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Sciatica is not a diagnosis and we shouldn’t blame piriformis.

Lets get things straight. Physiotherapy or osteopathy works brilliantly for pain down the sciatic nerve pathway,… But only if the cause is established by the physio or osteopath first.

Warning, anatomy alert! The sciatic nerve starts in the low back, comes out in multiple branches though little holes in the lumbar spinal vertebra, joins into one massive nerve and heads south, passing through the buttock, past the hip joint and down the back of the leg where it splits off into different branches again. However, just to complicate matters, there are also other structures that refer pain down the same route that have nothing to do with the sciatic nerve.

The piriformis is just one small muscle in the buttock that the sciatic nerve passes close to, or in about 20% of the population, runs through. However, there is absolutely no way of isolating this muscle from the others (a ‘piriformis stretch’ is really a stretch of a number of muscles in this region) and therefore proving that it is or is not the cause of someones problem. It’s potential contribution to the problem should equally not be discounted, the little guy should just never get given all the blame…. and yet time and time again the diagnosis of ‘piriformis syndrome’ is incorrectly given. 

What is more, the diagnosis sciatica isn’t really a diagnosis! it is more a description of pain along the sciatic nerve pathway. As a physiotherapist I establish what is causing the pain by listening carefully to how the pain came on and asking specific questions to narrow it down to a few structures. Then I do some special tests which check which muscles, tendons, nerves and joints are involved. Once the detective work is over I will then work on the structures causing the pain – of which there are usually at least two. Physiotherapists and osteopaths use techniques like massage, acupuncture, joint manipulations and loading exercises to enable recovery, healing and repair. Most importantly though I need to establish the underlying biomechanical cause of the pain and treat these. These may be a combination of things like instability in the lumbar spine, incorrect pelvic or hip posture, weakness in the hamstrings or gluts muscles and stiffness in the thoracic spine or mid back

The wrong treatment could make you worse whether from a physiotherapist, osteopath or chiropractor. For example nerves will flare up if stretched but calm down if mobilised, tendons respond well to loading but will flare up if loaded incorrectly, muscles that are weak can go into spasm and flare up the symptoms if they are exercised wrongly and joints can get a lot worse if they are over manipulated (someone regularly clicking and clunking you might feel good but it’s NOT going to enable your body to heal.)  

So, in summary. The good news is that if you are suffering from pain down the back of your leg, buttock or lower back then it can and will get better with the right treatment but please arm yourself with this knowledge before you go and see a physiotherapist, osteopath or chiropractor….and if in doubt don’t forget to get a second opinion (more on that in my previous blog.)

If you would like any more information or would like to discuss things with me please do not hesitate to get in touch.

In the meantime I look forward to your comments.


Lucy Macdonald
Chartered Physiotherapist

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