The Cause of Your Sciatic Pain May Be In the Butt, Not the Back

SymptomsBack PainSciatica

Can sitting too much become a pain in the butt? “Maybe,” says interventional pain management specialist Kaliq Chang MD of the New Jersey-based Atlantic Spine Center, “but a sedentary lifestyle is probably just one of the multiple potential causes of piriformis syndrome.”

Causes of Sciatic Pain

The syndrome takes its name from the piriformis muscle, which stretches from the lower spine to the top of each thighbone and assists in hip movement and turning of the leg and foot outward, says Dr. Chang, who is dual board-certified in interventional pain management and anesthesiology. Some experts contend that inflammation and swelling of the piriformis muscle due to injury, overuse and spasm, or irritation of nearby musculoskeletal structures like the hip or the joint connecting the lower spine and the pelvis (sacroiliac joint), can compress the thick sciatic nerve, which is the largest nerve in the body. Pressure on this nerve, which typically extends vertically below the piriformis muscle, leads to sciatica-like symptoms, including an ache in the buttocks, especially after prolonged sitting, shooting pain down the back of the thigh and calf and limited hip rotation.

A study published in July 2017 in the International Journal of Science and Research concludes that sedentary individuals are more likely to develop tightness in the piriformis muscle, and this tightness may lead to piriformis syndrome. Other scientists contend that exercising improperly or extensively, and engaging in sports like running; bicycling and tennis heighten the risk for the disorder – which many health professionals describe as “uncommon.” But such explanations of the cause may be somewhat oversimplified, Dr. Chang says. A Harvard Medical School rheumatologist, writing in a 2018 online article, states that “piriformis syndrome may be the most common cause of sciatic-type back pain you've never heard of, or it may be rare, no one is really sure.” Dr. Chang concurs with authors of a September 2018 report in Practical Neurology indicating that piriformis syndrome is more accurately described as “sciatic nerve entrapment neuropathy,” which may be due to “different disparate and unique orthopedic and neurologic disorders” deep within the anatomy of the buttocks and its associated muscles. The researchers cite fibrous bands that can entrap the sciatic nerve, strained or injured hamstrings, weak or stretched hip-rotator muscles, cysts, or tumors near the piriformis muscle, and even anatomical anomalies, as all being potential contributors to piriformis syndrome. In a small percentage of the population, for example, the sciatic nerve runs through, rather than under, the piriformis muscle.

Precisely pinpointing the exact cause of a patient’s pain “in deep gluteal space” may oftentimes prove difficult and elusive, but Dr. Chang emphasizes what piriformis syndrome is not. “It is not sciatica, although the problem is sometimes misdiagnosed as such,” he states. Sciatica develops from lower back problems caused by injury, herniated or bulging spinal discs, lumbar spinal stenosis, and degenerative disc diseases like spondylolisthesis or bone spurs (an overgrowth of bone on the vertebrae). Piriformis syndrome is most often the result of soft tissue inflammation or muscle spasm emanating from the gluteal (buttocks) region.

In conclusion, sciatic pain can be caused by various conditions, including herniated discs, spinal stenosis, degenerative disc disease, piriformis syndrome, spondylolisthesis, and trauma. It is essential to consult with a healthcare provider to determine the underlying cause of your sciatic pain and develop an appropriate treatment plan.

“A patient misdiagnosed as having sciatica may undergo back therapy that provides no relief for the pain. That’s why patients with sciatica-like symptoms should be seen by a specialist for proper evaluation and treatment before the problem worsens or becomes chronic,” Dr. Chang advises.

Symptoms of Sciatic Pain

Patients with mild or moderate pain from diagnosed piriformis syndrome oftentimes benefit from conservative approaches and home remedies, including hot and cold applications; hamstring stretches and other strengthening exercises; non-steroidal anti-inflammatory medications like ibuprofen and naproxen; even physical therapy and deep massage therapy. For severe or resistant pain, “the interventional pain management specialist may inject a local anesthetic and corticosteroid or botulinum toxin (Botox®), a muscle-weakening substance, directly into the piriformis muscle. Electrotherapy applied to the buttocks also may prove effective,” Dr. Chang says. “Surgery may be necessary if all else fails.”

