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Sciatica and Piriformis Syndrome

Sciatica and piriformis syndrome is usually caused by abnormal movement in the sacroiliac joint (pelvis to spine attachment), which generally is an immobile joint. This movement has then caused the Piriformis muscle surrounding it to become over protective and thus pressing on the sciatic and possibly other nerves on the left side. We will only know if this is the case by testing out the stretches, manipulations and possibly massage to see if this helps the symptoms.

Nerve impingement pain is technically called “lancinating” pain. It is typically hot or sharp, instead of diffuse and aching. Most people strongly agree that it feels “electrical.” However, do not be too convinced by the quality of the pain alone: trigger points are quite capable of causing pain that feels exactly like nerve pain.

Trigger points rarely causes a “pins and needles” sensation, so if you have pins and needles, that is a pretty strong indication of nerve impingement. But even then, you can’t be sure, because trigger points do occasionally cause a very nervy tingling.

The only symptom that is virtually guaranteed to be caused by nerve impingement alone is true tactile numbness. If you have a “dead” patch of skin, then you almost certainly really do have a pinched nerve, which I believe, you said you had experienced numbness. We may have to examine this further, if you still get this as a symptom.

However, even then, some uncertainty remains. Although trigger points cannot cause a truly numb patch of skin, they can (and routinely do) cause a feeling of “dead heaviness” or feeling of ‘lead’.

People routinely start an appointment for sciatica by telling me that their leg is numb — but after a little discussion, it becomes clear that they mean that the leg feels sick, heavy, weak and useless … but not actually numb to the touch. Without numbness to touch, nerve impingement cannot be diagnosed, and by far the more likely cause of the symptoms are a batch of nasty trigger points in the low back and hips.

I find it helpful if trying the exercises below, to read and record yourself on a tape machine or phone and then follow the instructions, rather than trying to read them and do them at the same time, or if someone can read them out to you as you do them.

 

Treatments.

Relax the area with heat and vibration

Whether the pain is caused by the sciatic nerve itself, or just by tight muscles, the muscles need to relax in either case. Hot tubs, with jets, are ideal for all kinds of sciatica.

Due to the thickness of the tissue in the buttocks, the heat will not have any circulatory effect on the nerve or the piriformis muscle, but it will be neurologically sedative. The vibration of jets will amplify that effect. Muscles relax when they are vibrated — a neurological effect

Stretching

When stretching for sciatica, please stretch very gently and calmly: the piriformis muscle, which is probably producing the pain directly or indirectly, tends to be reactive in character. It needs to be gentled. The focus of the stretching should be neurological, not mechanical — that is, slowly get the muscle “used to” a greater length and lower tone. There are a few variations on stretches that are particularly helpful. ALWAYS breathe slowly and deeply and use the exhale to deepen the stretch and soften into it. Muscles relax and release on the exhale and this is why it vital that you breathe into stretches. It’s the key to keeping them safe.


1) Piriformis stretch

starting from a seated position on your bottom, legs out in front of you, cross your ankles and stretch forward. Avoid simply slumping forward. The key to this stretch is to “push your belly button between your legs.” Stretch for 10-15 seconds and then slowly release and change to the other side. One side might feel tighter on any of these stretches, that is normal.

2) Laying pigeon 

another option to the Pigeon poses which still works on the piriformis muscle, sacroiliac joint and thus the sciatic nerve. This one is only useful if you find laying on your back comfortable. It’s worth trying all variations and see what works for you.


Come down onto your back, having the knees bent and feet flat on the floor. Bring the left foot up and place the left ankle on the right thigh towards the knee. Let the right knee and hip just open up and get used to the position before moving on. Then, when ready, inhale and on the exhale, lift the right leg, still with the left ankle on the thigh, scooping the left hand into the hole in the centre and the right hand on the outside. Take hold of the right thigh (as you see above) and work the legs in towards you till you feel the stretch into the right hip/thigh. Work gently, easing into your maximum stretch, working on deepening the stretch only on your outbreath when muscles relax and lengthen. Hold the stretch for 15-30seconds and then gently come out of it, hug both knees into the chest and rock on your back as in the last stretch that is on the curves board. This realigns everything. Then you can repeat the stretch to the other side. Ending with the knee hug and back rock again.

 

3) Seated pigeon

Come in to sitting on your bottom, with the knees bent and the feet flat on the floor, then gently take one leg up and place the ankle and foot resting on the thigh near the knee, let the hip and knee that’s lifted just open out and settle before moving on. When you feel ‘comfortable’ with progressing then place the hands on the floor behind you and start to inch your bottom forward towards your feet, lifting your chest out towards the lifted leg so that you keep the spine straight and experience the stretch in the hip/thigh of the leg that is lifted. Work to your maximum stretch, without force or strain and hold for 15-20 seconds on each side, breathing nice and slow in and out through the nose if you can. Muscles relax and let you in a little deeper on the out breath. End by coming down onto the back, hugging knees and rocking.

