Sciatica

Sciatica is a common condition that is often misdiagnosed or colloquially used for lower back pain. Sciatica by definition is an impingement on the sciatic nerve which causes a shooting pain that travels down the back of the thigh to your calf. This pain is often worse at night time, causing disturbed sleep and when standing for long periods of time. Can also be accompanied by general lower back pain and discomfort. Sciatica pain should be able to be replicated by moving the leg to impinge on the nerve causing a similar sensation. Piriformis syndrome is often misdiagnosed as sciatica and is important to differentiate between the two conditions for the correct treatment.

The piriformis is a muscle of the lower back that is involved in stabilising the hip, lifting and rotating the leg. The piriformis goes from the sacrum, near the buttock to the large leg bone known as the femur. The muscle travels over the top of the sciatic nerve, which supplies the leg. When this muscle is inflamed or injured, it can put pressure on the sciatic nerve, causing it to send a shooting sensation from the buttock into the leg. This sensation will often only travel half way down the thigh or into the back of the knee.

The sciatic nerve branches from spinal segments, L4, L5, S1, S2, and S3, runs all the way down your leg and splits into two different segments, the tibial nerve and the common peroneal nerves. The sciatic nerve travels through the greater sciatic foramen, which is a large hole in the pelvis that a number of muscles run through. When there is inflammation in this area, it can cause pressure on the nerve which produces a pain that shoots down the leg to the calf muscle.

The greatest difference with piriformis syndrome and sciatica is the presentation of pain. It is more often than not that it is piriformis syndrome rather than true sciatica. Both conditions can be treated with cupping, acupuncture and massage and generally respond well to treatments. Applying heat also often helps relieve some tension in the lower back and alleviate the symptoms. If you are suffering from a shooting pain that travels your leg, it is important to determine how far that pain travels and the type of pain that it is. If you are experiencing piriformis syndrome, there is a simple stretch that you can do to help release the piriformis muscle so that you can get some relief before seeking treatment.

It is called the piriformis stretch. You create a figure four like structure with your legs, having the painful side leg resting on your knee and pulling the other leg closer to the body. You can see how to perform this stretch below.

• Dr Nicholas Watson.