Dora is a 36-year-old woman who recently began jogging and practicing Yoga. Gradually pain has developed deep in her left buttock. She describes the pain as an ache, and its aggravated by climbing stairs and running. Sometimes she feels pain in the back of her thigh and lower leg or a weird feeling on the side of her left foot. She hasnt taken any over-the-counter pain medicine for it, explaining that she doesnt like to take medicine. She wants to know whats wrong with her and how to fix it naturally without pills or surgery.
On physical examination, there is tenderness elicited over the left sciatic notch when pressure is applied with the thumb. When lying on the right side, lifting the left leg up is painful.
Usually pain in the sciatic nerve distribution is attributed to compression of the nerve by a slipped disk in the spine. An MRI may be done, and it may even show just that.
Two out of three adults pulled off the street randomly and offered an MRI of their lower back will have that same abnormality. The vast majority of them dont have pain. Its hard to be sure if symptoms are caused by the ruptured disk or irritation elsewhere along the course of the sciatic nerve.
Thats precisely what happens in Piriformis Syndrome. The piriformis is a muscle that runs from the sacrum of the spine to the outer aspect of the thigh bone underneath the big butt muscle, the gluteus maximus. On its way it passes through the sciatic notch of the pelvic bone. The sciatic nerve also passes through the notch below the piriformis muscle.
In Piriformis Syndrome, the sciatic nerve gets compressed or irritated by movement of the piriformis muscle rubbing against it with resulting inflammation. It can cause a chronic pain syndrome that lasts for years without appropriate recognition and therapy. Sometimes there is a precipitating trauma or bruise to the hip or buttock. Sometimes there is a history of a recent increase in activity, particularly jogging. Occasionally frequent and repetitive forward bends with straight legs, such as with padhastasana or paschimottanasana, appear to trigger or unmask it. Prolonged sitting is also a risk factor due to direct compression.
What to do:
- First, what NOT to do. Forward bends with the legs straight, both standing and sitting poses, stretch the sciatic nerve and may increase pain and irritation. Avoid them for six to eight weeks.
- Dont sit for more than 20 minutes at once. Set a timer while on the computer or doing whatever at a desk. Get up and move around for a few minutes to relieve compression and improve blood flow to the area.
- If a repetitive motion, like initiation of a daily jogging routine, seems to have triggered the symptoms, stop doing it. Give the body a chance to heal itself of the inflammation without continuing aggravation.
- Concentrate on the following asanas during Yoga practice. If possible, do at least one of the three every two hours.
- Raja Kapotasana
- Matsyendrasana with minimal torso twist
- Continue the program for six to eight weeks even if feeling better in order to ensure complete healing and avoid re-injury.
Boden SD et al. Abnormal magnetic resonance scans of lumbar spine in asymptomatic subjects. J Bone Join Surg Am 72:403-408, 1990.