Any sort of spasm or abnormal tension on the Piriformis Muscle can cause pressure on the Sciatic Nerve. The result is Piriformis Syndrome — a deep ache in the buttock that is often accompanied by pain, numbness, tingling, paresthesia (odd sensations), or weakness in the leg.
The piriformis muscle (piriformis; “pear shaped“) is a tiny muscle located deep in the buttocks underneath the much larger Gluteal Muscles. This little muscle is the most well-known of a group of several muscles known as the “Hip Rotator Cuff” and is frequently the source of one’s gluteal pain.
Piriformis Syndrome is a miserable condition in which the piriformis muscle becomes overly tight and either compresses the sciatic nerve, pulls at its bony attachment points, or both. Although there are frequently underlying biomechanical / physical issues that contribute to piriformis syndrome (excessive sitting; bow legs or knock knees; high or low arches; leg length discrepancy; pelvic deficiency; past traumas; obesity; sedentary lifestyle; over-training; poor posture, etc.), this pathological tightness of the piriformis muscle is frequently the result of fascial adhesions and/or tendinosis.
Piriformis syndrome can be aggravated by bending, lifting, sports, and even driving but sitting tends to be the worst aggravating factor for most people. A serious inability to sit without severe buttock pain and / or Sciatica is a big red flag as far as Piriformis Syndrome is concerned.
Piriformis Syndrome is an extremely common condition, and is far more likely to be found in women than men (most studies claim 12-15 times more often). Although we can only venture on the reason for this, we suspect that it is largely a child-bearing issue (the naturally wider shape of a woman’s pelvis).
As I stated earlier, Piriformis Syndrome is a major cause of sciatica (leg pain, numbness, tingling, or weakness, in any combination), hip pain, and / or buttock pain. Because sciatica is so often involved, it is often misdiagnosed as a slipped disc, herniated disc, or a chronic low back or sacroilliac problem. A 2005 study by UCLA’s Mount Sinai Medical School revealed that of 240 randomly picked individuals with Sciatica; the number one cause was Piriformis Syndrome. This is quite revealing and perhaps the UCLA got this study right —— Piriformis Syndrome is being incredibly under-diagnosed / misdiagnosed.
The Sciatic Nerve is both the largest and longest nerve in the body, and at its largest point is about the thickness of one’s thumb. The sciatic nerve originates in the low back (lumbar spine region) and angles toward the middle of the buttock. It then extends down through the leg after passing underneath the piriformis muscle. Be aware that in as much as half the population, the sciatic nerve travels through the Piriformis Muscle, passes over the piriformis muscle, or splits in two and passes directly around the piriformis muscle. Due to mechanical stresses causing chronic tightness or outright muscle spasm, the piriformis muscle can actually become shortened over time. This can often result in microscopic scarring of the fascial sheaths that tightly surround the muscle itself, which in turn causes both local pain and compression of the sciatic nerve (leg pain).
Collagen fibers of fascia is disrupted by injury, a host of really bad things begin to happen. The first thing that occurs is restriction of joint motion. Understand that if you have tissue restriction, you will inevitably have some degree of loss of normal joint motion and proprioception in the corresponding area(s) of the body. Also understand that loss of normal joint motion virtually assures you that sooner or later there will be pain — even if you are not yet experiencing pain. Again, this is because according to the latest research, scar tissue can be over 1,000 times more pain-sensitive than normal tissue. Unfortunately, pain is not the worst thing that is caused by loss of normal joint motion. That would be degeneration.
Loss of, or abnormal joint motion, is the known cause of localized joint degeneration. These are things like calcium deposits, bone spurring, and loss of articular cartilage or disc height that occur in very specific joints or spinal discs. Degeneration is a great example of a “vicious cycle“: Abnormal joint motion causes joint degeneration —– and joint degeneration causes abnormal joint motion which frequently causes increasingly severe pain,
Fascia is the single most pain-sensitive tissue in the body and it does not image well with even the most advanced imaging technologies such as MRI!