Piriformis or Sciatica? The Ultimate Guide to Diagnosing Your Pain

Piriformis, also called the pear-shaped muscle, may be behind abnormal buttock or pelvic pain and you clicked on this video because you want to determine which is the cause of the symptoms. Absolutely great, because this information package is surely comprehensive and with the instructions in this video you can easily test at home which one is the cause of the trouble. In piriformis-related symptoms there are certain specific characteristics and in ischias nerve symptoms there are also typically their own small particles. How do these differ from one another?

You will get the answer in a moment, but first we slightly need to understand anatomically how these structures travel in our body. Let's start by locating where the pear-shaped muscle resides. When you place the tip of the finger in the outer surface of the thigh, you should feel kind of bony lump. That is the greater trochanter of the femur.

When you are at the upper edge and slightly backwards, the fibers of the piriformis muscles are located and the muscle body originates from the anterior surface of the sacrum, so roughly from S2 to S4 level. The sacrum has its openings and at each opening there is an individual level and this is how the naming of the origin comes from. The sciatic nerve, on the other hand, is the largest single nerve in the body, originating from the fourth vertebra of the lumbar spine down to the third level of the sacrum. From there, it continues along the back of the thigh and branches into multiple smaller nerves before the kneecap.

How are these structures tested? Well, we'll come back in later in the video as we need to figure out what are the typical symptoms of the condition and how the symptom picture might be different at the origin of the trouble. Let's first consider the features of the typical piriformis issue and where the piriformis pain is felt. And here are the answers for that.

Typical look client comes to the appointment saying that the symptoms has been present for a long time around in buttock area on the symptomatic side and sometimes the symptom is described as a dull ache in buttocks. Initially, when the symptoms might be localized at the buttock area, but it has prolonged, it has started to spread down the symptomatic leg. Notable factor in here is that the sensation felt in the lower area is somewhat vague and not sharply defined. If a client, due to everyday activities or work demands, has to sit for extended periods, this situates heavily aggravated symptoms.

Gradually, as the sitting periods extend, the symptoms creep down to the leg and one must begin to wonder what kind of chaos can occur during the traffic jams if the discomfort worsens. Or the client mentions that climbing the stairs upwards is extremely painful, so they have long relied on using the elevator. Where is the sciatic pain felt and what symptoms does the sciatica cause? In sciatica-related issues, a certain type of reverberant pain tied to skin enervation is typically present.

The client usually describes in their story that the symptom starts, for example, from the upper part of the buttock and, for example, in this blue area. And from there it follows a line in front of the thigh and then to the inner side of the shin. This pain is often well-defined and when you show the client's picture of these dermatomenal enervation maps, they often respond, oh, this looks familiar. When the sciatic nerve is under significant strain or has some sort of impairment, noticeable weakness begins to appear.

Certain muscles are unable to receive sufficient neural input, resulting in difficulties like in walking on the heels or performing tiptoe lift on the symptomatic leg. In sciatica symptoms, bending of the back forward often feels very uncomfortable. Pelvic rotational movements and side bend can cause also discomfort and in some cases even coughing can intensify the pain radiating in the leg. A curious detail about the sciatic nerve is the variation in the pathways.

In most people it runs nicely underneath the piriformis muscle, but there are some anatomical anomalies to note. These are statically rare. In some individuals, the nerve may pass through the fibers of the piriformis muscle, over the top of the muscle or split and run both sides of the muscle. Lie on your back with the legs straight.

Start with the non-symptomatic side and do internally rotation of the thigh. So you will going to move your foot inwards towards the midline. Observe how far the rotational movement goes and what kind of sensations are felt. Next, repeat it on the symptomatic side.

If you sense an increase of the symptoms deep in the buttock where the piriformis anatomically lies, it's a good finding. Note that this test is not considered positive if the discomfort is felt more towards incroying area. That might indicate some other issues. This is the test to provoke deep buttock symptoms.

Lie on your non-symptomatic side with the hips bended approximately to 90 degrees and put your kneecaps to 120 degrees. Lift the symptomatic side's leg off from the surface and the test is positive if the familiar pain is felt in the buttock area. Start by testing non-symptomatic side. Keep the leg straight with the angle in 90 degree angle.

Gradually lean your upper body forward. When you feel the tightness, note the intensify of the forward flexion. Then repeat on the symptomatic side. If the familiar symptoms intensify, externally rotate the thigh to see if the sensation eases.

This indicates the sciatic nerve involvement. Conversely, if internal rotation worsens the symptoms, it may point towards the piriformic syndrome. Slump test. Sit deeply in the chair that the edge comes under the knees.

Cross your arm behind your back. Tuck your chin down towards your chest and round your lower back. With the angle at the 90 degree angle, first extend the non-symptomatic leg. Observe the sensation and then compare them to the symptomatic side.

Familiar shooting pain along the nerve pathway is indication of the sciatica. If lifting of the head relieves this tension, it confirms the sciatica nerve tension involvement. And you can also test it with the movement of the ankle. Get your leg straight and put it upwards.

What helps with the buttock pain? Pain in piriformis area is often caused by small injuries leading to soft tissue inflammation or muscle tension. And in Nalgi cases both. Since the piriformis is a relatively small muscle, it becomes problematic when overloaded.

Straightening the surrounding structures above the pear-shaped muscle helps distribute the workload among other muscles, allowing overworking piriformis to calm down. Good exercise is straightening the gluteus medius and maximus. Place the resistance band around your knees that they will going to pull the knees inward. Position your feet shoulder-width apart and spread them so the knees, feet and hips are in straight line.

Then keeping the knees in a good alignment, lift your hips from the surface until they align with your thighs. Side plank. Lie on the symptomatic side with your elbow beneath your shoulder. Raise your hip off the ground and hold this position.

Ensure the body remains straight from the front and from the side. Exercise should be done 3-4 times per week, approximately same length in each session. And progressive overload should be applied over time. If the piriformis issues are not addressed, they can become challenging and debilitating problem that greatly impacts quality of life.

However, early interventions with the exercises and self-care can significantly reduce the symptoms within 1-3 weeks from the starting. Recurrence is common, so regular gluteal exercises are excellent way to keep the symptoms at the bay in long term. For the best tips of stretching and self-care, click here.