Piriformis Syndrome Versus Sciatica – What Are You Suffering From? | Physical Therapy for everyBODY
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Piriformis Syndrome Versus Sciatica – What Are You Suffering From?

Piriformis Syndrome

Do you have a literal pain in your butt that you cannot figure out? Have friends told you that you are suffering from sciatica? And, Dr. Google tells you that it’s Piriformis Syndrome?

Are you wondering what is the difference, why is it important, and MOST IMPORTANTLY what can I do to feel better now? If you are struggling with butt and leg pain and want to learn more – then read on!


What is Piriformis Syndrome?

The piriformis is a muscle that starts on the front of the sacrum (tailbone) and moves out to the side to attach on the femur (thigh bone). It’s job in life is to turn your foot outward and bring your leg out to the side like when you’re getting out of the car.

The piriformis, just like any muscle, can get tight. This may be caused by overuse, poor posture, or weakness in the muscle. The reason why the piriformis is of particular interest is because it is located very close to the sciatic nerve. In fact…

Want to know a fun fact you can use at your next party? The sciatic nerve either travels THROUGH, underneath, or on top of the piriformis muscle. Yep, all three positions are considered “normal”. How do you know which one you have? Well, you don’t really. And, truly, it doesn’t really matter. The sciatic nerve can get “trapped” in all 3 positions.


What Are The Most Common Causes of Piriformis Syndrome?

Most commonly, the piriformis gradually tightens over time due to repetitive activities such as prolonged standing or activity without proper strength in the piriformis. You can also have direct trauma (such as a fall on your buttocks) that causes scarring and spasm.


How Do I Know if I Have Piriformis Syndrome?

Many people suffering with Piriformis Syndrome have increased pain when they are sitting down. Which makes sense because this puts increased stress on the piriformis muscle. Because you are sitting on it!

You may find that symptoms initially improve when you stand up and start moving around. However, walking for more than 20 minutes may increase your symptoms. You also may have increased symptoms if you perform a squat like motion either for exercise or daily activities like gardening.

As symptoms progress, you may start to have numbness and tingling going down the back of your leg and even into your foot. When symptoms progress to this point, you know that the piriformis muscle is very tight and putting increased stress on the sciatic nerve.

If your symptoms started in your buttocks and are progressing by traveling down your leg and even into your foot, it is time to get help from a specialist. When your symptoms start traveling, your body is telling you that this situation is headed in the wrong direction. And, you want to find real answers before this gets any worse.

One patient we worked with, we will call her Kathy, started having piriformis symptoms when she was running. After a long run, she would have some numbness and tingling down the back of her left leg for the rest of the day. Initially, her symptoms would disappear as she was sleeping and the next day everything would be fine.

Until the day that Kathy started noticing the tingling while she was sitting for work. This time the symptoms did not go away overnight.

By the time Kathy got in to see us, she was no longer able to run at all due to the constant pain and her piriformis muscles felt like a giant ball. We were able to use manual therapy techniques to get rid of the tension in the piriformis as well as deal with the pelvic malalignment that had started the whole problem in the first place.

Kathy was grateful to get back to running and even completed a half marathon recently. When we asked her what she would tell herself when her symptoms first stared she said “Don’t wait. It doesn’t hurt just to get it checked out”.


Are You Ready to Figure Out What The Root of Your Leg Pain is? 

Are you tired of living with the pain and letting it control what you are able to do in life? If you are ready to learn more about how our Specialist Physical Therapists can help with your leg pain, then we encourage you to sign up for a Free Discovery Visit. During this visit, we will listen to your story and see if you are a good fit for what we offer at PT4EB.

Okay, so the sciatic nerve goes through/under/on top of the piriformis – but where else does it go?

The sciatic nerve is the largest nerve in your body. It starts in your low back where FIVE of the nerve roots join together to for the sciatic nerve. The nerve then travels into your buttocks and either through, underneath, or on top of the piriformis muscle. Leaving your buttocks, it travels down the back of you leg and splits at about the level of your knee. The sciatic nerve then branches into other nerves that continue down your leg and into your foot and toes.


