Sciatic Pain and the Piriformis Muscle

By Dr Ryan French

Yesterday a new patient presented to our office having been given the diagnosis of "SCIATICA" (pronounced sigh - attic - ah) by their family physician.
The sciatic nerve runs from the lower back, through the gluteal region and down the leg, right into the toes. It has many branches to it, is one of the longest nerves in the body, and pressure on it is downright painful. In fact, it can be completely debilitating.
"Sciatica" is the name used to simply describe inflammation or irritation of this nerve. But, a diagnosis of simply 'sciatica' is the same as saying a diagnosis of headache, or back pain... all of which are descriptions of a type of pain, but do not clearly identity the cause of the symptom.
This is why a simple diagnosis of "sciatica" is incomplete at best as it does not differentiate sciatic pain caused by vertebral subluxation, piriformis spasm, the presence of disc or bone pathology, a degenerative process, weakness in surrounding musculature, etc.

In order to properly correct a problem, I believe you need to understand the cause of it first.
In some circumstances (about 15% of the time), the main muscle involved is the piriformis muscle.
It is a small muscle that extends from the bottom of the sacro-iliac joint to the top part of the femur bone. The job of the piriformis is to rotate the hip outwards, or to lift the leg outwards from the body when the hip is bent or knee is raised.
Tightness in this muscle is related to sacro-iliac pain and some types of sciatica. It is most often involved when someone feels a sharp pain in the buttocks, sometimes with pain radiating down the back of the leg.
To stretch the piriformis muscle, lie on your back and cross the involved leg (the sore side) over the other, placing the outside of the ankle on the front of the opposite thigh. For example, if your right lower back is sore, lay on your back, bend your knees, and then cross your right leg over your left, ensuring that your right outside ankle is placed on the left thigh, just above the knee.
Then, with both knees now bent, clasp your hands together behind the knee of the lower leg, and gently pull the lower leg toward your chest. In the example above, you would be holding your left leg in your hands, in order to stretch the right piriformis. Pull until you feel a stretch in the gluteal region.
Depending on the shape of your hips, you may need to pull towards one shoulder or the other to feel the stretch more intensely.

Hold for 30 seconds, then rest 30 seconds. Repeat 1-3 times. Feel free to stretch both sides for symmetry and balance in the pelvis.
If you are experiencing a re-occurring problem with this muscle, you'll need to have someone diagnose WHY this muscle is in spasm. Many times, simply stretching it or massaging it to loosen it up still does not address why the muscle is in spasm in the first place.
A standard chiropractic evaluation that includes assessing your posture, range of motion, palpation, nerve scan and x-ray will easily identify the cause of the problem. Once a proper, more detailed diagnosis is made, treatment protocol can be more customized/specific to your individual needs.

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