On the Mend
---- — Sciatica certainly gets its fair share of press. Considering that it can be completely disabling, it’s understandable why we give it so much attention.
During the search for the origin of sciatic pain, it’s best to start with the low back. It’s always high on the list of usual suspects responsible for the symptoms and is treatable with conservative therapy.
If it’s not coming from your back, though — excuse the pun — you’d better have a back-up plan.
After eliminating the back from the list of possibilities, the next area to check should be your hip. There’s a muscle that’s found on the backside of the hip joint in the direct vicinity of the sciatic nerve called the piriformis. If that muscle spasms or is damaged, you’re at high risk for developing piriformis syndrome.
Hallmarked by extreme pain and mobility deficits among other things, piriformis muscle dysfunction can produce sciatica by squeezing or pulling at the sciatic nerve. So if you have pain traveling down the back of your leg and your back is feeling generally well, here are some things that may help you diagnose the problem.
Limping is a trademark feature of piriformis-based sciatica. It also means that you need to get checked out. Limping invariably leads to more limping and thus, more pain essentially perpetuating the problem. So if your gait is a little gamey, it might be time to drag yourself (with your leg behind you) to see an orthopedic clinician before other areas are affected.
If it feels like your leg has a toothache or that it throbs, you definitely have a pinched nerve someplace along the line. If that throbbing starts above the level of your buttock close to your waist, the back is your probable culprit. But if the pain begins somewhere around the middle of your buttock, the piriformis should be high on the list of things to exclude.
If sitting on an uneven surface or sitting on your wallet increases your pain, it’s probably because the sciatic nerve is irritated at the level of the piriformis muscle — which, funny enough, is exactly where your weight is distributed when you sit.
If your hip is stiff you’re a candidate for piriformis syndrome at the very least. If you’re struggling to put on shoes, cross your legs when sitting or feel a pinch in the groin when you bend forward, please consider these as warning signs or precursors to full-blown sciatica with piriformis involvement.
When active, piriformis syndrome feels like it’s deep inside the buttock. It’s not a superficial pain, nor is it light or mild. Most cases produce a gnawing-type throb that lasts for minutes to hours at a time and fall under the category of “you’ll know it when you see it” so keep your eyes peeled.
If the pain in your leg worsens throughout the day it very well could be coming from the piriformis. Classic, lumbar spine-based sciatica often improves over the course of the morning and afternoon, but aches at night before bed. Because the root of the problem is a muscle, and muscles are subject to fatigue after usage, piriformis syndrome has a tendency to worsen steadily, peaking in the afternoon hours — especially if you’ve been on your feet for any length of time.
Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes “On the Mend” weekly. Questions may be submitted by email to firstname.lastname@example.org