Piriformis Syndrome & Sciatica. – Sorry, you’re not that special!

Hey Everyone couldn’t sleep. Been up for oh…19.5 hours so I decided I am going to write a few things tonight.

Firstly some knowledge (Not only for the public, but clearly for some physical therapists, and chiropractors as well).

Sciatica is a SYMPTOM, not a DIAGNOSIS. It simply refers to a wide variety of sensations be it pain, burning, tingling, numbness, jolts, electricity, shooting, ache that occur in some region from the hip to the foot. Those symptoms and locations are dependent upon where and how much the nerve is compressed.

Piriformis Syndrome is primarily a garbage diagnosis by people that have no clue. I say primarily as there is a very, and I mean very small chance that someone can actually have true piriformis syndrome. That being said I have never seen one, and for me there is a logical way to determine that. Piriformis syndrome is where the sciatic nerve is compressed from generally either trauma to the surrounding area that causes a hematoma (big ass bruise/clot) that in turn presses on the nerve or an anatomical variance that has the sciatic nerve passing through the piriformis muscle, so when that muscle contracts it compresses the nerve, and voila sciatica symptoms.

So here is the real deal, I have seen patients after MASSIVE car wrecks, trauma everywhere, broken pelvis, broken femurs, and guess what? Never seen a hematoma causing sciatica. Once had a guy who literally fell 2-3 stories on to his backside. Guess what? No hematoma with sciatica. I can not imagine what kind of trauma one needs to cause that.

Now whats left is we have the anatomical variance. Here is where you are not that special. It only occurs in around 2% of of people, and I am not sure I believe if its even that common. The likelihood of your being one of the “lucky” few is very low. There is probably a much more common, simple and logical explanation. (For those not following along, its kinda my theme).

So what if left? Well, 98% of the time or more, sciatica is caused from compression of a nerve root in your lumbar spine, almost always from a bulging disc. Some rare things can cause it but statistically unlikely as well.

What most PT’s and chiropractors suggest exercises for sciatica pain. Typically piriformis stretches. Laying on you back putting your ankle on the knee of the other leg and pulling it to your chest, or a hamstring stretch, Reach and touch your toes. Guess what happens? You feel better!!! It must be piriformis syndrome! WRONG!

Now, some logic.

Think about it. If the sciatica is happening from a tight piriformis, or because a hematoma is taking up space in the area, or the sciatic nerve actually runs through the muscle, wouldn’t it get worse if you stretched that muscle. Muscles get tighter during a stretch.They approximate to the underlying tissue to try and limit the stress on it. Take a rubber band and loosely lay it over a pen on a table. Now take each end of the rubber band and pull them apart. Did it clamp down on the pen? Ahhhh…that makes sense. Your starting to see it aren’t you? I see the flicker of enlightenment.

Stretch your hamstrings. Are they nice and loose during the stretch? Nope they a tight, and pulled up tight to the femur.

Soooo logically if it was “piriformis syndrome” that was the problem why would it feel better during the stretch? ANSWER: It wouldn’t. Now someones going to come along and say but when you stop the muscle is longer and stretched out. For a short time yes, but it takes a lot longer, and repetitive loading to create a permanent change in muscle length. It will return to its original length in a few minutes.

Still don’t believe me that it will get worse? Keep doing your hamstring and piriformis stretch, and watch what happens.

OK so we know that doing those stretches doesn’t make sense now, but why the relief?

The key is thinking about what else is happening when you do those stretches, and that my friends is lumbar spine flexion. It is the key to all your problems.

Watch for my next post to learn why. (Its 12:30 am. I gotta get up soon)

Think Simply. Think Logically