stage (first 5 days of management) of Piriformis syndrome is rest and cold treatment on the tender buttock region by the patient. Once the inflammation has reduced down the Physical therapist can decide then if the piriformis muscle can be lengthened by graded manual techniques, this is important as the sciatic nerve itself maybe inflamed. In addition stretching exercises can commence. It is very important that the tight hamstring and hip flexor muscles are addressed also to prevent re-occurrence. In addition the outside hip muscle known as the glute medius should be strengthened to stabiles the pelvis.
Tomás Ryan is a Registered Physical Therapist (MIAPT) with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 0504 26672
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