Piriformis Syndrome/Sciatica. Which is it? How Can it be Fixed?


We are continuing our deep dive into sciatica and sciatic-like pain. We are going to look at a couple of deep muscles in your rear called the piriformis and gluteus medius. A diagnosis called “Piriformis Syndrome,” has become quite pervasive in today’s society. Piriformis Syndrome is a condition in which the sciatic nerve bisects the piriformis muscle; each time the muscle contracts it causes sciatic pain. And while that is a proper medical diagnosis, it is quite rare. It’s roughly 6% of the population rare. Unfortunately this misdiagnosis and misunderstanding of the true cause has led to years of pain and numerous unnecessary surgeries.

But, even if the sciatic nerve doesn’t pass through the piriformis muscle in an overwhelming percentage of the population, it doesn’t mean we can ignore the piriformis muscle all together. You see, the piriformis and another muscle that works in conjunction with the piriformis, the gluteus medius, are commonly weak and irritated. These two muscles are big hip rotators and stabilizing muscles. Unfortunately, we all know we sit too much as a society. This ends up stretching these muscles out too much and weakens them simultaneously.

sciatic nervesciatic nerve side view

So, why are we talking about weak hip muscles when the theme this month is sciatica? Well, when these muscles are weak and mad, they start forming trigger points (adhesions/knots). These trigger points (TPs) refer pain to other parts in the body. In the case of these two muscles the referral pattern they produce is a doppelganger for sciatica. What ends up being even trickier is both sciatica and TPs in these muscles are aggravated by sitting for prolonged periods.

The Fix:

OK, we’ve established the piriformis can cause sciatic like pain, but often isn’t piriformis syndrome and therefore doesn’t require surgery. What can be done? In the short term, dry needling and active myofascial release can be administered to calm down the TPs and muscle. But, if we just stop there and don’t address the well-being of the muscle, more TPs will develop/return. The long term fix is to adequately strengthen the muscles.

Quite frankly, there are numerous ways to strengthen these muscles. For this article we will demonstrate goblet squats. This is an awesome whole body exercise that emphasizes both muscles we’ve talked about in the hips.

For the goblet squats you’ll need a kettle bell, dumbbell, or some other item that weight 20-40 lbs. I have even used my two year old son (he thinks it’s a game and loves it). You’ll hold the kettle bell in front of your chest as you perform a squat. To do the squat, keep your back straight, feet hip width apart and turned out 5-10 degrees. As you squat down, keep your knees over your feet. Do three set of ten reps, two times per day.

If these exercises haven’t fully resolved the issue, or you know someone that might benefit from our services, be sure to schedule from our website www.activehealthKC.com or call 913-341-1200.