Back Clinic Sciatica Chiropractic Team. Dr. Alex Jimenez organized a variety of article archives associated with sciatica, a common and frequently reported series of symptoms affecting a majority of the population. Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side.
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower back and runs down the back of each leg as it controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot. Dr. Jimenez explains how sciatica and its symptoms can be relieved through the use of chiropractic treatment. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Herniated lumbar discs, although considered common, can be very debilitating and disabling. While it may be impossible to prevent disc herniations, understanding the mechanism of injury and implementing that knowledge can cut the odds of developing this unpleasant injury. A range of factors may promote lumbar disc damage or injury. The mechanism of injury for herniated discs often involves flexion, compression and twisting of the lumbar spine.
Mechanism of Injury: Herniated Discs
The lumbar spine’s discs are specialized connective tissue structures which function as shock absorbers between the spinal bones or vertebrae of the spine. Intervertebral discs are springy in nature due to a moist, jelly-like center portion known as the nucleus pulposus. The nucleus pulposus is contained and surrounded by a more layered, fibrous tissue that makes up what is known as the annulus fibrosis. Herniated discs or ruptured discs occur when harm to the annulus fibrosis causes the nucleus pulposus material to escape its boundaries and protrude outward in the disc.
Flexion
Where lumbar disc herniations occur regularly in a normal setting, these aren’t easily reproduced in a research setting. It is notable that in scientific research studies, where disc herniations were created in animal or human lumbar spine specimens, most demanded a small amount of spine flexion. Because of this, Stuart McGill, Ph.D., author of the book “Low Back Disorders,” concludes that repeated or prolonged spine flexion will be the primary mechanism leading to lumbar disc herniation. In a lab setting, McGill and other scientific doctors found that the way they could produce herniated disc injuries was to place weight, or a weight, onto the spine while bending into flexion. These circumstances are consistent with what could happen with repetitive lifting activities where the spine is flexed forward.
Compression
A research presented in 2001 in the journal “Clinical Biomechanics” demonstrated a link between compression of the spinal joints, technically known as vertical loading, and disc herniation. Even though the analysis used spinal sections taken from the necks of pigs, the researchers tried to replicate loading patterns common to the lumbar spines of humans. In the scientific study, severe and more frequent cases of herniated discs resulted when compression forces on the spinal bones had been increased. However, compression forces were essential to cause damage or injury such as disc herniations, that were subjected to repetitions of forward and backward bending. The authors reasoned that flexion and extension moves likely play a larger part than compression alone in inducing disc herniations. To put it differently, the spine can resist compression forces, such as lifting, when in a vertical position. Including a load whilst bending forward and backward though, may quickly spell difficulty for the individual.
Twisting
Another study published in 2010 in “Cinical Biomechanics” analyzed the role of axial torque, or twisting, in disc herniation. Using an animal model, the researchers discovered that disc herniation was not caused by twisting that was isolated. However, twisting did damage the annulus fibrosis. With damage to the annulus, the discs were more vulnerable to rupture or herniation when subjected to flexion movements. This implies that if the mechanism of injury of a disc herniation is flexion, these may be contributed to by damage brought on by twisting weakened discs.
Occupational Factors
A study published in 1987 in the “Journal of Chronic Diseases” examined the risk of lumbar herniated discs associated with occupation. The researchers noted that the risk for this condition is greater among men in blue-collar jobs in contrast to those in white collar jobs. This relates to increased lifting and bending activities among blue-collar workers when compared with white-collar employees. The writers noted less variation by occupational groups among women. The risk of lumbar disc herniations, however, was greater among women who described their work as strenuous. An additional finding that may relate to the spinal flexion mechanism of injury is that the risk of lumbar disc herniations is high among individuals whose work entails driving an automobile. Sitting while driving places the lumbar spine in a sustained posture of slight flexion.
Diagnosis for Herniated Discs
Lower back pain and symptoms associated with sciatica, are common manifestations resulting from lumbar spine disc herniation. Healthcare professionals, including chiropractors who specialize in sciatica, can help diagnose herniated discs as well as help determine the source of the individual’s symptoms. A spine specialist may provide the patient with or direct them to a clinic to have x-rays, MRI’s or CT scans to properly determine the presence of a herniated disc. Seeking immediate medical attention is essential towards the patient’s recovery.
