Piriformis Syndrome, Low Back Pain, Sciatica – Sock Doc

Piriformis Syndrome, Low Back Pain, Sciatica – Sock Doc

Hey, this is Doctor Gangemi, The Sock Doc.
Today’s Sock Doc video is on piriformis syndrome, lower back issues, and
sciatic-type pain, or what many people perceive as sciatic-type pain. Lara
O’Brien, who is a principal dancer with Carolina Ballet, is going to be
helping us out today, and we’re going to go through some of these common ailments
and some things that you can do, hopefully at home or with a friend
to alleviate some of the pain that you might be having. First on sciatic nerve, let’s talk about that.
Your sciatic nerve comes down the back of your thigh here and comes
all the way down and exits the back of your knee, which is called the popliteal
region, and then forms two common nerves, your common peroneal and your
tibialis nerve. Down here in the lower leg is where most of
the people experience actually true sciatic type pain. This is where you
might get some numbness, some tingling, some loss of feeling in your toes,
your foot area, or your calf. A lot of people think that this area, just
because the sciatic nerve comes down through here and in your glute region
is actually sciatic type pain, but it’s actually usually not that. It’s called
sclerotogenous type pain. What pain in this region is, this sclerotogenous
pain, is a referred pain from other areas, other areas of tissue, most
commonly muscles, ligaments, and tendons. Or it can even be a direct tightness
of the hamstring muscle, or even your glute max which we’re going to
talk about in a minute. Sciatica is a symptom most often misdiagnosed,
but when the sciatic nerve is even pinched up in the lower back region
here, it could be from a disc issue, it could be from some arthritis, or
it could be from some muscle imbalance, some instability of your biomechanics
of your pelvis that’s impairing the sciatic nerve, putting some
pressure on it, resulting in pressure all the way down and causing numbness,
or pain, or discomfort in the foot. However, you end up dealing with
the issue usually way up here where the sciatic nerve originates, or starts to come
together from the nerves of the lower back and the sacral region. The most common muscle is your piriformis.
The piriformis muscle comes off of the front part of your sacrum actually,
tucked in on the side here, and then comes to the outside of your hip here.
That piriformis muscle like this, you can turn around, does two things:
It turns your foot out, and it brings your leg up and elevates it, which
you can do that on both sides. You can see they’re pretty symmetrical. Someone
with pretty bad piriformis syndrome, or pain in their piriformis is,
first of all, they’re going to feel pain deep in their butt region, in the
glute, especially right here on the side, and they’re going to have some imbalance
or pain doing that motion from side to side. The sciatic nerve, pretty much in most people,
80 percent, it is said, the sciatic nerve comes below your piriformis
muscle. In about 20 percent of people, the sciatic nerve actually goes through
that piriformis muscle. If you had an injury to your piriformis muscle
resulting in imbalance, or resulting in a hip rotation issue, then that
can put pressure on that sciatic nerve and cause pain in your foot. I’m going to show you in a minute how to deal
with that sciatic nerve, but the other muscle we’re going to talk about
real quick for a second is the glute max. Your glute max as I talked about
in the ITB syndrome, iliotibial band video, is that big hip extensor muscle
that comes, actually, all the way down into your thigh here and joins with
your tensor fasciae latae to make up your iliotibial band. Most people
think of their glute max, or butt muscle, just as this area right here but you’ve
actually got to think all the way down here. Glute issues which have
to do with extension, a lot of times will cause an imbalance of the lower
back, obviously cause a person to have lower back problems and result in
hip pain and lower back pain, that sort of thing. Piriformis issues are going to do more left
and right problems. Piriformis, which come off the side of your pelvis, those
are major sacral stabilizers. Having a piriformis imbalance will actually
cause pain anywhere up your spine since it’s sort of like the base of
your spine, like the pyramid, the foundation to your spine. You can get pain
all the way up in your neck. People get shoulder problems. People get headaches
from actually their piriformis being aggravated on the one side
rather than the other. That will cause your sacrum to rotate one side
to the other, or your pelvis. Where glute max issues will cause your pelvis
to rotate forwards and backwards rather than side to side like the
sacrum. We’re going to think about those two things when we talk about
the stability of the pelvis. If you can lie on your belly. With the piriformis here, as the piriformis
comes out to the side and attaches to the top of the thigh muscle here,
