Piriformis Syndrome or Sciatica?

Many of my clients come to me asking for help after having been diagnosed with Piriformis Syndrome (PS) aka "Pseudo Sciatica". PS is caused by either a tight piriformis muscle or a spasm of the same causing irritation to the underlying Sciatic nerve. The term "Pseudo Sciatica" already indicates that it is hard to differentiate between true Sciatica and PS, as both cause the same symptoms (pain, tingling, burning, "electrical shock" sensations, and/or numbness down the leg, often all the way to the foot). Some recent studies contribute a tight piriformis or a piriformis spasm to the fact that the muscle is overworked due to weakness in gluteus medius and maximus (buttock muscles). True Sciatica is most commonly caused by the compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region.

How can you actually tell the difference? There are two simple diagnostic exercises that give you a very good idea whether you are dealing with Sciatica or PS. If from a sitting position the patient/client straightens his/her painful leg and experiences an increase in pain you very likely are dealing with true Sciatica. If your client/patient pulls up his/her knee (painful side) from sitting position towards the same-side shoulder an increase in pain is only likely in severe Sciatica cases. If the same maneuver is performed towards the opposite shoulder and causes an increase in pain you most likely are looking at a client/patient with PS.

Can Exercise Therapy reduce the symptoms of Piriformis Syndrome?

Unfortunately there are no real scientific studies available that address this particular question. Treatment for PS has traditionally included physical modalities like heat, ice and ultrasound, stretching, and a combination of local anesthetic, corticosteroid and botulinum toxin injections into the piriformis muscle, muscle sheath, or sciatic nerve sheath. Furthermore Physical Therapy included soft tissue mobilization, positional release, and joint manipulation, performed two to three days per week over a three months period.

Recent case studies suggest that exercises strengthening the gluteus maximus and medius and help with movement reeducation can reduce PS symptoms dramatically and in some cases lead to a full symptom resolution within a couple of months.

Exercises recommended in these case studies and have shown improvement in my own PS clients included:

• Piriformis Stretches
• Resisted Side Step Abduction
• Supine Bridging
• Resisted Clam Shells
• Myofascial Release of Piriformis with Foam Roller
• Clock Lunges
• Clock Single Leg Hops

I hope I was able to shed a little light onto the problem of Piriformis Syndrome vs. Sciatica and my tips prove to be helpful to you or people you might train.

A Sante,
Hartmut