MRI of a Lumbar Herniated Disc
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sciatica
Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.
Sometimes called a ruptured or slipped disc, your lower back pain often occurs due to a herniated disc in the lumbar spine. In fact, it’s one of the most common causes of low back pain, in addition to sciatica.
Between 60 and 80 percent of people will experience back pain at least once throughout their lifetime. A high proportion of these individuals will have low back and leg pain brought on by a herniated disc.
Most people feel better with just a few weeks or months of non-surgical treatment though a disc can sometimes be very debilitating. Surgical therapy can also help alleviate discomfort and disc pain if symptoms are not resolved.
Nonsurgical Treatment of Herniated Discs
After the first injury, the doctor may recommend cold treatment and drugs.
During the first 24 to 48 hours, cold treatment helps to reduce pain by decreasing blood flow, muscle soreness, and swelling. Never use ice or cold directly to skin; instead wrap item or the ice pack in a towel and then apply for more than 15 minutes.
Medications may include an anti-inflammatory to lessen swelling, a muscle relaxant to calm anxiety, and a pain-killer to relieve intense but alleviate pain (severe pain).
Mild to moderate pain may be treated with anti inflammatory anti inflammatory drugs (NSAIDs). These work by relieving pain and swelling.
Please discuss use with your physician.
Usually heat treatment can be applied. Blood circulation increases to heat and relax soft tissues. Higher blood flow will help to flush out toxins that may accumulate in tissues as a consequence of muscle spasm and intervertebral disc injury. Never use heat directly to skin ( just like chilly); rather, wrap the heat source in a thick towel for no longer than 20 minutes.
Spinal Injection
Leg weakness is developing, or if leg pain is intense, the doctor may prescribe an anabolic steroid injection. Anti-inflammatory medication is put by an epidural steroid injection into the space near the nerves on your lumbar spine. Before beginning this therapy you need to discuss this option with your doctor and ask.
Physical Therapy
The doctor may recommend physical therapy. The doctor’s orders are transmitted to the physical therapist by prescription. Physical treatment includes a mixture of treatments to reduce pain and improve flexibility. Heat and ice therapy stretching, and grip are a few examples, but your therapist may work together to develop the best treatment plan for the pain and symptoms.
Surgical Treatment of a Lumbar Herniated Disc
If symptoms does not relieve spine surgery is known as. Persistent pain, leg fatigue, or lack of function requires additional evaluation. Rarely, does a lumbar herniated disc cause bowel/bladder incontinence or groin/genital numbness, which demands immediate medical attention.
In case surgery is recommended, constantly ask what outcomes you can expect and the goal of the surgery. You have to understand all details of what’s being advocated, and do not hesitate to get a second opinion. Surgery is a big decision, so you odn’t wish to rush in to it.
To alleviate nerve pressure and leg pain, surgery generally involves a discectomy (elimination of all or part of the intervertebral disc).
In addition, by removing some of the bone covering the nerve the surgeon may need to access the herniated disc. This procedure is called a laminotomy.
These processes can be done using minimally invasive methods. Minimally invasive spine surgery doesn’t require large incisions, but instead uses apparatus like endoscope and a microscope during the surgery and tiny specialized instruments and cuts.
Can You Prevent a Lumbar Herniated Disc?
Earlier we advised you that a cause of a lumbar disc is aging, and that can’t be avoided by us. Does that mean that you can not do anything to prevent a lumbar herniated disc?
Of course not. There are numerous factors which are also to take care of your spine, and within your hands, observe your posture, do not smoke, make healthy food choices, exercise, and use body mechanics, especially whenever you’re lifting something.
They’re usually healthy actions you can take to try and prevent lower back pain, although doing all of those things won’t ensure that you never get a lumbar herniated disc.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sciatica
Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.
A common cause of lower leg and back pain is a ruptured disc or herniated disc. Symptoms of a herniated disc may include muscle spasm or cramping sharp or dull pain, sciatica, and leg weakness or loss of leg work. Sneezing, coughing, or bending intensify the pain.
