Symptoms Of Piriformis Syndrome
Wallet sciatica better known as piriformis syndrome typically starts with pain in one buttock, the pain can extend down the back of the leg toward the foot and this referred pain can be severe like sciatica. The pain with wallet sciatica is considered to be due to the piriformis muscle compressing the sciatic nerve which can happen during activities such as just sitting on a car seat, running or lunging… In some circumstances the pain may be significant enough that the individual tries to avoid putting pressure on the area so chooses to adopt a lopsided sitting approach with the sore buttock side tilted up.
Causes Of Wallet Sciatica
The exact causes of wallet sciatica are unknown the main reasons suspected to be the cause of piriformis syndrome may include:
- Piriformis muscle tightening or muscle spasm because of irritation in the muscle itself, or irritation of a nearby structure such as the sacroiliac joint (SIJ) or hip joint.
- Swelling or tightening of the piriformis muscle, due to injury such as blunt trauma to the area or prolonged pressure such as sitting down with your wallet in your back pocket (hence the name wallet sciatica).
- Muscle anomalies of the piriformis muscle and partial or total anatomical nerve abnormalities.
- General core stability weakness and weakness of the deep hip stability muscles.
Either a combination of the above or as the result of one of the above in isolation can trigger wallet sciatica. Impacting the sciatic nerve adjacent to the piriformis muscle causing pain, tingling, or numbness down the back of the leg to the foot.
Diagnosing Wallet Sciatica
The diagnosis of wallet sciatica is controversial because it is a clinical one for which there is no definitive test and no confirmatory tests exist to support clinical findings. When arriving at a diagnosis of piriformis syndrome first spinal nerve root compression from disc bulges must be eliminated as a cause of the sciatic symptoms. The presence of sciatica in the absence of lumbosacral spinal pathology means piriformis syndrome may be suspected.
As a result of the above a diagnosis of wallet sciatica is made from the subjective history of the condition coupled with the exclusion of any spinal involvement and positive signs on clinical tests designed to cause stretch or load to the piriformis muscle such as the Freiberg’s test and Pace test among others. Generally the use of MRI , CT, ultrasound, and other investigations are mainly useful in excluding conditions that could replicate wallet sciatica.
Treating Piriformis Syndrome
Once a diagnosis of piriformis syndrome has been established treatment will look to address the reasons behind the onset of the symptoms which may include any number of approaches.
- If pain is caused or aggravated by sitting or certain activities then alternatives will be offered in an attempt attempt to avoid positions that trigger the pain and allow things to settle.
- If pain was triggered by blunt trauma to the area then rest, ice and even anti-inflammatory medication may be recommended in the early stages with the idea of reducing the swelling and bruising causing compression to the sciatic nerve.
- If the muscle is deemed to be tight or in spasm and this is felt to be causing the compression around the nerve then ways of addressing this such as massage techniques, dry needling, stretching or foam rolling may be advised.
- If it is considered to be a hip stability, weakness or biomechanical trigger then the approach may look to address this via orthotics, postural control and core strength exercises targeting the areas of weaknesses in the hip or pelvis regions.
Surgery or injection with botulinum toxin (botox) are occasionally used as a last resort if things aren’t settling with more conservative treatment. The paralytic properties of the, botox injections is thought to relieve muscle tightness and spasm and thus reducing the and sciatic nerve compression helping to minimise pain.
The Prognosis And Prevention Of Wallet Sciatica
In the majority of cases wallet sciatica is effectively treated with physiotherapy and short-term symptoms can resolve within a few days. More longstanding piriformis syndrome symptoms may take weeks to address as the muscle strength, length and general biomechanics that predisposed the individual to the complaint need to be addressed prior to the condition settling. The good news is that only rarely is botox or surgery contemplated.
Prevention of a recurrence of piriformis syndrome is generally via maintaining good muscle length and strength in the hips, pelvis and lower back as well as keeping ‘good form’ with loading activities known to stress the area such as lunging or running… As well as form during exercise being important so too is good form when adopting sitting postures to avoid sitting in positions causing direct pressure to the piriformis muscle and sciatica nerve. And obviously keep that wallet out of your back pocket!
Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Diagnosing And Treating Wallet Sciatica should consult his or her general practitioner, physiotherapist, sports medicine specialist, orthopedic surgeon or otherwise appropriately skilled practitioner.