Sciatica and Piriformis Syndrome are painful conditions affecting the lower back, buttock, leg and foot that impact on overall mobility and quality of life. Identification of the cause of pain is difficult but necessary to produce effective treatment outcomes. Anatomically, the sciatic nerve originates from the lumbosacral plexus, a network of nerves formed by the anterior branches of spinal nerves L4, L5, S1, S2, S3 which contribute to the tibial portion, and the posterior divisions of the L4, L5, S1, and S2 which contribute to the common peroneal portion. These nerve roots combine to form the sciatic nerve which exits the pelvis via the sciatic foramen and enters the piriformis muscle (buttock) travelling down the leg through the biceps femoris, semimembranosus and semitendinosus muscles and the hamstring portion of the adductor magnus indirectly innervating all the muscles of the leg. The sciatic nerve divides behind the knee and progresses medially and laterally towards the ankle. The condition Sciatica often occurs through injury or trauma and sometimes simple movements as twisting at the waist or over-reaching can cause irritation or compression of the sciatic nerve in the lower back or spinal lumbar region such as a herniated disc, spinal stenosis, or other spinal issues. Triggering lower back pain, pain in the buttocks and hip, burning or tingling down the leg and into the feet aggravated by sitting, coughing or sneezing with movement such as walking often easing discomfort. Piriformis syndrome is diagnosed when the piriformis muscle compresses the sciatic nerve creating pain that mimics sciatica with pain in the buttock and upper leg that may radiate down the leg. Prolonged sitting, climbing stairs and running will increase discomfort and pain can be intensified by internal rotation of the leg at the hip. Simply, sciatica is caused by a nerve compression originating from the spine whereas piriformis syndrome is caused by nerve compression originating in the (buttock) muscle. As the nerve is involved in both conditions it is possible to be diagnosed with sciatica and piriformis syndrome at the same time creating a treatment dilemma for practitioners. The NHS offers physical therapy, pain medication, corticosteroid injections or surgery in severe cases and X-ray and MRI scans to identify if spinal compression is the underlying cause. Using a holistic approach to address the immediate symptom of pain in these conditions I firstly observe the functionality of the feet. Irregularities in the form and function (including pronation of the foot) will have a knock-on effect in the action of the ankle, knee and hip joints and may affect the lumbar, thoracic and cervical (neck) spine. Secondly, I will apply pressure using thumb or index finger to specific acupuncture points on the medial side (arch), the plantar (underside/sole) and the dorsum (top) of the foot to identify areas of focus. Thirdly I will massage using a steady firm pressure the lower leg and whole foot to relax and calm the irritated nervous system with the purpose of releasing tension in the muscles of the lower back, buttock and legs. The effectiveness of the treatment is recorded using patient feedback. Advice is given on appropriate stretching exercises alongside suggested changes to diet to reduce inflammation generally. Recommendations of Tiger Balm or Arnica applied to trigger points in the foot may be helpful alongside Homoeopathic remedies, vitamins and minerals. I will always refer patients back to their GP if pain is not managed or if concerned with my findings during assessment and treatment. Patients, please note as a holistic practitioner there is another cause of pain I always consider when treating sciatica and that is the emotional link. Once the sciatic nerve has been triggered for whatever reason it is my experience that it becomes vulnerable to subtle changes in the body’s energy. Chemical transmitters are released by the body when shock, trauma or feelings of stress and anxiety are experienced. The nervous system responds and muscles react, creating tension which may re-trigger historic sciatic low back/buttock pain. If you are experiencing pain emotionally, physically or mentally and think I might be able to help get in touch.
