Sciatica "The Scourge & The Treatments"

The piriformis is a large and powerful muscle beneath the gluteal/buttocks muscles. It runs from the bottom of the sacrum, where the base of the spine and pelvis converge to the top of the femur. This muscle plays a critical role in running motion; it helps externally rotate the hips and upper leg outward, provides hip flexibility and stability, and stabilizes the pelvis. The sciatic nerve passes next to, over, under, or through the piriformis muscle. When the piriformis contracts or spasms, it can irritate, become entangled and compress the nerve, resulting in painful symptoms. This can lead to various problems and is how piriformis syndrome occurs.

Running Piriformis Syndrome

The proper function of the piriformis muscle is essential for athletes who participate in running sports. Repetitive activities, like running, can fatigue the muscle and irritate and inflame the nerve.

Symptoms

Piriformis syndrome can be challenging to diagnose because it can be confused for a herniated disc, sciatica, a proximal hamstring strain/high hamstring tendinitis, or lower back problems. A few symptoms that can help determine whether the piriformis is the cause include:

Sitting, Stairs, Squatting Discomfort or Pain

• Individuals don't always experience discomfort while running.
• Instead, it's sitting, climbing stairs, and squatting where pain symptoms present.
• Pain while running, specifically an overstretched sensation when going up a hill or increasing speed, is more associated with a proximal hamstring strain.

Tenderness

• The area around the piriformis is tender.
• Applying pressure can cause discomfort or pain around the area and radiate down the leg.

Centered Pain

• Piriformis syndrome is usually felt in the middle of the glutes.
• A proximal hamstring strain typically causes non-radiating pain at the bottom of the glutes, where the hamstrings connect to the pelvis.

Causes

• Pelvic misalignment.
• Pelvic misalignments created by other conditions, like a tilted pelvis, functional leg-length discrepancy, or practicing unhealthy posture, make the piriformis work harder to compensate, which leads to tightness and/or spasms.
• Sudden increases in distance or workout intensity can worsen any weakness in the piriformis and other gluteal muscles.
• Continuing to run, which is possible, can worsen and prolong the condition.
• When running, the muscle's signal transmissions are interrupted by inflammation and/or compression and cannot synchronize with each other.
• The result is the inability to withstand the repetitive strain of running.
• Not warming up with glute-activation exercises increases the risk of running piriformis syndrome.

Chiropractic Treatment

Resting may not be enough to alleviate piriformis syndrome. This is especially true if the problem involves spine and pelvic misalignment. Chiropractic can provide significant relief from running piriformis syndrome. A combination of spinal, pelvic, and extremity adjustments, therapeutic massage, MET, decompression, stretches, and anti-inflammatory nutrition will take the pressure off overly tight areas, realign the body, and maintain nervous system function.

• Running form could be evaluated and checked for leg-length discrepancies and muscle-strength imbalances.
• Running can continue if the individual can do so without pain or symptoms.
• But it is recommended to avoid slanted surfaces, which increase the risk of pelvic misalignment.
• Avoid long runs, which increase the chance of overload and fatigue.
• The goal is to relax and release the piriformis.
• If it’s impinging on the sciatic nerve, loosening and releasing the muscle will significantly lessen radiating pain.
• Orthotics may be recommended for excessive overpronation or inward movement of the foot when landing.

Other treatments to stop piriformis spasms.

• Ice and take over-the-counter anti-inflammatory medications can be used during acute phases when the area is tender.
• Work out tight spots using a foam roller or percussive massager.
• Stretching and loosening the muscle before and after runs can help it relax and increase blood flow.
• Stretches like pigeon pose and standing figure four and exercises like side planks with a leg lift are recommended.

Building a Stronger Body

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Ahmad Siraj, Sidra, and Ragini Dadgal. “Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release.” Cureus vol. 14,12 e32952. 26 Dec. 2022, doi:10.7759/cureus.32952

Chang A, Ly N, Varacallo M. Piriformis Injection. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Heiderscheit, Bryan, and Shane McClinton. “Evaluation and Management of Hip and Pelvis Injuries.” Physical Medicine and rehabilitation clinics of North America vol. 27,1 (2016): 1-29. doi:10.1016/j.pmr.2015.08.003

Julsrud, M E. “Piriformis syndrome.” Journal of the American Podiatric Medical Association vol. 79,3 (1989): 128-31. doi:10.7547/87507315-79-3-128