Rarely, bowel or bladder control is lost, and when this happens, seek medical attention at once.
Sciatica is a symptom often associated with a lumbar herniated disc. Stress on one or several nerves that contribute to the sciatic nerve can lead to pain, burning, tingling, and numbness that extends from the buttocks into the leg and into the foot. Normally one side (left or right) is affected.
Anatomy of Lumbar Spine Discs
First, a brief overview of spinal anatomy so that you can better understand the way the lumbar herniated disc may lead to lower back pain and leg pain.
In between each of the 5 lumbar vertebrae (bones) is a disc, a tough, fibrous shock-absorbing pad. Endplates line the endings of every vertebra and help hold discs in place. Every disc includes a tire-like outer ring (annulus fibrosus) that encases a gel-like material (nucleus pulposus).
Disc herniation occurs when the annulus fibrous breaks open or cracks, permitting the nucleus pulposus to escape. Though you may have heard it be called a ruptured disc or even a bulging disc, this is called a herniated nucleus pulposus or herniated disc.
When a disc herniates, it can press on the spinal cord or spinal nerves. All along your spine, nerves are branching off from the spinal cord and travelling to various parts of your body. The nerves pass through small passageways between the vertebrae and discs, so if a herniated disc presses into that passageway, it can compress (or “pinch”) the nerve. This can result in the pain associated with herniated discs. (In the case below, you can observe a close-up look at a herniated disc pressing on a spinal nerve.)
Lumbar Herniated Disc Risk Factors
Many factors can increase the risk for disc herniation, including:
Lifestyle choices like tobacco use, lack of regular exercise, and insufficient nourishment significantly contribute to inadequate disc health.
As the body ages, natural chemical modifications cause discs to slowly dry out, which can impact disc strength and resiliency. To put it differently, the aging process can make your discs less capable of absorbing the shock from the body’s movements, which is one of their most important jobs.
Poor posture combined with the habitual use of incorrect body mechanics stresses the lumbar spine and influences its usual ability to take the bulk of the body’s weight.
Combine these factors with the eeffects from daily wear and tear, injury, incorrect lifting, or twisting and it is simple to comprehend why a disc may herniate. For example, lifting something incorrectly may lead to disc pressure.
Disc Herniation Phases
A herniation may develop suddenly or slowly over weeks or months. The four phases to a herniated disc are:
1) Disc Degeneration: Chemical modifications related to aging causes discs to weaken, but with no herniation.
2) Prolapse: The form or position of the disc changes with a few small impingement into the spinal canal and/or spinal nerves. This stage is also referred to as a bulging disc or a disc that was protruding.
3) Extrusion: The gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
4) Sequestration or Sequestered Disc: The nucleus pulposus fractures throughout the annulus fibrosus and can then go outside the intervertebral disc.
Lumbar Herniated Disc Diagnosis
Lately, not every herniated disc causes symptoms. Some people discover they have a ruptured disc or herniated disc after an x-ray for an unrelated reason.
Most of the time, the symptoms, notably the pain, prompt the patient to seek medical attention. The trip with the doctor includes a physical exam and neurological exam. He or she will examine your medical history, and inquire about what remedies you have tried for pain relief and what symptoms you’ve experienced.
An x-ray may be needed to rule out other causes of back pain like osteoarthritis (spondylosis) or spondylolisthesis. A CT or MRI scan verifies the extent and location of disc damage.These imaging tests can show the soft tissues (including the disc).
Sometimes a myelogram is essential. In that evaluation, you will receive an injection of a dye; the dye will appear on a CT scan, so allowing your physician to readily see problem areas.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sciatica
Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.
After ruling out a herniated disc is not causing your sciatic nerve problems, you should look to the pelvis and many times the culprit is the piriformis muscle.
When the piriformis becomes tight or inflamed, it can put pressure on the sciatic nerve and you can get the sensations going down the leg. �Symptoms such as numbness, tingling, and sharp shooting pain.
A common mistake I�ve seen on YouTube videos and at different gyms and clinics, is people using a tennis ball, lacrosse ball, or foam rollers to apply pressure to the piriformis muscle in order to relax it.
