Ever get a sharp pain in your back that runs down your leg? Does it stop at the foot, the knee, or the hip? Do me a favor and stand up. Try to touch your toes. Does this make your back or leg pain better , worse or no different? Next, lean backward. Does this make your pain better, worse, or no different? How about when you bend to the left or the right? Depending on the results of this simple home test you could fall into one of several categories regarding back pain and sciatica! Most people have heard of sciatica but don’t really understand what it is, fewer people have heard of piriformis syndrome but we are going to explore them both in this article.
Sciatica has been used as a general term for many years and is defined as any pain that radiates from the back down into one leg or the other, following the sciatic nerve, hence “sciatica.” The general term of “Sciatica” does not tell us the cause of the pain and can be further broken down into “discogenic pain” or Piriformis Syndrome. Discogenic pain is pain that is caused by the disc, which are 80% water. This means that the laws of fluid dynamics are at play which dictate that fluids will move from high pressure to low pressure, along the path of least resistance. Essentially the disc (which is the cushion between the bones of the spine called vertebrae) can be encouraged to move in any direction given your posture! If you are always leaning forward to work on the computer or play on your phone, then the front of the disc has more pressure on it than the back, thus the disc bulges toward to back. It hits a barrier and has to glide to the left or the right. When this happens, it closes down the space where the nerves live and can cause them to get irritated, resulting in pain in the back or into the buttock, hip, knee, ankle or foot. Sometimes a person won’t have pain but will have numbness or tingling, or weakness in that leg.
How does Piriformis Syndrome differ? 1st, the piriformis is a triangular muscle that anchors onto the front side of the sacrum (foundation of the spine) and travels out to the hip, creating part of the side wall for the pelvic floor muscles. The piriformis works with several other muscles so we can turn our hip outward (external rotation). Our sciatic nerve runs right next to the piriformis and in some people, actually pierces through it so you can imagine what happens if the piriformis gets tight or even goes into spasm and grabs the sciatic nerve, giving it a good squeeze! The resulting pain is similar to what you would see if this were a disc problem, same nerve, different part, same results.
Both of these conditions can make it difficult to sleep, get out of bed, up from a chair, or stand for any length of time, but the good news is both of these conditions are reversible if caught soon enough, and some research even suggests that stenosis, disc degeneration and bulges may be a normal part of the aging process. When looking at people my age, 50, 80% of us have disc degeneration with NO symptoms, and 60% of us have disc bulges with NO symptoms. Bottom line is that if you have back pain and go to get an MRI, chances are they will find something, but it does not mean it is the cause of your pain. This is where physical therapy comes in. An evaluation by a manual physical therapist can help determine the cause of your pain.
If your symptoms are reproducible then your symptoms are reducible.