Kraus, Emily, et al. “Piriformis Syndrome With Variant Sciatic Nerve Anatomy: A Case Report.” PM & R: the Journal of Injury, Function, and Rehabilitation vol. 8,2 (2016): 176-9. doi:10.1016/j.pmrj.2015.09.005

Lenhart, Rachel, et al. “Hip muscle loads during running at various step rates.” The Journal of Orthopedic and sports physical therapy vol. 44,10 (2014): 766-74, A1-4. doi:10.2519/jospt.2014.5575

Sulowska-Daszyk, Iwona, and Agnieszka Skiba. “The Influence of Self-Myofascial Release on Muscle Flexibility in Long-Distance Runners.” International Journal of environmental research and public health vol. 19,1 457. Jan 1, 2022, doi:10.3390/ijerph19010457

Hamstring syndrome is a condition where the sciatic nerve gets pinched between the hamstring muscles and the pelvic bone or by the tissue bands that connect the hamstring muscles causing compression on and around the nerve. It is seen in individuals that play sports that involve running, kicking, or jumping, in middle-aged individuals engaged in daily activities that have suffered falls, and in individuals that sit for many hours. Chiropractic care, massage, and decompression therapy can relieve the symptoms, release the trapped nerve, relax and stretch the muscles, and restore function.

Hamstring Muscles Trapped Sciatic Nerve

Three muscles make up the hamstrings in the back of the thigh. The sciatic nerve runs from the low back down the leg into the foot. A trapped sciatic nerve can cause various symptoms and sensations in the back of the leg, hip, buttock, and foot. It may hurt to sit down or stretch the legs out, and there is usually tightness in and/or around the buttock and back of the leg. The symptoms typically recede when lying on your back.

Cause

• Regular wear and tear on the back muscles and hamstrings can contribute to the condition.
• Often the sciatic nerve and/or the sheath surrounding the sciatic nerve gets trapped and irritated as it travels around the ischial tuberosity. The ischial tuberosities are known as the sit bones.
• The area where the sciatic nerve runs down the back of the leg can become narrowed, leading to nerve irritation and stinging, numbing, and tingling sensations.
• The injury often happens during sudden, quick, forceful movements that overstretch the tendons and/or muscles but can also happen during slow movements.
• Movement agitates the pulling and rubbing of the nerve on the muscles.
• A non-painful pull or pop of the hamstrings can cause the muscles to spasm and wrap around the nerve.

Symptoms

Symptoms usually include the following:

• Leg pain that worsens when sitting.
• Intense electrical shooting pain that makes it hard to stand or move.
• Difficulties moving the leg or foot.
• Numbness and weakness in and around the leg.
• Tingling or burning sensations running down the leg.
• Persistent pain on one side of the lower back.

Chiropractic Care

Chiropractic treatment can relieve the symptoms and release the trapped nerve. Treatment includes:

• Accurate Diagnosis - A chiropractor will examine and review physical activity, work, and medical history.
• Ice and Heat therapies will stop the swelling and increase blood flow.
• Massage therapy relaxes the muscles and increases circulation.
• Decompression therapy incrementally and gently stretches the body.
• Chiropractic adjustments realign and reset the body. 
• Targeted stretches and exercises will keep the muscles loose and increase strength.
• Nutritional recommendations will help reduce inflammation and prevent flare-ups.

Hamstrings and Sciatic Nerve Relationship

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Lohrer, Heinz, et al. "Nerve entrapment after a hamstring injury." Clinical journal of sports medicine: official journal of the Canadian Academy of Sports Medicine vol. 22,5 (2012): 443-5. doi:10.1097/JSM.0b013e318257d76c

Mattiussi, Gabriele, and Carlos Moreno. "Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided "Intratissue Percutaneous Electrolysis" application." Muscles, ligaments and tendons journal vol. 6,2 248-252. 17 Sep. 2016, doi:10.11138/mltj/2016.6.2.248

McGregor, Catriona, et al. "Traumatic and overuse injuries of the ischial origin of the hamstrings." Disability and rehabilitation vol. 30,20-22 (2008): 1597-601. doi:10.1080/09638280701786138

Saikku, Kari, et al. "Entrapment of the proximal sciatic nerve by the hamstring tendons." Acta orthopaedica Belgica vol. 76,3 (2010): 321-4.