Do you know the runner’s false sciatica?
Do you practice running regularly or have started recently and feel pain in the lower back or buttocks reaching to the back of the thigh? Have you heard about sciatica caused by a herniated disc? This meaning nerve compression in the spine that could be the source of your pain and causes electrical sensations. Careful, the diagnosis could be piriformis sciatica.
What is the difference between sciatica due to a herniated disc and piriformis sciatica?
It is simple; the sciatic nerve leaves the lumbar spine to reach the buttocks (middle area), goes down the back of the thigh to the popliteal fossa (back of the knee) where it will split. Due to inappropriate mechanical strain, the vertebrae's discs can flatten and cause the rupture of the circular fibres. These contain a gelatinous substance that causes a herniated disc and finally a compression of the sciatic nerve. When the nerve is affected it is normal to feel that tingling at the buttocks and the back of the thigh, which can reach the tip of the toe.
In the case of piriformis syndrome, the problem is not at the lumbar level but at the level of the piriformis muscle. Where is this muscle? It is a muscle that originates in the sacrum and extends towards the femoral head obliquely. This muscle is quite small but a contracture in it causes sciatic nerve compression and its inflammation as it runs just below it.
How to establish the differential diagnosis?
First you have to consult a professional so he can suggest some additional tests and get to know the origin of that compression and / or swelling of the nerve. In order to rule out the herniated disk an MRI is recommended.
If one suspects of a piriformis syndrome, firstly one will feel discomfort or pain to palpation of the muscle, furthermore trying to take the knee to the belly and against resistance will increase the pain. An musculoskeletal ultrasound is also recommended to see if there are fibrous scars or bursitis. The piriformis syndrome diagnosis is very difficult to stablish, but if it is confirmed, it can avoid treatment failures.
How to treat piriformis syndrome?
It is common to find piriformis syndrome in runners as it can be caused by overtraining on tarmac (very hard surface), by a lack of core stability (lack of plank exercise amongst others), by poor gait biomechanics, inadequate footwear, a muscle distension and many other factors.
Treatment consists of muscle relaxation in the case of a trigger point, with stretching or compression of the taut band. In the case of a rupture or a muscle fibrosis, deep transverse massage is recommended.
If you want to add further treatment other than that offered to you by the doctor, physical therapist or other health care professional you can self-treat yourself in the home, also if you would simply like to prevent that injury, our 3TOOL can help you.
Its peculiarity is that one can treat muscle trigger points applying compression over trigger points in your home. Using zone 1, lying on the ground, you have to let your bodyweight fall over the tool to compress the painful spot that is at the buttocks level, focusing on a taut band that runs from the sacrum to the femoral head with an oblique direction. You can combine this treatment with stretching to relax the overworked muscle (prevention) or contracture (treatment).