the greater trochanter, typically there’s going to be a trigger point
somewhere in there. Trigger points are these points we’ve talked about
in other videos where you’re just going to hold that or have someone hold
it for you, and any sore spot you basically hold, rub it out. If you have
trouble getting in there, if your hands aren’t strong enough for your partner
that you’re doing this with, some people like to use their elbow,
and you can come in like this. You’re kind of scooping the glute muscle out
of the way a little bit and pulling it towards you to hold that in there.
That’s one thing with the piriformis. One other thing as I’m thinking about it to
mention here is if the piriformis is painful on one side, you always
want to check the other side because a lot of times what happens is it’s
the weakness on the one side, the muscle that is not functioning well that
is actually the side of the problem, where the other side is going to
spasm to try and balance the sacrum from left to right. So she might have
a lot of pain, say standing, and doing that hip rotation, or leg rotation on
side to side, she might do worse on the right, but the problem could
actually be on the left hand side. Now with the glute max, a simple test you
can do on your own is to elevate each leg. Lift this leg up as high as you
can, Lara. You can see she can lift about to right here on this right side,
and then switch to the left. She’s about there, about the same on the other
side. They’re not going to be maybe exactly symmetrical, but if this
leg, say, only came up to here and then she raised this leg and it went way
up, then that would be obviously something typically going wrong
on that, the right side, if there was a constriction or a weakness, some muscular
inhibition on that glute max. We’re going to look for trigger points
in that area to see where we can alleviate some of the imbalance of that
muscle. Again recognizing that that glute max comes all the way down and
intertwines and forms that iliotibial band, so what someone might perceive
as hamstring pain could actually be glute max pain. You can stand
back up. I would say I see a lot more glute max issues
because it’s such a powerful muscle and such a powerful mobilizer with
the hip rather than hamstring issues, even though someone thinks that they’re
having hamstring issue problem. Another major action of the glute
max muscle is squatting and climbing stairs, so many people that have
knee pain or hip pain while you’re climbing stairs or squatting down,
think more your glute max, even though a lot of people like to think of their
thighs. That’s what we’re going to do to start to stabilize the pelvis
there and look for imbalances in the piriformis and the glute max. One other thing to mention quickly is the
role of vitamin E in the pelvic stabilizer muscles, the piriformis and the
glute max. That doesn’t mean go out and buy vitamin E right away. But some
people, especially women, have vitamin E imbalances and they’re lacking the
vitamin of the natural vitamin E found in wheat germ oil, found in nuts like
hazelnuts and almonds, and that helps basically balance hormones in your
body. Hormone imbalances will cause pelvic imbalance problems in women as
well as guys, too. There’s a link between the prostate and vitamin
E imbalances, and prostate and hip problems. With women, uterine and
ovarian problems, and hip problems. That’s why a lot of women who have
PMS or hormonal issues also have hip pain. It could be a direct muscular
imbalance. It could also be a vitamin E problem. Sometimes taking the natural
oils of wheat germ oil, unrefined and organic, can do wonders for
you as well as taking a little vitamin E. I typically don’t use too high
of a dose but around 50 to 100 IU’s of natural mixed tocopherols. That’s
the natural tocopherols and the tocotrienols that can help with your pelvic
imbalances. Two other things we’re going to talk about
real quick to help with stabilizing the lower back, and therefore
piriformis issues and the pelvic issues as well as what one might perceive
as sciatic type pain are the psoas muscles which do this, – bring your leg
up and out and flex it, – and again on the left. This would give you more
pain doing that from left to right, or just bending forward as if you were
touching your toes. A lot of times if someone’s feeling, even though you
might feel back pain as you go and do that, it’s actually coming from the
front. Now we’re going to talk about a couple things
that actually cause you to get back pain even though they’re actually
front problems. So you can lie on your back again. If you ever feel pain
while you’re lying on your back, supine, or especially as you sit up; go ahead. If she
was to experience pain in her lower back right now that’s usually going
to be from the abdominal muscles, including the abdominal obliques, or the psoas
muscles which help to hold her leg like that. If you can’t hold your
