Dr. Sandeep Dhar

Exercises for Sciatic pain from Piriformis Syndrome
Sciatica is a symptom. It consists of leg pain, which might feel like a bad leg cramp, or it can be excruciating, shooting pain that makes standing or sitting nearly impossible.

The pain might be worse when you sit, sneeze, or cough. Sciatica can occur suddenly or it can develop gradually.

Symptoms:

• Pain in the rear or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness, or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.

For some people, the pain from sciatica can be severe and debilitating might include the inability to bend your knee or move your foot and toes.. For others, the sciatica pain might be infrequent and irritating, but has the potential to get worse.

Causes of Sciatic Pain:

• Slipped Disc: In majority of cases sciatica is caused by a herniated or "slipped" disc. This is when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.
• Spondylolisthesis (a condition in which one vertebra slips forward over another one)
• Other causes include spinal stenosis (narrowing of the nerve passages in the spine), a spinal injury or infection, or a growth within the spine (such as a tumor).
• Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.
• Piriformis Syndrome: It is referred as neuritis of branches of the sciatic nerve caused by pressure of an injured or irritated piriformis muscle. Symptoms associated with piriformis syndrome typically consist of buttock pain that radiates into the hip, posterior aspect of the thigh, and the proximal portion of the lower leg.
• Piriformis syndrome typically does not result in neurological deficits such as decreased deep tendon reflexes and myotomal weakness.

Diagnosis:
Sciatica is diagnosed with a medical history and physical exam. Sometimes X-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of the sciatica.

• X-ray- to look for fractures in the spine
• Magnetic resonance imaging (MRI) or computed tomography (CT) scan - to create images of the structures of the back
• Nerve conduction velocity studies/electromyography - to examine how well electrical impulses travel through the sciatic nerve
• Myelogram using dye injected between the vertebrae - to determine if a vertebra or disc is causing the pain

Treatment:
Primary treatment consists of self-care and non-surgical strategies. The aim is to correct the underlying problem, restore function and prevent re-occurrence.

• Self-Care: Sciatica may resolve with rest, ice or heat, massage, pain relievers and gentle stretches. Muscle inflammation and pain can be reduced by application of an icepack for 20 minutes several times a day during the initial 2-3 days. Thereafter a hot pad may be applied to relax muscles. If the self-care exercises aren’t working within the first couple of days you must consult your doctor.
• Medication: Over the counter Nonsteroidal anti-inflammatory drugs (NSAIDs) can bring pain relief. Muscle relaxants may be prescribed for spasms.
• Physiotherapy: A normal schedule is recommended physical therapy can help you return to full activity as soon as possible and prevent re-injury. Physiotherapists will show you proper lifting techniques / postures, walking techniques, exercises to stretch and strengthen your back muscles.
• Massage, ultrasound, diathermy, heat and traction may also be recommended for some time.

The hot topic in Pain research over the last ten years, Chronic Pain (now termed Persistent Pain) is any pain lasting longer than the normal biological healing time frame (6-12 weeks).

We used to think pain was from damage to tissues, stimulating nerve cells, telling our brain we were suffering. High quality research shows that our brain can have little or no pain with direct stimulation of these cells, or certainly for very short periods. Contrasting studies have shown severe pain being experienced in the absence of activity in these fibres.

It has become clear that pain is an OUTPUT of the brain, not an INPUT from our tissues; depending on our FEAR of THREAT to our tissues, not a simple response of the tissues themselves. This doesn’t mean that you can ignore a sprained ankle, but it provides strong psycho-physical treatment pathways for people who have become stuck in patterns of pain, depression, weakness, reduced activity, and withdrawal from life.

Ask your physiotherapist if they can help; we can’t always fix you, but we can certainly help YOU get your life back.