What Are The Most Common Causes of Sciatica?

The most common cause of a true case of sciatica is increased pressure being put on the nerve from the discs in the lumbar spine. This may be due to a disc that is bulging or herniated and is putting increased stress on the nerve roots. Or you may have a narrowing in the spinal canal that decreases the space available for the nerves to travel through. This is called spinal stenosis. Some people have arthritis in their spine that can also increase pressure on the sciatic nerve.

Side note here: Many people come to see us because they have been diagnosed with arthritis in their spine and been told that surgery is the only option to eliminate the arthritis. Well, the research tells us that although arthritis is common in the spine, it may not be the cause of our pain. You see, many people have arthritis in their spine and are completely pain free. So, if you have been told that you have arthritis in your spine and you have to have surgery – there is hope!


How do I know if I have Sciatica?

Many people with sciatica have moderate to severe pain in the lower back, buttock, and down your leg. As symptoms progress you may also find you have weakness in this same path.

You may find that you have a loss of motion in your low back and hips. Or that your pain increases significantly when you try to move so you stop trying to do that!

As symptoms progress, you may start to have “pins and needles” feeling in your low back, buttocks, feet or toes. When symptoms get to this point you know that the pressure on the nerve is increasing. It is time to seek help from a specialist who can figure out the root of your problem and help alleviate the pressure.

Some people also have a loss of bowel and bladder control.

Really important side note here:

If you have loss of bowel and bladder control, you need to see a doctor immediately. This is a very rare condition called cauda equine syndrome and needs to be evaluated immediately. Do not pass go, do not collect $200. Get to a doctor and get this evaluated.

There you have it! True sciatica starts in the lower back due to pressure on the nerve roots that form the sciatic nerve. While piriformis syndrome involves the sciatic nerve getting “trapped” in the piriformis and causing buttock pain.

Did you know that there are actually specific tests that a Specialist Physical Therapist can perform to determine if you are suffering from sciatica or Piriformis Syndrome? Yep, there certainly are. If you want to understand more about what is going on with your body then we encourage you to sign up for a Free Discovery Visit. During the 100% free, no obligation appointment we will hear your story and determine if we are a good fit for what your body needs.

We will also answer all your questions about your symptoms and what the probable cause is. In most cases, imaging is NOT required to determine if you have Piriformis Syndrom or Sciatica. And, once the proper diagnosis has been established we can work together to develop a program that will get you back to all the activities that are important to YOU.

If this sound like what you are looking for, we encourage you to click here to sign up for a Free Discovery Visit and finally get to the root of your pain – literally!


Dr. Amy Konvalin

Dr. Amy Konvalin

Struggling with pain and dysfunction can impact every part of our lives — it drains our energy, distracts us from our goals, and keeps us from the people and activities we love. As an Orthopedic Clinical Specialist, Dr. Amy Konvalin understands how frustrating those limitations can be — and she knows how to help get you back to the life you want to live! Beginning with a focused evaluation, Dr. Amy works to determine the root causes of your pain, as well as understanding how it affects the way you move through your world. Dysfunctional patterns of movement often grow worse with time and cause further damage if left untreated — so it’s important to address these issues as soon as possible. Dr. Amy knows there is no one-size-fits-all plan for success, and she partners with patients to identify their unique treatment goals and personal values. Using these goals as a guide, Amy uses her doctorate training in manual (hands-on) therapy and exercise prescription to treat patients with a wide variety of medical challenges and histories throughout the Maple Valley, Black Diamond and Covington areas. Dr. Amy is also a wife to a Boeing superstar/former C-130 navigator. While they lived in Germany, Dr. Amy was able to volunteer with the US Army to treat military personnel and civilians on base. She has two beautiful teenage ballerinas who keep her on her toes and educate her on all things ballet! Bailey, the princess pup, is her running partner and her napping partner. In the spare moments in between, Amy enjoys reading, yoga, wine with friends, Pilates, and walking on the beach.
Dr. Amy Konvalin

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