Piriformis Syndrome – a pain in the ass
So over the last few weeks I’ve talked about lower back pain and sciatica in particular. I’ve also been talking about those conditions that can sometimes get bundled up in a general “sciatica” muddle like Iliotibial Band Syndrome. (it’s ok, you can go read them, I’ll wait!)
And today we are going to look at another one of those conditions that can cause similar symptoms – Piriformis Syndrome. This may be the most common cause of sciatica-type back pain that you’ve never heard of.
What is it?
The piriformis muscle is a small muscle located deep in the buttock (behind the gluteus maximus).
“Great,” you’re thinking, “what has a muscle got to do with nerve pain?”
When muscles are relaxed and happy they lie smooth and flat with space between for all your body’s communication systems to pass through – blood, nerves, lymphatic etc.
But when a muscle gets overworked or unhappy it clenches up, getting fatter and inflamed. This reduces the space between the muscles and the body’s communication highways are suddenly down to single lane traffic with a speed camera up.
And guess which nerve passes right alongside the piriformis muscle? Yup, you guessed it – the sciatic nerve.
Symptoms – the bottom line
Unsurprisingly a common symptom is pain in and around the buttocks which then starts to “spread” down the legs as the sciatic nerve becomes more irritated.
Sitting can often make you more uncomfortable, as can walking or running while lying flat eases symptoms.
Cyclists, equestrians and rowers who “sit” for long periods as part of their sport can often find they feel worse after training.
There is also one other common cause – your wallet in your back pocket! The fatter the wallet, the bigger the pain in your ass. (!)
Placing your wallet in your back pocket and then sitting for a long time (particularly in the car) can place unbalanced pressure on the spine and buttock muscles and eventually irritating the nerve.
The solution is a “walletectomy”. This means, take your wallet out of your back pocket and put it somewhere safer, like your front pocket.
The beauty of preventative medicine!
What to do?
Get an accurate diagnosis! Piriformis syndrome can often be confused with hip problems or lower back problems as symptoms get muddied and it takes time and solid movement review to identify.
Get the wrong diagnosis and you can spend a lot of time (and money!) on treatments that aren’t solving the problem.
The primary goal of any treatment is to reduce the overworking piriformis muscle, get it to relax and reduce the pressure on the sciatic nerve.
That can include exercises to strengthen other complimentary muscles, training review, stretching to improve mobility and looking at how you move in everyday life.
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