leg up like that then you most likely have a psoas imbalance, that would
be the same on either side. The psoas muscles are your powerful hip flexors
as you can see, and they actually originate mostly from the front of
your lumbar spine. That’s the front. They’re very hard to get to. Then they
come down and they wrap around and attach to the inside of the leg,
allowing someone to flex the hip. A couple things we’re going to do for this
is to have her touch and put a little bit of deep pressure, even though she
can’t get directly on top of her lumbar spine, to put pressure on one side,
if she was to have lower back pain right now, to put pressure on that
psoas muscle, and then she would sit up again. And lie back down. Obviously
this is assuming that she could sit up because sometimes someone’s lower
back pain is so bad that they can’t sit up at all. If she was able
to sit up easier by doing that, we would look for corresponding trigger points
in that area and then again would switch and check out the right side
too, the opposite side. We’re always checking both sides. We’re going about an inch over, and a couple
inches up and down on the side of the naval on either side, so like here,
here and here, and that would look like that. If that didn’t help she could
go a little bit lower and then check a couple on the opposite side,
and she would sit up each time. Or if she had someone like me doing that with
her, or a friend, I could hold this and you would sit up, and if it
felt any better to her lower back, then we would look for areas to treat
in there. Again, just rubbing slight pressure. Got to be careful in here. There’s obviously digestive organs, there’s
an abdominal aorta in there, so you have to be careful and don’t just be poking
away. Usually it’s pretty tender if someone’s lower back is hurting
from a psoas problem. Obviously, the other muscles here are your
abdominals, your rectus abdominis and your obliques, and sometimes
you’ll have trigger points or sore spots on the side here, right where they
start to attach on the top of your ilium. One thing she could do there is
put her hands here on the side of the pelvis, see if there’s any tender spots,
or I could do that for her, and she could sit up again and see if there’s
any pain in there. One thing you’ll notice too is if someone
has pain while they’re sitting up, usually they’ll twist from one side to
the other, indicating that there’s imbalance on one side. You don’t always
know that that’s the side of the problem it’s on because you could be
twisting away from the pain, or you could be twisting towards the pain depending
on what’s going on in that area. A weakness in that psoas muscle or imbalance
of the psoas muscles from left to right as well as the abdominal
muscles will obviously put a lot of stress on the lower back. It’s one
of the reasons why people get sway back. You think of like a pregnant woman or a person
with a belly. Then they put a lot of pressure on their lower back, causing
a lot of disc degenerations, causing a lot of arthritis and lower back
problems which then in turn can cause sciatic type pain and influence that
sciatic nerve and cause pain all the way into the foot, numbness pain or similar
issues. Even though it’s coming from way up here, an imbalance of those
hip flexors, an imbalance of the abdominal muscles, or the glute max, or
obviously the piriformis. Those are the four muscles that we’re going to think
about for lower back issues, or any disc displacements, or what might be
perceived as sciatic type pain. In terms of exercise and therapies for these
sorts of things after you’re working out the trigger point, if they continue
to come back, it’s the same thing that I’ve always said. No orthotics
because you’re trying to work the muscles to their fullest by being barefoot
and feeling the ground and using the muscles the way they’re intended to be,
not by some false supportive device. So you’re going barefoot and not wearing
any orthotics or trying to wean yourself off those orthotics and wearing
minimalist type shoes whenever you can. Of course, you’re not stretching these things
because whenever you stretch a muscle that’s been injured or strained,
you’re further elongating those muscles and you’re not going to feel it. We
don’t stretch our psoas muscles, we definitely don’t stretch our piriformis
muscles like a lot of people like to do, like bring these over and
trying to stretch the hip. It’s just going to further irritate that
muscle and if you have a sciatic issue, especially if you’re one of
those people whose sciatic nerve goes through your piriformis, it’s just going
to cause more problems over time. By walking, running, dancing for her, or doing
your normal daily activities, that will help to rehab those
muscles once they’re actually functioning normal. Consider vitamin E, and
especially fatty acids too, that help fight inflammation like fish oils
and others, nuts, seeds, flax oil, that sort of thing in those beneficial
categories. That should do it. Thanks.

