Sciatica, or nerve pain that goes down the leg, can have multiple causes including disc herniation, spinal stenosis, a little pain in the butt muscle called the piriformis. In this video we're going to focus on piriformis syndrome which is sciatic nerve pain caused by the piriformis muscle being too tight. Now the piriformis muscle can cause problems because it passes right over the sciatic nerve. Therefore, when it gets tight it compresses that nerve. And this can be particularly problematic because we sit on that nerve and muscle everyday which, when it's irritated, can be quite painful. Symptoms of piriformis syndrome include pain in the buttock, pain down the leg, numbness and tingling into the leg and foot, pain with sitting especially but also with standing and squatting. It can sometimes cause swelling in the leg as well.
Sometimes it can be difficult to tell if the sciatic nerve pain is coming from the piriformis or from the spine. But in general piriformis syndrome will feel like it originates in the buttock not the spine. Also with piriformis syndrome you usually won't get weakness in the leg whereas you can if it has spinal origins.
In some people sciatic nerve pain can be caused or aggravated by sitting on a thick wallet. Make sure to remove your wallet from your back pocket if you suffer from piriformis syndrome.
Piriformis syndrome can also be accompanied by S.I. joint problems, so if you feel like this is the case see my S.I. joint correction and exercise videos for help with that.
To get some relief we're going to do some exercises. We'll start with releasing and stretching the piriformis muscle.
Get on a foam roller in a figure 4 position and lean towards the affected side. Roll slowly 10-20 times. WARNING: this can be pretty intense! Don't beat yourself up too much! You can ease your pressure by pushing more with arms and opposite leg. It can also be performed with a tennis or racquetball, but these are likely to be even more intense.
Follow up the foam roller release with a targeted piriformis stretch. While lying on your back or sitting in a chair, get in a figure 4 position and pull your knee toward your chest. You should feel this stretch in your buttock where your pain begins. If not you may need to adjust the angle of your hip or pull harder until you do. Hold this stretch for 30 seconds and repeat 3 times. If you need to get a little more aggressive this can be performed standing with your leg in the same position up on a table or a bed.
Next while you're on your back hold your hip at 90 degrees and extend your knee while actively pushing you ankle back until you feel a moderate to strong stretch. If this causes your leg pain, don't push it too hard. Just go up to the point where your symptoms begin, or just short of that point. Hold for 5 seconds and repeat 10-20 times. This exercise can flare you up if you push it too hard, but if done correctly it can really reduce your nerve pain.
Last we'll do an exercise that activates the piriformis and gluteal muscles. While lying on your back, perform a single leg bridge. Lift your hips as high as you can off the table without aggravating your pain. Hold for 5-10 seconds. repeat 10-20 times.
Do these exercises 2-3 times per day. If there is any particular exercise that seems to give you more relief you can do it even more frequently. Try to avoid positions or activities that aggravate your pain the best you can. If you have to sit for prolonged periods during the day get up every 30 minutes or so and walk for 2 or 3 minutes or do some of your stretches to help break the pain cycle.
These exercises have worked quite well for my patients in the clinic and I hope they do the same for you. If you need more help, dry needling effective in getting that piriformis muscle to let go, which is available here at Stronglife Physiotherapy.
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AJ Ludlow is a Doctor of Physical Therapy serving the Provo/Orem area and specializing in the treatment of musculoskeletal pain and injuries.
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Conveniently located in Jamestown Square, in the heart of Provo, Utah.
AJ Ludlow, DPT
Doctor of Physical Therapy
3585 N University Ave.
Provo, UT 84604
Monday - Friday
8:00 AM to 6:00 PM
By appointment only