If your sciatica is caused by piriformis syndrome, applying pressure to an area that�s already compressed will only add more pressure to the sciatic nerve and cause more pain.
What you should do instead, is stretch the muscle causing the problem so that it relaxes and takes pressure off the sciatic nerve. In this video you�ll learn an easy stretch you can do on the floor.
You simply lay on your back with both legs bent. Then cross the painful leg over the good one. And pull the affected leg towards the opposite shoulder and hold that stretch for 30 seconds.
Repeat the stretch as needed.
This will help to relieve the sciatic pain associated with piriformis syndrome.
As with any conditions, there is no quick fix. You have to consistently perform sciatica stretches and exercises to achieve the best results.
Individuals with persistent low back pain can choose from a variety of proven nonsurgical treatments, including: medications, physical therapy, and exercise, to name a few. A 2017 study discussed another therapy for chronic low back pain and sciatica: massage.
In a first-of-its-kind study, researchers used a real world� strategy that was � compared to running the study in a managed setting.
More than 50 percent of the research participants reported, �clinically purposeful development� in their low back pain after their massage therapy plan, composed co-first authors William G. Elder, PhD, Family and Community Medicine at the University of Kentucky, and Niki Munk, PhD, LMT, School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis.
�Clinical massage therapy appears to be effective for low back pain, and patients should discuss with their provider and consider clinical massage therapy before attempting highly debatable opioid drugs,� says Dr. Elder, who was the lead researcher of the study.
A Closer Look in the Study
The research team collaborated with primary care providers in Kentucky who referred patients for 10 massage sessions with licensed massage therapists in the community over a 12-week interval. The massage therapists crafted exceptional massage therapy recommendations on the foundation of the specific patient�s requirements.
The participants were measured before they began their massage program, in the close of the 12-week program, then at 24 weeks after the onset of system. At 12 weeks, 54.1 percent shown clinically significant development in their long-term low back pain. At 24 weeks, their development was kept by 75 percent of patients who demonstrated improvement at 12 weeks.
Some crucial insights related to drug regimen, and patients� age, weight were found by the researchers: Adults age 50 and over were more prone to possess significant progress inside their particular long-term low back pain as an outcome of massage therapy. The advantage didn�t hold, although heavy patients had great results from massage.
Patients who reported taking opioid pain drugs did report reduced pain as a result of the massage treatment, but they were two times not likely to have clinically significant change in comparison to patients not taking opioids.
While Dr. Munk, who is a licensed massage therapist, says she expected the patients to have favorable results from the course of massage treatment, some facets of the study results surprised her.
�I was a bit surprised the baby boomer generation was more likely to have better results,� Dr. Munk says.
Dr. Munk hypothesizes that old people may have a distinct perspective on pain tolerance. Since elderly individuals likely have had more time including every one of the state she also wonders if folks that are older might be more accustomed to living with pain and had heightened perceptions of pain alleviation.
Massage Drawbacks and Expectations
While the study suggests that massage could offer individuals with chronic low back pain with pain relief that is purposeful, it truly is not a fast repair. Dr. Munk says people should level-confirm their expectations by taking into consideration how long they�ve lived with their state when they go to their first massage.
�If you�ve had a state for 10-15 years, the chance that a one-hour session will fix it is probably not realistic,� Dr. Munk says.
Dr. Munk notes that massage, given its foundation as a muscle treatment, should be viewed as a care therapy�not a short term strategy.
The body goes back to routines its used to and has, and also �Muscle patterns grow to be retrained she says. � you also must take another dose for alleviation, and Like a pill that wears off after a couple of hours, it could take several sessions to get the job to �hold.��
Another consideration patients must understand is the cost of massage, as the treatment isn’t covered by most health insurance plans. Investing in massage is an individual decision that requires weighing pros and cons. If massage therapy can help you manage your chronic back pain without the significance of spinal column surgery or other treatments which can be more significant, you might find it’s worth the out of pocket price.
Tips on Making Massage Effective
In case your doctor recommends massage therapy, building a trusting and comfortable therapeutic relationship is significant. Request your doctor if he or she recommend a massage therapist in the locality.