70 comments on “Piriformis Syndrome, Low Back Pain, Sciatica – Sock Doc

  1. Daniela Rizzi Post author

    This is really informative. The part about being careful with stretching (which I read in his site) is even more interesting. I am sure going to try that!

  2. Nichole Lynn Post author

    I had a VERY debilitating bout of sciatica, my first ever, and ALL of my doctors, chiros, acupuncturists told me "zero impact and tons of stretching". After I was after to walk again and the pain subsided to bearable, I tried this plan for 3 months with very little improvement. I watched this video and decided to do the opposite of what my doctors said. I ran on a treadmill and didn't stretch a bit. I was pain free within 2 days. Best. Advice. Ever. I'm shocked lol

  3. grneyez808 Post author

    Aloha Sock Doc. I'm in the MOST pain I've ever been in. Can hardly stand, walk anymore. It's a pain in My gluteus down to My ankle. I've gone to a pain specialist, He gave Me toderol and it had no affect. Chiropractor, no affect. Is there a shot to heal this? I wathced the video.. What is the first things I personally should do In My case? Please help, Thanks much

  4. TheSockDoc Post author

    I can't advise you past the video. Find another doc who can hopefully help you – maybe a different chiropractor or holistic therapist.

  5. TheSockDoc Post author

    Lengthening of the tissue is very temporary with stretching and the act of stretching does not increase circulation. Moving increases circulation.

  6. green jew Post author

    I am 15 and have a bulging disc in my lower back. I believe that because of my disc bulge my sciatic nerve is being irritated also. This causes pain down the back of my leg and also the front of it where my hip flexor is. Is there anything I can do to alleviate the pain for good? Also, once i find out where the cause is in my leg without the pain how do I treat it? Please HELP

  7. Christopher Rosiak Post author

    So if you have sciatic nerve pain you shouldn't stretch? Every where I look they advise to stretch, but when I do stretch it becomes more painful.

  8. Smora505 Post author

    Where is your practice? I have severe left back pain, from the neck to the traps…radiating down to the left buttocks and hamstring. Had an MRI of the L-S spine, revealed 3 herniated discs on the left.

    Would love a consultation with you.



  9. TheSockDoc Post author

    It was in response to the comment " i dunno if I trust a doctor who walks around barefoot"

  10. Jeff Oiler Post author

    I know you said not to stretch the piriformis but mine is super tight. it is way out of balance when compared to my left side. I get back pain every now and again but its not a constant issue. any suggestions

  11. paul hepburn Post author

    hi doc , i need your help .im a footballer that has had a few injurys over they years. when iam playing my hamstring starts to tighten , also if i run very intence for the 90 minutes i end up with stomach cramps both sides of my stomach , also when i lie on my stomach on a masssage table and the masseure pushes on my back i can feel pain at the from of my stomach like its my psoas .if i lay on my stomach for a long time ,i find it very hard to get up as my back seizes up .

  12. paul hepburn Post author

    also when i warm up and stretch my groin by standing raisng my knee and swing . i feel a click feeling up my spine

  13. TheGsinghg Post author

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  14. TreachMarkets Post author

    Everyone else on the internet is recommending stretching exercises for priformis. Why is this? It seems like common sense, that stretching out the muscle would relieve this area.

  15. Sadie Deckman Post author

    I have a question. I am 21 years old, was very athletic and a gym junkie about 10 months ago until I woke up to excruciating lower left back pain. I don't remember inuring it all I remember is the night before doing lunges, incline abs with a medicine ball, and jogging on an incline. I have had this pain for going on 11 months now and no one can seem to help me. I have had the sacroiliac injections which worked for a month, nothing shows up on tests. It hurts to walk, bend. and pain comes…

  16. Sadie Deckman Post author

    every night even if I don't do a lot of physical activity. The pain usually last a few hours then slowly goes away until I get up to move. In physical Therapy it doesn't hurt until I do some kind of lunge or running, then the pain last hours. Simple bending of back or hip thrust causes immediate pain which goes away once I go back to normal position. Bending my head to my chest causes pain also, and I almost feel like I can feel some toes tingle but I am not for sure. Does this ring any kind

  17. Sadie Deckman Post author

    of bell to you? I am sorry for blowing up your youtube, I just really want my life back, not being active is killing me, and 10 months is a long time for someone to be going though this with no help from Drs. All they want to do is push medicine on me or tell me I am too young and that because nothing has shown up on scans that they cant help me. Please feel free to message me back. thanks for your time.

  18. Sadie Deckman Post author

    No, never heard of it. I Have been to a chiropractor 7 times… is that kind of the same thing?

  19. illriginalized Post author

    Hm… this pinch I have is right at the top of the butt just to the right of the spine.. Only in the morning when I get out of bed, as soon as I put my weight onto my right foot does this pain kick in.. making it difficult to stand on my right foot to put my left foot/leg through the pant leg. In fact, the pain exists until I simply walk it off. And doesn't really exist until again the next morning. I assume this happened from squats two weeks ago and fear to do squats again until the pain goes.

  20. Julia Rechter Post author

    I have piriformas sciatica (for about 4 months now). Was going to P.T. and doing lots of balancing and core exercises, but after researching on Web, tried out the stretches pin-pointing the piriformas muscle. First relief I've had from the awful leg pain. So, why do you recommend no stretching to release that balled up muscle? seems like that with the pressure points and continue to strengthen and stabilise, would be the solution.

  21. Lind Alvarez Post author

    I'm not a very activate person and I spent a lot of time sitting in front of my computer. My muscle have gotten very tight and my lower extremities hurt like hell which makes sleeping through the night a living night mare. Moderate stretching helps me along with other techniques so I don't understand why you say not to do this. Stretching is very important in keeping tight muscles limber.

