Sciatic Pain

A Pain in the Butt – is it Sciatica or Piriformis Syndrome?

Have you ever had a pain in your buttock and just didn’t know what it was? Typically the terms sciatica and piriformis syndrome are commonly thrown around by GP’s, friends and the good old Dr Google search!

It's time to remove the guesswork and make you a bit more educated as to what the source of your problem is. Both problems are similar only in the area of the body that they affect. The source of the symptoms and how they are managed can be entirely different – this is where it pays to know what you are dealing with so that you can get a resolution to your symptoms.

A common problem with buttock pain is misdiagnosis and mismanagement leading to it lasting much longer than it actually should. Both issues can be easily diagnosed and there are plenty of treatment and exercise options to help you.

In this blog we are going to look at some basic anatomy and causes, then dive into each problem in a bit more detail and conclude with the solutions to both issues!

Piriformis Syndrome

Piriformis syndrome can be defined as:

“Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain)” (www.spine-health.com).

Causes of piriformis syndrome are commonly reported from sporting activities such as running, hill walking and forms of gym-based exercise – typically it may be due to poor technique, imbalances within local muscle groups or a sudden change in the amount of exercise that is being performed. Another common cause is compression due to sitting on hard seating or in a poor position which can compress the nerve.

Symptoms of piriformis can include localised buttock pain at the location of the muscle which extends into the larger buttock area. Pain can cause changes in comfort of sitting and ability to perform simple movements such as walking and standing without discomfort. Tingling can also be reported.  Symptoms of piriformis syndrome can be reduced within 4-8 weeks if the cause and pain are managed properly

It is important to note that in severe cases the nerve compression can cause symptoms to extend down into the thigh – which is where the similarities lie with sciatica, however, this is not true sciatica. The cause of the pain is the piriformis muscle being compressed or tight with primary symptoms of localised buttock pain which in turn puts strain on the sciatic nerve causing secondary symptoms.

Treatment & Prevention

If you are struggling to identify the cause or type of back, buttock and / or leg pain you have – visiting a healthcare professional or injury specialist would be advised – as discussed before the management of each problem differs due to its cause and so does the management plans in how you treat each problem. Gain the best diagnosis you can before starting a treatment plan.

Treatment from a therapist for sciatica and piriformis syndrome would likely involve the same treatments. Focus would be placed on soft tissue techniques ranging from spinal mobilisation (for sciatica), sports massage and deep tissue massage and percussive therapy (Theragun G3Pro) for the affected areas to help reduce tightness and tension.

If you have particularly bad nerve pain from either problem then acupuncture is an excellent way of managing pain levels in a comfortable way.  Nerve pain can affect the mobility of your leg and often the buttock and thigh may be painful to touch. Acupuncture can effectively aid reduction in nerve pain and is painless to perform.

Progressing your care at home and independently will involve exercises to help mobilise the affected areas and begin to regain strength. If you have had sciatica then back mobility exercises combined with neural mobility exercises will benefit you. If the problems have been more due to piriformis then the focus of the exercises will be local to the gluteal muscles. Self-treatments for managing pain levels can include foam roller and mobility tools (see our blog on this topic) – this is an effective way to manage pain levels and aid the reduction in tension of muscles in the surrounding areas.

Prevention of both problems comes with a careful approach to exercise, new activities and postural positions. Pilates is also an effective way to strengthen the lower back and glute muscles to make your body more robust. Take a look at our previous blog on Pilates – A Self-management Guide to Lower Back Pain.

MSK Sports Injury Clinic
Mark Poolan
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