Dr. Elder and Dr. Munk additionally propose asking the following questions to any prospective massage therapist before your first session:
Have you ever been a licensed massage therapist?
What kind of training and education have you ever received?
How long are you now practicing?
Would you work with other healthcare professionals?
Have you had further education in other illness-specific areas (like back and neck pain)?
Do you remain current on any specific medical conditions you focus on and improvement in the massage therapy field?
Persistent low back pain can take a crucial cost on your own own life. By good fortune, many nonsurgical treatments can help you manage the pain. The results with this particular study suggest massage is a legitimate decision to lessen pain while you could possibly believe massage is only a relaxing indulgence. Request your doctor if massage is a treatment worth investigating for the specified state.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Lower Back Pain After Auto Injury
After being involved in an automobile accident, neck injuries and aggravated conditions, such as whiplash, are some of the most commonly reported types of injuries, due to the force of the impact. A study discovered, however, that the seat of a vehicle can often lead to injuries as well, causing lower back pain and other symptoms. Lower back pain is also among one of the most common types of automobile accident injuries in the U.S. alone.
Around 80% of the population is plagued at one time or another by back pain, especially lower back pain. Associated leg pain (called lumbar radiculopathy or sciatica) happens less frequently. Pain could be debilitating and bothersome, restricting daily activities. Leg and back pain can result from a number of reasons, not all of which originate in your spinal column.
With the aim of this particular article, we’ll concentrate on lumbar radiculopathy, which refers to pain in the low extremities in a dermatomal pattern (see picture below). A dermatome is a special place in the lower extremity that’s nerves going from a particular lumbar nerve to it. Compaction of the origins of the spinal nerves in the lumbar region of the back causes this pain. Diagnosing leg and lower back pain begins with assessment and a detailed patient history.
Diagnosing Lower Back Pain and Sciatica
Your medical history helps the issue is understood by the physician. It is essential to be specific when answering medical questions linked to pain beginning but recalling every detail is often not critical. Keeping records of your medical history, including medical issues, medicines you’re taking and surgeries you have had in the past is helpful.
Journal Symptoms
Seeing your leg and back pain, it may be helpful to keep the activities that aggravate your pain, a journal of your actions, when the pain began documenting and those who alleviate your symptoms. It’s also important to ascertain whether your back pain is than visa versa or your leg pain. If you are experiencing any numbness or weakness in your legs or any difficulty walking, maybe you are asked. Remember, understanding the reason for your issue is founded on the advice you supply.
Most of the individuals describe radicular pain as a burning or sharp pain that shoots down the leg. This is what many people call sciatica. This pain may or may not begin in the low back. Leg pain caused by nerve roots that are compressed normally has routines that are particular. These routines of pain is determined by the degree of the nerve being compressed. After reviewing your history, your physician will perform a physical examination. This will assist the doctor determine in case your symptoms are due to an issue that’s caused by spinal nerve root compression. To assist you understand the exam performed by your doctor lets pause to get an instant anatomy lesson.
Understanding the Anatomy of the Spine
The spine is comprised of 33 vertebrae (bones piled on top of each other in a “building-block” fashion) that have 4 distinct areas: cervical (neck), thoracic (upper/mid back), lumbar (low back), and sacrum (pelvis).
Discs are cushion-like tissues that separate most vertebrae and act as the back’s shock absorbing system. Eaach disk is comprised of a tough outer ring of fibers known as the annulus fibrosus, plus a soft gel-like center known as the nucleus pulposus.
There are 7 flexible cervical (neck) vertebrae that help to support the head. Twelve thoracic vertebrae attach to ribs. Next, are 5 lumbar vertebrae; they are large and carry nearly all the body weight. The sacral region helps disperse the body weight to the pelvis and hips.
The spinal cord is placed within the protective components of spinal canal. Spinal nerves exit the spinal canal through passageways between the vertebral bodies and branch from the spinal cord. The passageways are called neuroforamen. Nerves supply sensory (permitting you to touch and feel) and motor information (allowing the muscles to function) to the complete body.
In another article (click the Continue Reading link below), we discuss how your doctor determines what’s causing your lower back pain and sciatica, which is critical to the appropriate treatment strategy and symptom relief.