  22. Ezequiel Vital Post author

    yep i agree. even i was very sad since i workout well for abs but nothing was coming. And My international body building trainer also recommended this 7 food elements to kill your fat belly. if you are serious go for it now bit.ly/13b7QG1?=svtqp

  23. Mark B Post author

    he says static stretching is inferior to movement. Since you do not exercise, at least moderate stretching is some sort of movement for you

  24. Siddappa Nagabhushan Post author

    can you explain why pyriformis syndrome,

    which means it is not a disease should give head aches to any body

  25. David Mendez Post author

    Hey Sock doc. I've been having back pain for almost 10 months now and im limited to walking the most 2 blocks a day. I cant seem to extend my leg straight. I have back pain, butt pain and pain behind the knee. Ive only been sleeping 2 hours a day very hard to find a comfortable sleeping position. I do notice when i stretch the Piriformis I cannot walk or manage the pain. Ive been to numerous physical therapies and "bone setters" nothing work. Where is your office ill come from NY.

  26. Ginger Olson Post author

    Sock doc, looking for information on over stretched ligaments and hyper mobility in the hips.  Do you have any videos or information on this?

  27. Bethany Patterson Post author

    Hi, I have been suffering with this type of pain..always thought it was hip pain but I know I'm wrong now bc it hurts exactly where you said. tender all around that area. I have numbness on my right side mostly..where this problem is and dizziness. Been going to neuros who cant find anything wrong. I was wondering if it was possible that Piriformis dysfunction could casue dizziness and vision symptoms as well since you mentioned it can go all the way to your head to cause headaches. Thanks in advance.

  28. sherry a Post author

    I watched many of these videos 48 hrs ago, for this God Awful pain I had No Name for. For 20;years now I awake with tears every single night due to this horrific pains in both sides of my butt and lower back, EVERY SINGLE NIGHT !!!! I EVEN BOUGHT A STUPID TEMPURPEDIC BED WHICH DIDNT WORK. IVE BEEN TO THE DR WHO ONLY PUMPED ME UP WITH VICODINS AND LIDOCAIN INJ. I DID THE MASSAGING BEFORE BED USING A BALL AND AWOKE WITH NO MORE PAIN ANYWHERE, I CANT BELIEVE IT, THANK YOU!!

  29. Eden Edments Post author

    To stop your sciatica pain permanently, it is important to take away the root cause of your condition.

  30. dontre2333 Post author

    so no stretching no muscles at all so whats your sugeestions for rehabilating back pain and tight hip muscles I shouldn't stretch my hips if they are tight ?

  31. JimVanLe Post author

    One of the best videos on sciatica – no competition. Thank you very much SockDoc, look forward to learning more from your other videos!

  32. jeisco scilyn Post author

    Thanx Sock Doc for this informative vid,I've suffered for a few years from piriformis syndrome and is been torture every day even going to the chiropractor for several times did not help much.This vid explained why I've been having so much pain in the butt,back,abdomen and lower back.Thanx a lot

  33. Rick Cyclist Post author

    Hi SD, I've been listening to you and the guys on TRN podcasts for the past few months and always find them informative and quite funny. My problem: I've had a tight right hamstring for about 4-5 months now. I've tried everything from massage, stretching, trigger points, etc. to no avail! I have still kept running (I'm primarily a runner, despite my username) because though it wasn't getting any better, it also wasn't got any worse and I had races on. However, it seems to be a bit better when I run harder, especially up hills (I'm mostly a trail runner). Today, though, something happened. After a brisk, hilly 10 miler I did some crossover side step drills on my cool down. It felt pretty 'right' so I kept doing it. It was a bit clumsy at first but got better as I went on. One side was clearly more 'clunky' than the other. After about 5 minutes of these drills I stopped and bent over to test my hamstring and bam – I reached straight to the ground with no pain/tightness at all! I almost forgot what it feels like to do this without severe pain in my piriformis and hamstring. I should add that earlier today I did some self-administered trigger point therapy on my piriformis so not sure if this helped get things going. But the drills were definitely the capper. I surmise that they helped resynchronise the tissues/musculature that was obviously traumatise a few months ago. I just wanted to share this experience in case it might help others. It's an easy thing to do and in my opinion worth a try. I'll be looking into adding more pelvic area exercises for the future. If you have any you can recommend I'd love to hear about them.

  34. Alfredo Venegas Post author

    Hello I been carrying my wallet in my right side pocket for about 14 years I believe I believed I developed a condition called piriformis syndrome or Sciatica, any  advise you have for me I can tell  my chiropractor

  35. Joe Crowder Post author

    If you have no one to press on the trigger points for you, does anyone know if it's okay to use a tennis ball or other type of ball to do it yourself? If so, which type of ball do you recommend?


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