A fair amount of what is diagnosed as sciatica is actually piriformis syndrome. The symptoms are very similar. Basically instead of the skeleton putting pressure on the sciatic nerve its the piriformis muscle being overly tense that creates the pressure. The good news is that piriformis syndrome is easier to address. Some of the stretches shown above are a good place to start, as is competent soft tissue massage. Mike
Mike, just in case you had not seen it written up before, piriformis syndrome is a sub-syndrome within sciatica :' ) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001706/ ''Sciatica Neuropathy - sciatic nerve; Sciatic nerve dysfunction Last reviewed: July 10, 2009. Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or compression of the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own. Causes, incidence, and risk factors Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the spine and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot. Common causes of sciatica include: Piriformis syndrome (a pain disorder involving the narrow piriformis muscle in the buttocks) Slipped disk Degenerative disk disease Spinal stenosis Pelvic injury or fracture Tumors Symptoms Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The sensations may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak. The pain often starts slowly. Sciatica pain may get worse: After standing or sitting At night When sneezing, coughing, or laughing When bending backwards or walking more than a few yards, especially if caused by spinal stenosis Signs and tests Sciatica might be revealed by a neuromuscular examination of the legs by a physician. There may be weakness of knee bending or foot movement, or difficulty bending the foot inward or down. Reflexes may be abnormal, with weak or absent ankle-jerk reflex. Pain down the leg can be reproduced by lifting the leg straight up off the examining table. Tests are guided by the suspected cause of the dysfunction, as suggested by the history, symptoms, and pattern of symptom development. They may include various blood tests, x-rays, MRIs, or other tests and procedures. Treatment Because sciatica is a symptom of another medical condition, the underlying cause should be identified and treated. In some cases, no treatment is required and recovery occurs on its own. Conservative treatment is best in many cases. Your doctor may recommend the following steps to calm your symptoms and reduce inflammation. Apply heat or ice to the painful area. Try ice for the first 48 - 72 hours, then use heat after that. Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol). While sleeping, try lying in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure. If at-home measures do not help, your doctor may recommend injections to reduce inflammation around the nerve. Other medicines may be prescribed to help reduce the stabbing pains associated with sciatica. Physical therapy exercises may also be recommended. Additional treatments depend on the condition that is causing the sciatica. Nerve pain is very difficult to treat. If you have ongoing problems with pain, you may want to see a neurologist or a pain specialist to ensure that you have access to the widest range of treatment options. Expectations (prognosis) If the cause of the sciatic nerve dysfunction can be identified and successfully treated, full recovery is possible. The extent of disability varies from no disability to partial or complete loss of movement or sensation. Nerve pain may be severe and persist for a prolonged period of time. Complications Partial or complete loss of leg movement Partial or complete loss of sensation in the leg Recurrent or unnoticed injury to the leg Side effects of medications Calling your health care provider Call your doctor right away if you have: Unexplained fever with back pain Back pain after a severe blow or fall Redness or swelling on the back or spine Pain traveling down your legs below the knee Weakness or numbness in your buttocks, thigh, leg, or pelvis Burning with urination or blood in your urine Pain that is worse when you lie down, or awakens you at night Severe pain and you cannot get comfortable Loss of control of urine or stool (incontinence) Also call if: You have been losing weight unintentionally You use steroids or intravenous drugs You have had back pain before but this episode is different and feels worse This episode of back pain has lasted longer than 4 weeks If any of these symptoms are present, your doctor will carefully check for any sign of infection (such as meningitis, abscess, or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer, kidney stone, twisted testicle, or other serious problem. Prevention Prevention varies depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks. References Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007;(2):CD003010. [PubMed] Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491. [PubMed] Review Date: 7/10/2009. Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.'' Not sure if I agree with everything in the above but not a bad general overview. powchoy
Interesting, I've previously only seen sciatica used to described skeletal (ie. stenosis or disc herniation) causes, with piriformis syndrome being considered a separate (and usually milder) entity. Thanks for that link. I must confess I prefer the distinction between the two, if only from the point of view that the label 'sciatica' has connotations of being essentially incurable in a lot of people's minds (regardless of the reality of that). Whereas piriformis syndrome, other than being relatively unheard of, is muscular in origin and therefore can be addressed - cured even. Semantics I know (granted it's all about aggravation of the sciatic nerve), but it can give the afflicted hope and therefore motivation to do something about it themselves. And that is at least half the battle. Mike
Mike, that's why I asked about back pain. We were taught that true sciatica does not involve the back and that pain referred down the leg is more appropriately called something else.. usually a radiculitis if it is from a stenosis or disc injury. People should not give up easily with any type of leg pain related to the back or sciatica as many complaints can be effectively managed by patients. Good point on always trying to give people a reason to be positive and expect recovery. powchoy
Saw the quack today - he must read MAP! Doc: "What's up?" Me: "You can pack that in for a start!" Doc: "Sorry. A little surgical humour. What's the trouble?" Me: "I think I've got sciatica." Doc: "Why?" Me: "Sharp pains shoot from my buttocks to my calf, but my back itself seems okay." Doc: "I think you've got sciatica." Me: "That's what I thought." Doc: "What do you want to do about it?" Me: "Well I've been taking ibrubofen and now I've come to see you." Doc: "That's good, because I reckon you should take ibrupofen. And paracetamol. And do some exercise, stretches and think about some physiotherapy." Me: "That's good, because I do a lot of exercise and stretching and I can get free physio therapy at work." Doc: "Well give it a few weeks and if it's not better come see me again." Me: "It's already been more than a few weeks." Doc: "Give it a few more weeks then." Me: "Okay." Doc: "Bye." Me: "Bye."