Comments by way of a Spine Specialist
Lumbar is a familiar problem that results when nerve roots are compressed or irritated. This excellent article discusses the basic anatomy and clinical manifestations of lumbar radiculopathy, which will be regularly referred to generically as sciatica. These symptoms can be due to a selection of causes such as disc bulges, degenerative narrowing of the space for the nerves (spinal stenosis or foraminal stenosis), spinal instability, deformity of the vertebrae, or herniated disc fragments outside the disc space.
In 70-80% of patients, sciatica is ephemeral, and works out with nonsurgical treatments for example anti-inflammatory drugs, physical therapy, exercise, spinal manipulation, or alternative nonsurgical modalities. Surgical intervention is required by a proportion of patients with sciatica in cases where nonsurgical treatments have failed to supply sufficient pain relief, and there is pathology [cause] that is present compressing the nerves. A tiny proportion of patients need urgent surgery. If an extremely large lumbar disk herniation causes serious nerve damage, with paralysis or acute bowel or bladder incontinence, then emergency surgery might be needed.�Curtis A. Dickman, MD
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Lower Back Pain After Auto Injury
After being involved in an automobile accident, neck injuries and aggravated conditions, such as whiplash, are some of the most commonly reported types of injuries, due to the force of the impact. A study discovered, however, that the seat of a vehicle can often lead to injuries as well, causing lower back pain and other symptoms. Lower back pain is also among one of the most common types of automobile accident injuries in the U.S. alone.
Many people suffer from lower back pain that spreads downward to the limbs and feet. This can often be alleviated by doing a deep piriformis stretch � a stretch that releases tight piriformis muscles, and relaxes the sciatic nerve.
Constriction of the piriformis muscle can irritate the sciatic nerve because they lay in close proximity to each other. By irritating the sciatic nerve, the result is pain (either in the lower back or thigh), numbness and tingling along the back of the leg and into the foot.
What Is The Piriformis?
The piriformis muscle is a small muscle located deep in the buttock, behind the gluteus maximus. It connects the spine to the top of the femur and allows incredible flexibility in the hip region (it�s the main muscle that allows for outward movement of the hip, upper leg and foot from the body).
The sciatic nerve passes underneath this muscle on its route to the posterior thigh. However, in some individuals, the sciatic nerve can actually pass right through the muscle, leading to sciatica symptoms caused by a condition known as piriformis syndrome.
Unfortunately, for a lot of individuals, their sciatic nerve passes through the piriformis muscle, leaving them with pain that just won�t go away (as well as poor mobility and balance).
Causes Of Piriformis Syndrome
The exact causes of piriformis syndrome are unknown. The truth is, is that many medical professionals can�t determine a cause, so they cannot really diagnose it. Even with modern imaging techniques, the piriformis is difficult to identify.
Lower back pain caused by an impinged piriformis muscle accounts for 6-8% of those experiencing back pain (1).
Suspected causes of piriformis syndrome include (2):
� Tightening of the muscle, in response to injury or spasm � Swelling of the piriformis muscle, due to injury or spasm � Irritation in the piriformis muscle itself � Irritation of a nearby structure such as the sacroiliac joint or hip � Bleeding in the area of the piriformis muscle
Any one of the above can affect the piriformis muscle, as well as the adjacent sciatic nerve.
Also, a misaligned or inflamed piriformis can cause difficult and pain while sitting and when changing positions (from sitting to standing). I actually stretched too far in a yoga pose once, and irritated my piriformis muscle � this took about 1-2 years to fully heal. I had major pain while sitting, and when changing positions from sitting to standing. I remember it being a huge pain in the butt (pardon the bun), but I just stuck with stretching and trigger point release and eventually it went away.
It is important to note, too, that over-stretching can actually make the condition worse. Light, gentle stretching is best. �No pain, no gain� does NOT apply here. I over-stretched my piriformis and that�s what made it inflamed for 1-2 years (because I was still doing yoga daily, and over-doing it in stretches).
Make sure you warm up your muscles before you stretch, because you can create a different injury. To warm up, simply walk or march in place or climb up and down a flight of stairs slowly for a few minutes before stretching.
