Sciatica or Piriformis Syndrom?

Many people experience sciatic pain, which can affect hips, lower back, and even radiate down the legs. Doctors are quick to throw out words like sciatica when a person has issues like this, but sciatic pain and sciatica are not synonymous. The sciatic nerve travels a long way from the lumbar region to the hips and down the back of the legs, and that gives it many places where nerve impingement can occur. When there is pain that appears to be associated with the sciatic nerve, doctors will usually blame it on a bulging disk in the lumbar region pressing against the nerve and aggravating it, but I would not be so quick to jump to this conclusion without an MRI, which just as often as not, will show nothing useful. For most physicians the first order of business would be steroid injection, which often do not yield good results, and even if they do, will eventually stop working. A bulging disk can be pretty serious, but why jump to the most serious conclusions first?

In my practice if someone comes in with sciatic pain, and or lower back pain, the first thing I want to address is the hips. Hip restriction can cause lower back pain for a variety of reasons, and restriction in the lateral hip rotators can cause sciatica symptoms, especially the piriformis. The piriformis is a muscle that attaches the top of the leg, the greater trochantor, to the sacrum, what we call our tail bone. The sciatic nerve runs through this space, and the piriformis can impinge the nerve against the bone. When this occurs the first thing to do is get in there and manually work it out, with attention to the muscle attachments and some leg movement. Sometimes it only takes a few minutes to relieve this sciatic pain, something that one might struggle with when seeing a doctor for years, possibly even leading to surgery. But even if a Rolfer or a massage therapist works out a tight piriformis, the pain might come back again so we must ask the question, why does it keep coming back?

The angle of the pelvis, how it is affected by the legs and how it affects the lower back is of interest to a Rolfer. If the pelvis is not supportive of the lower back, then we will very likely have lower back pain. Ida Rolf went so far as to state that the whole 10 series is about horizontalizing the angle of the pelvis, and though that is quite a statement, many of the sessions in a Rolfing series to address what affects the pelvis and hips. If we can free the hips and get the pelvis in a supportive position the tightness in the hips may not return, and the sciatic pain may disappear. Notice that I use the phrase, sciatic pain rather than sciatica. We are dealing with a symptom that could be caused by a variety of issues, and as a Rolfer, we do not diagnose, we hypothesize and experiment, keeping the question open instead of ending the discussion with a diagnosis.

#rolfing #sciatica #piriformis #structuralintegration