 

4) Split pigeon position

This is the harder position but gives the strongest release and stretch of them all.

Start in all fours. Inhale and as you exhale, gently slide the right knee forwards, as far forwards as you can so that its preferably in-between your hands, the open out or wiggle the right foot over towards the left side and a little towards the left wrist so that it is no longer underneath you, don’t force this, the foot doesn’t have to be too far away from you. Find your best place where it feels safe in the knee and where your hips remain even, centred and not leaning in anyway. Once you feel confident and comfortable with this, you can then work on sliding the extended left leg back a little, till you find your maximum stretch in that right hip/thigh. Stay in this for 30 seconds if comfortable then maybe walk the hands forward and relax down over the right knee a bit more.

To come out of this, walk your hands back so that they are in line with knee, hands flat down, tuck the right toes under and just nudge and inch your hips / body forward so that you feel like you’ve got the weight of the body into your hands and so the hip feels like its released and then slowly come out of it as you went into it. Wiggle the right foot back in towards you, and then gently slide the right knee back into all fours. Once back there, take a breath in and as you exhale take both hips down to your heels and rest, breathing nice and slow and deep to relax and realign muscles. This is Childs Pose as in the picture below. 


Repeat this sequence then to the left side and finish back in child’s pose again.


Downward Dog

 A good all round stretch for lower back, tight hips and hamstrings and lower legs is the downward dog. It’s a good one to finish any of these stretches with as it gives a full stretch and release everywhere and realigns everything keeping it safe.

Come into all fours. Hands underneath the shoulders and knees and feet hip width apart. Tuck the toes under. Take a breath in and on the exhale, push into the hands, lift the hips and knees up and start to work the heels towards the floor (doesn’t matter if they don’t make it, the important part is the aim and the stretch). Push back away from your hands by lifting the bottom up and back, sinking the shoulders. If this is tight in the legs as it often is for a lot of people, then you can bend the knees slightly, but still maintain that push back away from the hands. I believe you looked absolutely fine in this position yesterday without the legs needing to be bent but listen to your body every time you do the stretches and adapt them when /if needed.

Evaluate how you feel after each stretch. Observe if there is a feeling of release or if it feels achy and a bit of a tight sensation or pinching.  Both is normal and to be expected at different times, depending on how deep you went into a stretch, especially the split pigeon.

Practise exercise 1,  Every time you are in the gym with your usual stretches.

Practise either variations 2, 3, or 4 everyday along with the follow up stretches, be it Childs pose for split pigeon or backrock after the laying version and finish with a downward dog.

Don’t be too excessive with them, just a few minutes every day should be enough to re-educate your muscles.

Before going for a long walk, the best ones are number 1 and 4 (followed by its child pose) and downward dog as this will stretch the legs and hips. Any of these stretches can be done after a walk if you feel tightness or any aches.

Be careful doing the split pigeon if you actually have the symptoms, you still can do it but with extreme caution, the others would be safer.

 

Apply a tennis ball

The muscles of the hip and buttock are one of the few places in the body where it is possible to effectively treat your own muscle knots with a tennis ball. Simply lie on a tennis ball such that it presses on deep, aching sore points — and wait for the sensation to fade. I do have one caution about treating yourself in this particular case: the piriformis muscle is so unusually reactive, in my experience, that you must be particularly gentle and conservative in your approach if you wish to try this as a form of self-massage. Listen to your body. Ask for advice if not sure.

Posture and ergonomic improvements

Sciatica of these types are most commonly related to excessive sitting, and sometimes to poor ergonomic design of the chair, work station, and postural dysfunction as well. It is worth experimenting with these factors. The most obvious and relevant option is to buy a timer and use it to remind yourself to get out of your chair every fifteen minutes.

Manipulation

If someone can help you out with these and feel confident and comfortable to help. Then these are the manipulation used in osteopathy and Thai yoga massage.

Lay down with either the legs bent or feet flat down or you can keep one leg extended long.

*Have one leg lifted and bent pressing into the other persons hand, you push them away as they gently resist and hold for 5 seconds.

*They then change to holding on to the top of your foot or your knee if you prefer and they try to pull away as you pull towards yourself with the leg/foot for 5 seconds.

*have the person place their hand on the outside of your knee, gently try to push them away with your knee as they resist.5 seconds

*have the person then place their hand on the inside of the knee, gently press the knee inwards as they resist. 5 seconds.

*either you or the other person can then rotate the leg from hip a few times in one direction and a few times in the other direction but make sure the knee stays bent and close to the body.

Repeat the whole sequence to the other side and finish with the knee hug / back rock to realign.

 

© Vernette Butler 2012 www.vernyoga.com


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