Exercising and stretching the piriformis is well worth it � try it now with these 10 stretches:
1. Supine Piriformis Stretch
1. Lie on your back with your legs flat.
2. Pull the affected leg toward the chest, holding the knee with the hand on the same side of the body and grabbing the ankle with the other hand.
3. Pull the knee towards the opposite shoulder�until stretch is felt.
4. Hold for 30 seconds, then slowly return to starting position.
There are many variations of this stretch, but here is a good video to demonstrate:
2. Standing Piriformis Stretch
1. If you have trouble balancing, stand with your back against a wall, and walk your feet forward 24 inches. Position your knees over your ankles, then lower your hips 45 degrees toward the floor.
2. Lift your right foot off the ground and place the outside of your right ankle on your left knee.
3. Lean forward and lower your chest toward your knees while keeping your back straight. 4. Stop when you feel the glute stretch. 5. Hold for 30-60 seconds, then switch legs and do the same.
3. Outer Hip Piriformis Stretch
1. Lie on your back and bend the right knee.
2. Use the left hand to pull the knee over to the left side. Keep your back on the ground, and as you do so, you should feel the stretch in the hip and buttocks.
3. Hold for 20-30 seconds, and repeat on the other side.
�4. Long Adductor (Groin) Stretch
1. Sitting on the floor, stretch your legs straight out, as far apart as you can.
2. Tilt your upper body slightly forward at the hips and place your hands next to each other on the floor.
3. Lean forward and drop your elbows to the floor if you can. You will feel the pelvis stretching.
4. Hold for 10-20 seconds, and release.
5. Short Adductor (Inner Thigh) Stretch
1. For this exercise, sit on the floor and put the soles of your feet together.
2. Use your elbows to apply downward pressure to your knees to increase the stretch.
3. You should feel the stretch on the inner thighs. For a deeper stretch, bend your upper torso forward with a straight back.
4. Hold for 30 seconds, release, and flutter your legs in the same position for 30 seconds.
6. Side Lying Clam Exercise
1. Lay on your side with the hip that needs help on top.
2. Bend your knees and position them forward so that your feet are in line with your spine. 3. Make sure your top hip is directly on top of the other and your back is straight.
4. Keeping your ankles together, raise the top knee away from the bottom one. Do not move your back or tilt your pelvis while doing so, otherwise the movement is not coming from your hip.
5. Slowly return the knee to the starting position. Repeat 15 times.
7. Hip Extension Exercise
1. Position yourself on all fours with your shoulders directly over your hands. Shift your weight a little off the leg to be worked.
2. Keeping the knee bent, raise the knee off the floor so that the sole of the foot moves towards the ceiling.
3. Slowly lower the leg, almost back to the starting position and repeat 15 times.
8. Supine Piriformis Side Stretch
1. Lie on the floor with the legs flat, and raise the affected leg by placing that foot on the floor outside the opposite knee.
2. Pull the knee of the bent leg directly across the midline of the body using the opposite hand or towel until a stretch is felt. Do not force anything and be gentle.
3. Hold the piriformis stretch for 30 seconds, then return to starting position and switch legs.
4. Aim for a total of 3 repetitions.
9. Buttocks Stretch for the Piriformis Muscle
1. Laying with your stomach on the ground, place the affected foot across and underneath the trunk of the body so that the affected knee is on the outside.
2. Extend the non-affected leg straight back behind the body and keep the pelvis straight. 3. Keeping the affected leg in place, move your hips back toward the floor and lean forward on the forearms until a deep stretch it felt.
4. Hold for 30 seconds, and then slowly return to starting position. Aim for a total of 3 stretches.
10. Seated Stretch
1. In seated position, cross your right leg over your left knee.
2. Bend slightly forward, making sure to keep your back straight.
3. Hold for 3-60 seconds and repeat on the other side.
According to Myofascial Pain and Dysfunction: The Trigger Point Manual, written by doctors Janet Travell and David Simons, myofascial trigger points (tiny knot contractions) in overworked gluteus minimus and piriformis muscles in the buttocks are the main cause of sciatica and all the symptoms that come with it.
Picking up a copy of the book, or even following instruction in the video below can help release these knot contractions.
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