Piriformis Syndrome and Its Link to Sciatica

By Dr. Bryen Brown

March 15, 2018

Sciatica is not what you have but what you feel. It’s commonly a painful sensation when there is compression or irritation to the sciatic nerve that’s located in the low back. The sensation is usually described as pain, numbness, tingling, burning, and/or weakness that is mostly felt in the low back but can travel down into the buttocks region and down the back or posterior of either leg. When you feel those sensations down both legs simultaneously, its usually a different issue and not sciatica.

There are many different causes of sciatica. The most common culprits are vertebral misalignments which can compress the nerve, pelvic imbalance can lead to compression of the nerve, and muscle dysfunction can be a by-product of an imbalanced body and it also can compress the sciatic nerve. Other causes are structural changes caused by degeneration or traumatic events. The topic of discussion today falls under the umbrella of muscle dysfunction. One in particular called “Piriformis Syndrome”.

What is Piriformis Syndrome? I’m glad you asked.

First lets explain where a piriformis muscle is and what it does. There is a right and left piriformis located deep in the gluteal region in the pelvis. Its described as flat and pyramidal in shape. It originates bilaterally on the left and right borders of the sacrum and attaches to a notch on top of the femur(thigh bone). The piriformis muscle has two jobs, it laterally rotates the leg when the hip is extended and abducts the leg when the hip is flexed. So as you lift your leg in front of you it pulls the leg out away from the body. If you lift the leg behind you it rotates the leg out or clockwise.

The piriformis is an important muscle when walking. As you’re in motion, it contracts to shift your body weight to the opposite side of the foot that is being lifted which prevents you from falling. Also important when squatting and lunging.

Piriformis syndrome is when one of the piriformis muscles spasm, tighten, or become inflamed and cause compression to the sciatic nerve.

The sciatic nerve is comprised of multiple nerves from the lumbar and sacral spinal segments that bind together to create the larger sciatic nerve. The piriformis muscle belly sits next to the sciatic nerve in the gluteal region. When it becomes stressed it leads to irritation of the nerve.

A common cause of Piriformis syndrome is participating in activities that can cause an imbalance in the pelvis. When the pelvis is out of alignment the muscles and joints are forced to work at a different level causing one side to tire out before the other creating spasms, and in some cases strain and swelling. Poor body mechanics and bad posture can lead to an imbalance in the muscle which increase the risk of injury to the muscles.

A ton of Americans work office jobs where they are sitting at a desk or work in logistics where they are sitting in car or truck. The repetitive nature of your job activities while in bad posture for multiple hours a day and 5 days a week will eventually create a problem.

One of the self remedies most people try first after understanding that posture can help is trying to remember to stay in good posture. That should help right? WRONG…..

Remembering to sit in good posture every time you sit down is the worst strategy because it’s nearly impossible to sustain. The moment your mind focuses on the computer with reports, statements, etc., then typing in spreadsheets, all of your posture thoughts are thrown out of the window. This is especially the case when its the end of the day and your mind and body is tired. You may be thinking about the best position for your body at that time, but that’s called sleeping posture when you’re laying in your bed. (Good transition though)

Sleeping posture is also important for pelvic imbalance. Side sleepers are encouraged to sleep with a pillow between the knees so the top leg doesn’t fall in front of the body. This creates a sustained rotation in the pelvis that leads to issues. Or just try to start sleeping on your back.

The same with crossing your legs over and over throughout the day. For some, sitting with their legs crossed or sitting on their feet is a constant. Most people who cross their legs or sit on their feet throw the same sided leg over or under the other and they create this repetitive imbalance in the joints and muscles.

Guys who keep their wallets in their back pocket are hurting themselves on a daily basis as well. Imagine an object sitting on a table. Now imagine that same object with a huge wallet under one side of it. Can you imagine the difference in height on one side to the other. No matter the wallet size, sitting with a wallet under you on one side will create higher hip on that side and throw off the balance of the pelvis.

Recommendations to get relief or rid your body of sciatica via piriformis syndrome focuses around regaining pelvic balance throught the bones and joints while also releasing tension and spasm in the muscles. If you do like most and just think its a muscle issue, you may miss the boat like most and deal with sciatica issues long term. Muscles and bone play hand and hand.

When a muscle contracts what does it move? Whatever bone its attached to.

In this case its the piriformis muscle that spasms and pulling the pelvis out of it normal alignment. Chiropractic adjustments to help realign the pelvis would be necessary in this case to balance your pelvis, which balances the muscle use and prevent the spasms of the piriformis muscle that compresses the sciatic nerve. The correct exercises that stretch and strengthen the muscles that affect the pelvis will keep the pelvis loose and in good alignment. Get both back into balance and you give yourself the best chance to reduce your sciatic symptoms.

Dr. Bryen Brown

About the author

Dr. Bryen Brown is married to Dawn and has one son. He grew up in Bogalusa, LA and received his Bachelor of Science Degree in Biology from Grambling State University in 2008. He then attended and graduated from Texas Chiropractic College in 2012. Click Here To Read Full Bio

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