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what is false sciatica or piriformis syndrome?

What type of sciatica do you have?

Did you know that there are multiple culprits for sciatica symptoms and that they are not always caused by problems in the lumbar spine? 

Piriformis syndrome or False sciatica is a condition in which the small Piriformis muscle located deep in the buttocks presses down on the ischiadicus nerve with its tension and causes symptoms such as pain, tingling and reduced sensation in the buttocks area and along the back outside of the upper leg and lower leg. 

These symptoms are very similar or even the same as “common sciatica” and it is very important to distinguish the cause of these symptoms to know how to treat them. 

To understand and distinguish the causes, it is necessary to first understand what the sciatic nerve and the piriformis muscle are and which problems they can cause us.

First aid for sciatica
Piriformis syndrome

Ischiadic nerve is

Ischiadic nerve is the biggest and the longest nerve in the human body that extends from the lumbar spine and passes through the buttocks, the back of the thigh, the back of the lower leg and ends in the foot. 

The ischiadic nerve provides sensation and function in the thigh, lower leg and foot area and allows us to perform actions such as walking, running, climbing and standing. 

In its thickest part, the ischiadic nerve has even 2 cm in diameter

Given all of the above, we believe that you can imagine how many problems can occur if there is dysfunction and compression of this large and very important nerve. 

Piriformis Muscle

Piriformis is a small muscle of the gluteal region (buttocks area) located deep below one of the largest and strongest human muscles, the gluteus maximus. 

Piriformis belongs to the group of 6 short external hip rotators along with gemellus superior and inferior, obturator externus and internus and quadratus femoris. 

Since it is attached to the sacrum at one end and to the large trochanter at the other end, it is responsible for stabilizing the hip joint and moving the hip in different directions. 

The movements that the muscle primarily performs are external rotation in the hip joint and abduction when the hip is in flexion. 

Given its specific position just above the sciatic nerve, too much tension of piriformis can very easily cause symptoms of sciatica. 

Piriformis muscle
caution

How to recognize false sciatica?

Symptoms piriformis syndrome can occur in buttocks, thigh, lower leg and foot

Some of the most common symptoms in these areas are: 

  • pain
  • burning
  • tingling
  • anting
  • weakness
Symptoms can be aggravated by certain activities such as:
  • walking
  • running
  • climbing the stairs

How to diagnose it?

Diagnostics of the piriformis syndrome or false sciatica is often wrong because a specialist examining a patient with sciatica symptoms will very often assume another cause of the problem. 

Also there are no specific medical tests with which the existence of piriformis syndrome can be established with complete certainty. 

3 very important diagnostic elements in this situation are: 

  1. Medical history 
  2. Clinical examination 
  3. Palpation 
Medical history is necessary to be examined in order to understand whether the patient has previous similar symptomatology and whether there is damage to the lumbar spine.
Clinical examination contains specific tests with which we can identify certain problems or causes and exclude others. 
Palpation will be by far the most important part of the examination because by pressing hard on the muscle itself we will get feedback from the patient on whether the pressure causes pain, tingling, and burning along the leg. 
 
If after the examination the specialist is not sure whether there is a problem in piriformis or the problem comes from the lumbar spine, it is necessary to do further radiological tests. 
Physiotherapist Toni signing
Idea

Treatment of Piriformis syndrome

Since the cause of piriformis syndrome itself is too much tension or hypertonus of the piriformis muscle it will primarily be necessary release piriformis muscle

We can release piriformis using:

  • heat (warm compresses, deep heat gel, or similar gel that warms the tissue)
  • piriformis muscle-specific stretching 
  • rolling piriformis on the foam roller
  • massage 
  • trigger point therapies
  • dry needling technique
After relaxing the muscle and removing compression from the sciatic nerve it is necessary to do targeted strengthening of the piriformis muscle to keep symptoms from returning. 
In addition to the piriformis muscle, it is necessary to do targeted strengthening of the surrounding gluteal musculature and trunk muscles to restore balance of musculature and to make the locomotor system function optimally. 

8 steps to healing

1. Understand that the Ischiadic nerve is the longest nerve in the human body that can be compressed in a number of places.

2. The piriformis muscle is located just above the sciatic nerve and its tension easily causes compression. 

3. Symptoms that occur are pain, tingling, burning, and weakness in the buttocks, along the back outside of the thigh and lower leg, and towards the heel and the foot. 

4. Symptoms can be exacerbated by walking, running, and climbing. 

5. When diagnosing, it is necessary to determine the tension and sensitivity of piriformis using palpation. 

6. It is important to exclude disc protrusion and similar diseases of the spine. 

7. To eliminate symptoms, it is important to release the piriformis muscle. 

8. After relaxation, we need to strengthen the piriformis and the surrounding muscles so that the problem does not return again. 

Summary
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When to look for an expert?

If your symptoms of sciatica or false sciatica last for more than a few weeks and do not resolve with any of the methods listed in this article, you should see a medical professional as soon as possible to resolve the problem. 

Piriformis syndrome usually resolves very quickly through a few treatments and there is no need to drag this problem for a long time and struggle with symptoms. 

In Ad Sacrum clinic we treat Piriformis syndrome very successfully every day and do not hesitate to contact us if you suspect Piriformis syndrome or Lumboishialgia because we can help you quickly, accurately and in the long term! 

Contact can be made via E-mail manager@adsacrum.hr or by the contact form

Picture of Bsc. PT. Toni Marić

Bsc. PT. Toni Marić

Tony is a BSc. PT, owner of Ad Sacrum practice and director of Physioverse Academy, has been following elite athletes for years and teaches International courses for physiotherapists and other rehabilitation professionals.

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