Sciatica & Piriformis Syndrome in Runners
A detailed guide on the causes, symptoms and treatment options for sciatica and piriformis syndrome in runners.
A sharp, pinching pain in the buttocks with shooting pain down the leg is the typical symptom of sciatica, a condition caused by an irritated sciatic nerve.
In runners, the irritation is usually caused by a tight piriformis muscle constricting the sciatic nerve. This particular form of sciatica is called Piriformis Syndrome.
Sciatica & Piriformis Syndrome Quick Facts
- The sciatic nerve is the largest nerve in the human body. It starts in the spine and travels all the way down the leg. It also a thick nerve, reaching a diameter of up to 2cm.
- The sciatic nerve can get irritated by any of the structures it passes along its path. A bulging disc, inflamed joint, or spasming muscle can all irritate the sciatic nerve. The piriformis muscle is just one of these structures.
- Sciatica is not a sign that the sciatic nerve is permanently damaged or blocked. It is a temporary condition caused by inflammation. Once the inflammation settles, the pain goes away.
What Causes Sciatica and Piriformis Syndrome in Runners?
The piriformis a small muscle deep in your buttocks. It helps you balance on one leg and also rotates your hip.
The sciatic nerve passes straight through the piriformis muscle. If the piriformis goes into spasm, it can irritate the sciatic nerve and send pain along the nerve’s path (buttocks and down the leg). This is called Piriformis Syndrome.
In runners, the piriformis is particularly susceptible to spasm because of overuse and fatigue.
When running, your piriformis works hard every time your foot hits the ground. Together with other stabilizing muscles like the glute minimus and glute medius, the piriformis makes sure your hip and pelvis stay balanced, upright and supported as you absorb each landing.
If you’re new to running or training at a new level, your piriformis might not be ready to take on all this work. As the piriformis gets fatigued, over-worked and irritated it will seize up, compressing the sciatic nerve that passes straight through it.
Is Your Sciatica Coming From The Piriformis Muscle?
Sciatic pain can be caused by any number of structures that interact with the sciatic nerve so it’s important to identify the root cause of the pain before starting treatment. Physiotherapists and Sports Physicians go through a thorough assessment process to identify the cause of pain — they will take a detailed history, look at your movement and possibly get scans to look closer at your anatomy. All of these tests help to form a clear picture of what is causing your pain. One of the most important aspects of this assessment is identifying a pattern of symptoms and comparing that with what we know is typical for Piriformis Syndrome.
There are a few telltale symptoms of Piriformis Syndrome that differentiate it to other causes of hip pain and other types of Sciatica. For example, people with Piriformis Syndrome typically have the following symptoms:
- Sharp pain in the buttocks
- Increased pain with prolonged sitting
- Increased pain when walking or running uphill (or upstairs)
- Decreased flexibility (range of movement) in the hip
Sciatica that originates in the spine tends to present with a slightly different set of symptoms that are more localized to the lower back. If you suspect you have sciatica or piriformis syndrome, you should see a Physiotherapist or doctor who can perform the necessary diagnostic tests and prescribe an appropriate treatment plan.
How is Piriformis Syndrome Treated?
Once you’ve been diagnosed with Piriformis Syndrome, the treatment plan will be two-fold; the first stage will be relaxing the piriformis, the second will be strengthening the piriformis and all the surrounding muscles.
There are a number of ways the piriformis muscle can be relaxed. Here are some of the options you may be presented with:
- Deep sports massage
- Hip stretches
- Dry needling
- Self-massage
Each of these treatment options can be effective so you should choose something you’re comfortable with. You should expect to see some improvement within the first couple of weeks, if not, try another option.
The second part of the treatment will involve strengthening the piriformis and surrounding muscles. Strengthening these muscles will help them better tolerate the stress and endurance of running. Exercises such as bridges, lunges, squats and resistance band walks, are some examples.
Once the pain has decreased and you are doing regular strengthening exercises, you can gradually resume your normal running routine. However, be aware of any changing in symptoms and if you notice the pain returning, see your Physio or doctor.