Meanwhile, Dr. Chang says the risk of developing piriformis syndrome can be reduced by taking certain precautionary steps. He offers these tips:

  • Don’t just sit there. Be active.
  • Use good posture when engaging in an exercise like running, walking, or lifting to avoid putting too much stress on the piriformis muscle.
  • Warm up properly, increase the intensity of activity gradually, and take time to “cool down.”
  • If pain develops during exercise, stop and rest. If muscles become injured, let them heal completely before returning to activity.
  • Avoid trauma to the buttocks. It is not a soft-landing cushion.

Treatment of Sciatic Pain

Sciatic pain, also known as sciatica, is a type of pain that affects the sciatic nerve, which is the largest nerve in the body. The sciatic nerve runs from the lower back through the buttocks and down the back of each leg. The pain can be severe and debilitating, and it can interfere with daily activities.

Treatment for sciatic pain depends on the underlying cause of the pain. Common causes of sciatica include herniated discs, spinal stenosis, and degenerative disc disease. In many cases, sciatic pain can be managed with conservative treatments.

Resting and avoiding activities that aggravate the pain can help relieve sciatic pain. Patients should avoid prolonged sitting or standing, heavy lifting, and strenuous activities.

Over-the-counter pain medication, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can help relieve pain and inflammation.

Physical therapy can help improve flexibility, strength, and range of motion, which can help reduce the pressure on the sciatic nerve. Physical therapy may include exercises, stretches, and other techniques to help manage pain and improve function.

Epidural injections can help relieve sciatic pain by reducing inflammation and swelling around the nerve. The injection is usually a combination of a local anesthetic and a steroid medication.

In some cases, surgery may be necessary to relieve sciatic pain. Surgery may be recommended if conservative treatments have not been effective, or if there is a significant structural problem, such as a herniated disc.

In conclusion, sciatic pain can be a debilitating condition that affects daily activities. However, there are several treatment options available, ranging from conservative treatments like rest and physical therapy to more invasive options like surgery. It is important to consult with a healthcare provider to determine the best treatment plan for your specific condition.

Therapies for Sciatic Pain

Sciatic pain, also known as sciatica, can be a challenging condition to manage, but there are various therapies that can be effective in reducing pain and improving function. Here are some therapies commonly used to treat sciatic pain:

  • Chiropractic Care, during which chiropractors use a variety of techniques to manipulate the spine and other joints to reduce pressure on the sciatic nerve. Treatment may include spinal adjustments, therapeutic exercises, and stretching.
  • Acupuncture is a traditional Chinese medicine technique that involves inserting thin needles into specific points in the body. This therapy may help reduce inflammation and pain associated with sciatica.
  • Massage Therapy can help relax muscles and reduce tension around the affected area. This therapy can be effective in reducing pain and improving mobility.
  • Yoga is a mind-body practice that combines physical postures, breathing techniques, and meditation. Yoga can help improve flexibility, strengthen the muscles, and reduce stress, which can all contribute to the management of sciatic pain.
  • Heat and Cold Therapy such as applying heat or cold to the affected area can help reduce inflammation and relieve pain. Heat therapy, such as using a heating pad or taking a warm bath, can help relax muscles, while cold therapy, such as using an ice pack, can help reduce swelling.
  • Transcutaneous Electrical Nerve Stimulation (TENS) therapy involves applying a small electrical current to the affected area to stimulate nerves and reduce pain. This therapy can be effective in managing chronic sciatic pain.
  • Cognitive Behavioral Therapy (CBT) is a type of therapy that helps patients change negative thought patterns and behaviors that may be contributing to their pain. This therapy can help patients better cope with the physical and emotional effects of sciatic pain.