Piriformis symptoms can mimic any other form of pseudo-sciatica, since the sciatic nerve is often affected by compression from the piriformis muscle. The diagnostic name of this particular sciatica pain condition related to muscular compression is called piriformis syndrome and the theory of causation remains a much debated topic in the larger back pain treatment sector.
Piriformis syndrome is often a diagnosis that is suggested well into the treatment program for a condition that was originally theorized to be created by some abnormality in the lumbar spine. In other rare instances, piriformis syndrome might be the original diagnostic verdict suggested, especially if the patient seeks care from a provider who specializes in the muscular anatomy and soft tissue pain syndromes.
This patient guide explores the possible symptoms of piriformis compression of the sciatic nerve. We will detail how these expressions differ from traditional sciatica syndromes, as well as how they are similar.
Sciatica is defined as a neurological pain syndrome that affects the buttocks, legs and feet, but is sourced in the lumbar spine. Typically, the origin of these pain conditions are lumbar herniated discs or lumbar central or foraminal spinal stenosis that are caused by osteoarthritis. Less typical causes include lumbar scoliosis and lordosis changes that can affect neurological tissues or spondylolisthesis misalignments that can also trap nerve structures. True spinally-motivated sciatica conditions never affect the sciatic nerve directly, since they occur anatomically above where the nerve even forms. Instead, true sciatica comes from processes that affect one or more of the nerve roots that form the sciatic nerve by joining together lower in the body.
All true sciatica has a lumbar spinal origin, while conditions that do not come from the lumbar spine, but still have similar or identical expressions are called pseudo-sciatica. Piriformis syndrome is one of these pseudo-sciatica expressions, since the compression of the sciatic nerve occurs long after the nerve roots have left the spine. This compression occurs underneath or within the substance of the piriformis muscle, which is located deep inside the buttocks, near the frontier of the hip. Piriformis syndrome affects the fully-formed sciatic nerve which is created by the nerve roots from L4 to S3 coming together.
The actual symptoms of both sciatica and piriformis syndrome can be strikingly similar or even identical, depending on several variable factors. This can create diagnostic challenges for any care provider, especially in the very common event of the patient demonstrating the usual telltale signs of age-related degeneration in the lumbar spine. The most common symptoms of piriformis syndrome include any or all of the following expressions usually in the order presented below:
Pain may be present locally art the site of compression (in the spine or in the buttocks, respectively) and may radiate into specific parts of the leg and/or foot or throughout the leg and/or foot.
Tingling may occur in areas served by the compressed nerve tissues.
Numbness of a subjective or objective variety might exist in areas served by the compressed nerve tissue.
Weakness may follow objective numbness, showing a decline in neurological functionality and a distinct lack of proper innervation.
Foot drop might occur partially or completely.
All of these symptoms can be expressed unilaterally or bilaterally, depending on the particulars of the causative condition. Both diagnoses of sciatica and piriformis syndrome tend to be unilateral, but bilateral symptoms appear in more people who suffer from piriformis syndrome than from true spinal sciatica.
The expression of symptoms often provides hints as to the true causative process for care providers who are well versed in identifying both conditions and who take the time to complete proper diagnostic evaluation. Unfortunately, the latter part of this conditional statement is usually overlooked, since virtually all symptomatic patients are provided with lumbar imaging that shows an often incidental structural irregularity and put into treatment for this “problem”, when it is not even the actual cause of pain. Some important diagnostic clues include:
Widespread symptoms that move around often are rarely sourced from a spinal origin. If they are, there would have to be multiple spinal roots affected in order to explain the diversity of the symptom expression. This scenario is usually linked to a central spinal stenosis problem that compresses multiple nerve roots within the vertebral canal, prior to them leaving the spine and creating the sciatic nerve. Single or even dual level nerve roots compressed within the foraminal spaces will not logically explain such a diversity of symptoms. Meanwhile, piriformis syndrome can create a vast array of symptoms, since the entire sciatic nerve is affected by compression.
Piriformis syndrome might be linked to relatively common abnormalities wherein the sciatic nerve runs through the substance of the piriformis muscle, rather than underneath it. Diagnostic imaging can check for this irregularity, as it might be part of the symptomatic explanation.
Diagnosticians must also be careful that the piriformis is not in spasm due to a spinal innervation syndrome or a very common ischemic process that deprives the tissue of necessary oxygen. Both of these conditions can confuse cause with effect, which will spell disaster in the treatment process. If these root causes are the source of piriformis-enacted nerve compression, treatment is unlikely to be successful until the deeper origin is ascertained and resolved.