WHAT IS FALSE SCIATICA OR SCIATICA DUE TO PYRAMIDAL SYNDROME?

The sciatic nerve is the widest and longest nerve in the human body. This nerve crosses and passes through different structures on its way. This post raises the great frequency with which sciatica or sciatic pain is due to compression of this nerve as it passes through the gorge offered by the pyramidal or piriformis muscle at the level of the pelvis, and which is known as pseudo sciatica or false sciatica.

The piriformis or piriformis muscle of the pelvis

The pyramidal or piriformis is a thin triangle-shaped muscle, which is located below the gluteus maximus. This muscle inserts on top of the greater trochanter and passes through the posterior region of the socket. This small muscle acts as an external rotator of the hip in the neutral position, while it internally rotates with the hip flexed at 90°. As a general rule, the piriformis muscle is a muscle that tends to hypertrophy and harden, which can trigger the so-called piriformis syndrome or more commonly called the piriformis syndrome. In the following image you can see the relationship between the piriformis muscle and the sciatic nerve:

The biggest enemy, both for health personnel and for a patient with piriformis syndrome, is the lack of knowledge about this disease. This syndrome often goes undiagnosed or is confused with lumbosciatica. In addition, a piriformis muscle dysfunction can cause anterior pelvic rotation or tilt.

This syndrome mainly affects women with a 6:1 ratio compared to men, in the most severe cases it can be incapacitating, in order to limit daily activities. In anatomy, in 80-90% of subjects the sciatic nerve does not cross the piriformis, in 10-15% the sciatic nerve passes through the piriformis muscle, so the sciatic nerve can also be affected.

This syndrome is often called false sciatica, because it gives the same symptoms of sciatica but is not caused by an affectation of the sciatic nerve at the level of the spine. Piriformis syndrome, often misdiagnosed as sciatica, occurs when the piriformis muscle tightens, pressing on the sciatic nerve, resulting in nerve-related symptoms radiating down the leg.

What is piriformis muscle syndrome and what are its symptoms and causes?

In the following video we explain more about this syndrome, what alterations you can present if you have it and why it occurs.

What symptoms does pyramidal syndrome produce?

The symptoms related to this syndrome are:

• Pain, with the characteristic that radiates throughout the back of the leg to the level of the knee, and in some cases to the foot.
• Numbness or tingling in the back of the leg.
• Sensation of tightness or deep pain in the buttocks region.
• Weakness in the legs.
• Pain in the groin, abdomen and inner thigh.
• Difficulty walking (due to pain, when it becomes unbearable).
• Symptoms are often aggravated by sitting, especially on a low surface such as a sports car or sofa. Also, symptoms can be aggravated when the piriformis muscle is in a stretched position, such as when walking uphill or climbing stairs.
• Leg pain can become excruciating, but the piriformis may not be the cause. A good differential diagnosis is necessary, since disc herniations, lumbar stenosis, tumors, hematomas in the internal hamstring muscles (semimembranosus, semitendinosus and biceps femoris) or the piriformis muscle can present the same symptoms.

Treatment of pyramidal syndrome

The treatment of pyramidal syndrome will depend on the physiotherapist’s approach, but better results are obtained if conservative and alternative treatments are combined. There are multiple tools that are applied in the therapies of a pathology, and the case of a pyramidal syndrome is no exception.

The conservative treatment for piriformis syndrome includes:

• Reduction of inflammation through electrotherapy and self-massage (although there are no studies on the effectiveness of massage on the piriformis muscle, it has a relaxing effect and can reduce pressure on the sciatic nerve and separate scar adhesions).
• Increased flexibility of the piriformis through myofascial manipulation and self-stretching.

Exercise for the back Stretching of the pyramidal or piriformis

Maintaining range of motion is essential to decrease tension in the piriformis muscle. This stretching exercise will help you decrease tension.

What can be the causes or origins of pyramidal syndrome?

The most common cause then is the presence of lumbar problems: normally the blockages of the fifth lumbar vertebra irritate a nerve root which in turn will cause spasm of the piriformis muscle. These lumbar problems are often caused by organ alterations, and depending on the affected organ, it will be reflected in the left or right pyramidal.

Treatment of the right Pyramidal Syndrome

When it occurs on the right side, the treatment implies a different approach to its treatment, which you can see in this video.

Treatment of left pyramidal syndrome

When it occurs on the left side, the treatment implies a different approach to its treatment, which you can see in this video.

Summary

• The sciatic nerve is the widest and longest nerve in the human body. As it passes through the gorge of the pyramidal muscle, it can be compressed, causing false sciatica.
• The pyramidal muscle is a muscle prone to hypertrophy and hardening, so it is very common for the so-called pyramidal syndrome or false sciatica to develop.
• This syndrome is more common in women than in men.
• The blockade of the fifth lumbar vertebra is the most common cause of this syndrome, since the nerve root is irritated and a spasm of the pyramidal muscle is also generated.

This syndrome or this affectation of the sciatic nerve during its passage through the piriformis muscle is very often confused with another pathology and therefore it is very common for the wrong treatment to be applied, reducing its efficacy and effectiveness. This is why it is necessary and important to go to a trained professional, in this case, a physiotherapist, to carry out the pertinent evaluation and establish the appropriate treatment protocol.