Why is my leg burning?

            “My sciatica is acting up,” or “This sciatica prevents me from getting up and exercising!” These are just some of the things that we hear daily as a Doctor of Chiropractic. It seems that everyone believes now-a-days that getting older means that they are going to suffer through sciatic pain, otherwise known as sciatica. This is just NOT true! Step back for a second and think about why you are having this pain? It could very well be from your piriformis muscle, and by working on some stretches and exercises you can easily get out of pain and prevent it from returning. You will never have to be one of those people who do not do things that they love to do because their “sciatica is acting up.”

Inflammation of the sciatic nerve due to irritation of the piriformis muscle

Piriformis Syndrome

            Now, when you are feeling this burning pain down the leg, or feel your “sciatica” acting up, it may very well be from a condition know as piriformis syndrome. What is piriformis syndrome you ask? Well, it is a condition when there is sciatic nerve entrapment at the level of the ischial tuberosity. This entrapment of the sciatic nerve is due to inflammation or irritation of the piriformis muscle (see Fig. 1). According to research from Stat Pearl (Hicks, Lam, Varacllo), “the piriformis can be stressed due to poor body mechanics in a chronic condition or an acute injury with the forceful internal rotation of the hip. There are also anatomic anomalies that may contribute to compression, including a bipartite piriformis, direct invasion by a tumor, anatomical variations of the course of the sciatic nerve, or an inferior gluteal artery aneurysm that may compress the nerve.”¹ 

^{Figure 1: Anatomy of the piriformis muscle and sciatic nerve}

            There are 3 different variations of the course of sciatic nerve that vary from person to person. Some people the sciatic nerve runs on top of the piriformis muscle, some people it may run below the muscle, and on around 20% of people the sciatic nerve pierces the piriformis muscle. Now when there is an irritation or inflammation of the piriformis muscle it is going to cause pressure on the sciatic nerve and that is when you’re going to be feeling that burning, tingling, numbness or even shooting pain down the leg. Now that you know the basic anatomy and cause of piriformis syndrome and you have figured out that “Yes” this is exactly what is occurring with me, we are going to show you some stretches, exercises, and what we can do conservatively in our office to help increase your body’s function and get rid of that annoying burning pain!

Piriformis Stretches

            If you really are serious about getting rid of this pain, schedule an appointment with us in our office today and we can go step by step in person everything that you should be doing at home to stretch and exercise. But if you need to just do a few things to temporarily get out of pain follow a few of these stretches and increase your body’s range of motion and all-around functionality.

            Stretching to the piriformis muscle, hamstring muscles, and hip extensors will all aid in decreasing the inflammation and irritation of the muscles around the sciatic nerve. Start by stretching the piriformis muscle, here are two simple ways that you can go about and do that:

• Lie on the back with both feet flat on the floor and both knees bent. Pull the right knee up to the chest, grasp the knee with the left hand and pull it towards the left shoulder and hold the stretch. Repeat for each side.
• Lie on the back with both feet flat on the floor and both knees bent. Rest the ankle of the right leg over the knee of the left leg. Pull the left thigh toward the chest and hold the stretch. Repeat for each side.

What I tell a lot of my patients is that if you truly want to benefit from stretching you are going to need to hold the stretch for 30 seconds all the way up to 2 minutes per muscle. Obviously, if you are new to stretches start off on the low end and work your way up. Perform each stretch 2-3 times a day.

            Next up, you need to give some love to your hamstring muscles. There are several different ways to stretch your hamstrings, and it is a lot easier with a partner, but if you are alone here are a couple things you can do:

• Place two chairs facing each other. Sit on one chair and place the heel of one leg on the other chair. Lean forward, bending at the hips until a gentle stretch along the back of the thigh is felt, and hold the stretch.
• Lie on the back with both legs straight. Pull one leg up and straighten by holding on to a towel that is wrapped behind the foot until a mild stretch along the back of the thigh is felt.

Check out our YouTube video on piriformis syndrome to see a little more in depth look at some more stretches and treatments that we can do in office to help you with the piriformis issues.

Piriformis Treatment

            Yes, we are Doctors of Chiropractic so yes, I am all gung-ho for conservative non-invasive treatment. But our philosophy with treatment is we will do whatever we can to get you out of pain without having to take drugs or have surgery, both will cause long-lasting negative side effects. So, we will be with you every step of the way to get you out of pain and keep the pain away so you can live a long and happy life.

            First off, what we will first do in our office is a thorough exam to find out if your problem is coming from the Piriformis. Next up, we will palpate and test the functionality of your pelvis and sacrum, along with the lower lumbar spine. We will adjust what we find to increase the function and the range of motion of the lower back.

The brilliant Doctors at inTune Chiropractic Clinic performing a thorough examination of a patient in order to provide the best possible care

            Next, we will do some in-office stretches to really get range of motion and help loosen up the muscles. If we need to, we can do some manual deep muscle massage and some instrument assisted soft tissue mobilization. This will take care of any muscle knots, adhesion's, and increase the blood circulation to area and decrease the inflammation and irritation that is occurring.

            Time to gloat a little bit, our office is one of the only offices in the Nashville area who have a Piezowave2 therapy. This therapy can quickly and efficiently help a myriad of musculoskeletal conditions much quicker than drugs, physical therapy, and surgery. For an acute case of Piriformis syndrome, there may only need 1-3 (5-10 minute) treatments. For chronic cases 3-5 treatments may be needed. This therapy uses acoustic compression sound waves to go deep into the tissue and compress and manipulates unhealthy cells. It can also be used to break up scar tissue and adhesion's. This therapy will kick-start the healing process, help push out unneeded inflammation and bring in circulation in order to help with the issues incredibly quickly.

The Piezowave2 Therapy located in our office at 650 S Mount Juliet Rd on the Providence side of Mount Juliet, TN

What do I do now?

            Now that you have just become an expert on Piriformis syndrome it is time to do something about your pain and grab your health “by the horns.” Try some of these stretches, get into the office and let’s get you out of pain. The Doctors at inTune Chiropractic Clinic, Inc. in Mount Juliet, TN are the top chiropractic physicians in Mount Juliet and have all the tools to help you get out of any pain from headaches and neck/back pain to piriformis syndrome and "pulled" muscles! Go and see them today, you will not regret it!

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