I hope you're no longer suffering, but just in case, I thought I'd mention my experience with sciatica. I suffered for several years on and off, each bout coinciding with occasions when my partner was suffering from a bad back. I was bemused by the coincidence so I kept it to myself. Eventually a friend asked whether I was doing anything periodically that put uneven pressure on my spine. She had started to suffer from sciatica when she acquired a puppy and began to sit on the floor with it to dissuade it from sitting on the sofa. Each time she was resting with her lower back against the edge of the sofa. Curiously, every time my partner’s back was bad I was sitting on the floor with him, leaning against the edge of the sofa. I stopped and so did the sciatica! Thought I’d mention it, just in case… Hope it’s under control now. Greensox
No relief yet, I'm afraid. But I'm on stronger painkillers which helps. And I'm back on the motorbike for my commute to work as I can hold my lower back in a position which doesn't send shards of pain down my leg like the crappy old car seat! I've got a grading at the end of the month and I'd be loathe to postpone it again as I missed the previous one because of my work schedule.
Stay active and get a MRI.... hopefully this will show up the problem and u can fix it. I suffered for years and was constantly on painkillers, had a MRI, had a laminectomy from L3 to S1 and now take one ibuprofen per month....
A bit late to this thread but last summer I had exactly the symptoms you described when I was on holiday. It was agony and the only relief I got was from actually moving around (although 'relief' is how I'd describe it just hurting 'less'). I'm pretty sure it was the way I'd set the seat in the rental car, as soon as I got home - hey presto!- i was fine! So you haven't changed cars recently or altered your seat? Just thought I'd mention it so you can eliminate or investigate! Cheers Matt ps I believe a John Terry had a similar problem recently that seemed to stem from this
Had my first consultation and session with a physiotherapist this morning. After an hour of questioning and prodding, her thinking is that the pain is caused by a double whammy of a dodgy disc and spasms in the piriformis muscle. A few home exercises and body posture changes plus a few more weekly physio sessions to begin with - then MRI and further investigation if there's no improvement. She also recommended a break from martial arts. I said I'd think about it after my grading on Sunday! She was pretty scathing of some of the stretching/exercise routines we do in class!
The exercises set by my physiotherapist are also one highly recommended in that book. Many thanks! I pleased there has been some inprovement after two weeks treatment. I'm using the painkillers in a more structed way than I was before and have worked hard to improve my general posture at work and at home. I'm hoping the improvement continues through this course of action as she has proposed the totally unappealing prospect of injections into the deep piriformis muscle around the nerve if the pain continues.
Traditional Exercises I have to agree with you, Sama, that some of the stretching exercises in traditional martial arts are quite dangerous and cause more damage than good. Anything that involves "bouncing" to stretch is bad and can cause damage to the muscle tissues. Using steady stretches or PNF (proprioceptive neuromuscular facilitation) techniques are much safer and the PNF techniques can produce better results than the "bouncing". I hope your PT is wrong about the disc, because discs don't just do that. Disc problems are normally a symptom of something else going wrong. Please note: I AM a chiropractic physician, but I am not YOUR chiropractic physician. This post does not in any way establish a doctor-patient relationship. You need to discuss your health with your physician or other licensed health-care provider. Following any suggestions in anything I post is done entirely at YOUR OWN RISK.
Well I now wish I'd sought help as soon as the pain started. After a month of physio, diligently carrying out my physio's recommended exercises (and refusing to do certain exercise/stretches in my MA training!) and few changes to my posture - I'm almost pain free! Sporadic episodes now rather than continuous misery. So listen up kids, don't wait to get help or hope it'll get better on its own - see someone who knows the score nice and early!
Good stuff! The information in the book , Treat Your Own Back, is cheap, easy to apply and something that will help to keep problems away in the future without the need for alot, if any, treatment. The goal is self management and understanding how to be responsible for your own health. Hope to hear that things completely resolve soon. :' ) powchoy
