Sensei Adam Rostocki

Sciatic Nerve Compression by the Piriformis Muscle

Sciatic nerve compression by the piriformis muscle is also known as piriformis syndrome.  This diagnosis on the rise is often illogical and incorrect, leading patients to pursue needless and contraindicated therapy modalities.

Sciatic nerve compression by the piriformis muscle is a diagnostic speculation pronounced for many patients who suffer sciatica and related lower body symptoms, but do not seem to have a definitive spinal explanation for their pain.  Piriformis syndrome, as it is commonly called, is a diagnosis on the rise in the dorsopathy sector, despite the many inconsistencies with the facts of the condition and the often illogical explanation of why it occurs.  In my own extensive study of back pain and sciatica, I agree that this deep buttocks muscle is indeed implicated in many sciatica syndromes, but not generally for the reasons cited as being responsible for piriformis syndrome.

Piriformis syndrome is a mystery to most patients who have never heard of the muscle itself or why it may produce pain in the buttocks, legs and/or feet.  The diagnosis is made almost exclusively by chiropractors and other alternative care providers, particularly those who do “hand-on” treatment using some form of manual therapy.  The condition is based on the anatomical fact that the sciatic nerve does indeed run beneath the piriformis muscle and in some case actually runs through the muscle.  It may be no coincidence that a great number of patients affected by piriformis pain do demonstrate this atypical nerve through the muscle condition.

The theory of the pain syndrome states that due to some reason, the piriformis muscle clamps down on the sciatic nerve, compressing it and eliciting symptoms. I have seen this occur in many patients, and agree that the syndrome is a very real clinical entity in the back pain treatment sector.  However, this is where my agreement with most care providers ends in totality…

Most care givers who diagnosis piriformis syndrome blame it on some structural abnormality, rather than a far more logical explanation.  A great number of patients are diagnosed with injury to the piriformis, even though there is no history or explanation for said injury.  Others are diagnosed as suffering from the atypical nerve through the muscle condition, which is known to be innocent in many patients who have no pain at all, despite the presence of the irregularity in their anatomies.  Still others are diagnosed as having piriformis problems due to muscle imbalances and postural concerns.  In my experience, these are scapegoat explanations in the majority of cases, although a few may be accurate diagnostic verdicts.  The far more logical and sensible explanation for why piriformis syndrome occurs is certainly regional ischemia.

In my experience, piriformis pain mimics the incidence of oxygen deprivation anywhere in the anatomy.  The muscle goes into spasm, providing a “death grip” on the sciatic nerve, enacting the types of pain, tingling, weakness and numbness doctors see everyday in diagnosed patients.  Injury would never explain the chronic and treatment-resistant nature of the pain syndrome, but ongoing ischemia sure would.  Anatomical abnormality may play into why some people develop pain here as opposed to other areas, but is surely not causative unto itself.  This is reinforced by the great number of diagnosed piriformis patients who do not show the nerve through muscle irregularity and the large number of people who do have the abnormality, but do not have pain… Of course, there is also the huge number of patients who have pain above where the piriformis exists, making the entire theory of a dedicated piriformis causation fly right out the window…

The ineffectiveness of traditional treatment for piriformis pain is one of the most decisive supporters of an ischemic causation, since structural changes enacted via surgery rarely help the condition, while modalities which provide increased circulation (and therefore oxygenation) such as massage, do provide marked, but temporary relief.  Of course, the most important supporting piece of evidence is the fact that knowledge therapy, a purely non-physical modality, can cure the pain permanently, without any medical care, in most chronic cases.  This is the same system of care pioneered by the world famous Dr. John E. Sarno at the Rusk Institute of Rehabilitation Medicine at the NYC Medical Center and is also the same cure used by this humble author to end 18 long years of horrific lower back pain and sciatica.

Article Tags: Sciatic Nerve Compression, Sciatic Nerve, Nerve Compression, Piriformis Muscle, Great Number, Nerve Through

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