Understanding Low Back Pain and Sciatica: Importance of the Piriformis Muscle

Written by: Dr Tami Recesso PT, DPT

Updated on: July 12, 2023

Welcome to doctami.com.  I appreciate you receiving my suggestions that will help you achieve a pain free lifestyle. Today I’d like to talk about the importance and the simplicity of correcting low back pain and sciatica.  The importance of understanding the piriformis muscle.

Lots of times, people will come into my clinic and they will report heel pain, knee pain, leg pain, thigh pain, glute pain and they will think it’s in fact coming from their heel, their knee, their IT band, or their  hamstring. Oftentimes it’s coming from the low back,  piriformis, and the sciatic nerve bundle. When we’re looking at the anatomy, the sciatic nerve bundle is a collection of some of the lower lumbar spinal nerves.   As exit the spine they go down through the pelvis and they enter a bundle that goes right down through the buttocks and into the leg. Almost like an electrical cord.  Nerves allow two things. They allow sensory, which is the ability to feel sand on your toes, the ground as you step, and feel a person or object  touching you.  The sensory portion of a nerve also works as a protector when you step on something hot or sharp.  The nerve sends the signal to your brain and then quickly elicits a motor signal to lift your foot away from danger.   They are there to be a sense of protection and function.

In terms of function the nerve signals strength and movement for example pulling your foot away from the heat or the sharp object.  When the sensory portions of a nerve bundle are affected, what you’ll experience oftentimes is pain that presents in many ways burning,  sharp, dull, numbness, tingling, or falling asleep. When the motor portion of a nerve is compromised you may see some of the following signs or symptoms foot drop, knee buckling or giving out, heel pain, knee pain, foot pain, leg pain, or weakness of these muscles.

These symptoms are extremely common.  My clients often  report

 “My knee is buckling when I go down the stairs”

“ I am tripping on the step when I step up”

“My leg feels weak, I’m catching my foot on the carpet when I walk”

Oftentimes what that means is there’s something going on in the nervous system with a portion of the sciatic nerve. So even though we’re seeing or reporting or experiencing symptoms in our feet and in our knees and in our legs, we always want to make sure that our providers are looking above and below the body part in question and that they’re ruling out and sometimes ruling in a back or sciatic nerve involvement.

My platform DocTami.com helps your provider decipher the difference. It helps decipher the importance of looking above and below, how to look above and below. It also provides simple exercises that you can perform to help you alleviate your pain with your provider’s approval. I created DocTami.com to  help you take charge of your pain versus allowing your pain to take charge of you. Who is willing to take charge of their pain once and for all?  That doesn’t mean just going and getting an injection and masking it for three months and crossing your fingers and then going for another one and another one and another one, ignoring what those injections are actually doing to our joints and body.  They can be harmful and destructive.  They are masking our body’s brilliant mechanism of communicating with us and protecting us. What happens when we lose that communication? It’s very dangerous and guess what?  The pain only gets worse next time it presents. It doesn’t go away completely. It’s hiding out and being masked.

Who wants to live in avoidance of their pain? Who wants to ignore our only vessel that we are in for the rest of our lives? I’ll tell you right now, it doesn’t work out well. When we ignore our vessel, eventually the vessel wins. That results in all types of risks, and that’s where we end up with secondary complications.

Other issues that I oftentimes see in my practice are people with low back pain that have some involvement of the piriformis and or tightness in one hip versus the other. The piriformis muscle is a very small muscle. It’s a hip rotator. It goes from your sacrum, which is the triangular bone on the bottom of your spine, and it attaches to your outer hip.  What exists  anatomically is the sciatic nerve bundle either goes through or underneath this piriformis muscle.  The way I describe this to my patients is “Imagine the piriformis muscle being a vice grip and imagine your sciatic nerve bundle being a hose. If that vice grip pinches down on the hose, what’s going to happen in the leg?  Is the leg going to get any water? No, it’s going to get diminished water or none at all. That’s what happens with the nerve. If it follows  through an obstructed pathway of vice grips, restrictions, scar tissues, compensation, weakness, imbalances, how efficient will that nerve be? That’s  what we’re seeing. We see the weakness in the leg, we see the decreased sensation, we see the knee buckling, we see the signs and symptoms that are oftentimes being masked.  Some believe “oh, it’s plantar fasciitis. Oh, it’s a medial meniscus strain. Oh, it’s an IT band syndrome”. When in fact, if we really look at things above and below and do an efficient assessment above and below at the hip and the back, do an efficient medical history interview, we find out that the culprit is really the back and the hip and yes, in my opinion it’s one and the same. Studies have shown that the majority of people suffer from back pain at one point in their life. I see numerous complaints of spine pain, leg pain, and sciatica. Nine times out of ten, I give them the Piriformis stretch to be performed daily without pain.  I have a video on DocTami.com identifying a safe way to perform this exercise.  It gets to be pain free. 30 second  Hold, which studies have shown that 30 second  Hold creates a permanent lengthening in a muscle, and I ask my patients to perform it three times every day. It is a commitment and you’re worth it! You also don’t want to push through pain. It’s not no pain, no gain. Again, pain is your body’s way of telling you that it’s not okay. It’s time to listen to our bodies, take charge of our bodies, take charge of the pain cycles, listen, and do something about it.

Allow me to be your partner in healthcare and pain alleviation. I will help provide you with simple techniques and exercises that will be pain free and will help you live a healthier, pain free lifestyle. Purchase my assessment at the low cost of  $49.95 and bring your customizable  print out to your provider of choice as suggestions and guidance. Not telling them what to do, offering suggestions. Asking them to consider looking above and below, asking them to consider other diagnoses, and you’ll be surprised at how quickly you are living a pain free life !