You probably already know that there are far fewer back surgeries performed today than there used to be.
The reason is because too many times after surgery folks still had the same pain. It didn’t go away. That’s because the diagnosis for the cause of the pain was incorrect.
Muscles are the most common cause for pain and they are also the most commonly overlooked or ignored cause.
So sometimes a person truly does need surgery. But surgery should always be a last resort. Once something is removed or fused it’s changed forever.
And if it doesn’t cure your problem it makes it harder for natural methods to succeed. Maybe not impossible, just harder.
Probably the biggest problem with surgery for sciatica is that it’s only addressing the immediate symptom. It’s not addressing the muscle imbalances that probably caused the problem in the first place.
When your muscles are “out of balance” you get into pain.
That’s why you didn’t have pain when you were an active child; you were using ALL of your muscles then. And that’s why you have pain now; you aren’t using them all anymore.
You might not move much these days, right? 🙁
You see, when your muscles are out of balance they pull your spine out of the position it is supposed to be in.
Did you realize that just about everything that happens in your body has a cause? If you fall, you get a cut or bruise or broken bone. The reason was because you fell. Cause and effect.
Get rid of the cause and you can change the effect.
So if you really want to get lasting relief from sciatica, the very first thing you must do is figure out which muscles are out of balance and causing your pain. The second thing is to treat them and get them back to neutral.
I remember years ago when I was a new massage therapist. An elderly woman came in complaining of “sciatica.” As soon as I placed my hand on the gluteal (buttock) muscles on the side she complained about, I could feel the very hard piriformis muscle. It was tight!
She had sciatic pain for almost 20 years. She didn’t have it anymore when she left my treatment room.
It was her piriformis muscle pressing on the sciatic nerve. No one had ever helped her before. And it was only muscles. They just didn’t know.
Treating the muscle to cause it to relax took the pressure off the nerve. So logical. Bodies are logical.
When your muscles get back to normal and neutral, your pain can go away. But you have to keep your muscles that way. If you fall back into the same postures or habits that caused your pain in the first place…well, you will probably get it again.
Tennis Ball Therapy is a self help treatment that can help if the gluteal muscles around the piriformis muscle are pressing on the nerve. Please type Tennis Ball Therapy into the search bar here and you’ll find more information about how to do.
Are you going to have to do some work to get rid of your pain? Yes. But what’s the option? I’d rather see you have natural relief of your sciatica or piriformis syndrome.
Great and informative article Kathryn. I’d like to add a fact that not many people know – took me 5 years and 14 specialists to discover – but there a small instances of piriformis syndrome in which the nerve can only be extricated from entrapment thru surgery. In my case, the nerve had a genetic anomaly that caused it to go thru the piriformis, instead of around it. This did not show up on traditional MRIs and flummoxed everyone from neurologists to chiropractors to physical therapists to masseuses. There is a support group on Yahoo for piriformis syndrome sufferers, and there are a handful of surgeons in the U.S. who have performed this delicate operation. Incision is thru the hip. I had mine last Dec, after years of trying everything, including what you have recommended above, and finally found relief. 🙂 Here is a link to a published paper by my surgeon in OKC on the topic: http://www.arthroscopyjournal.org/article/S0749-8063(10)00687-0/fulltext
In cases like mine, massage and deep tissue therapy are harmful because the nerve is inflamed and goes right thru the piriformis.
Dear Linda,
Thank you very much for writing and for sharing your story. I am so happy you finally got the treatment you needed. This is something I learned years ago in my training from Paul St. John, the brilliant Neuromuscular Massage therapist.
No one body is exactly like another. There are three possible places for the sciatic nerve to be located near the piriformis muscle.
1. In most people the piriformis is deep to the other gluteal muscles (farther inside the body) and the sciatic nerve is deep to the piriformis. In that case, a tight piriformis can press on the sciatic nerve and cause sciatica symptoms.
2. In a few lucky individuals, the sciatic nerve is actually more superficial or in front of the piriformis. In those bodies, it would not matter if the piriformis became tight because it could never press on the nerve. The nerve is out of the path of danger.
3. But in a small population, the sciatic nerve or a segment of the nerve actually pierces the piriformis muscle. It runs through the muscle and so any amount of muscle tension in the piriformis will cause symptoms. Unfortunately, you happened to have that situation. But now you are better!
Massage would not give relief, as you state, if the nerve runs through the muscle rather than in front or behind. Rather, any additional pressure on the sciatic nerve that is piercing the piriformis would only increase sciatica symptoms.
The sciatic nerve is about the size of your index finger in girth. It’s a big nerve.
Travell MD and Simons MD document piercing in Volume 2, Myofascial Pain and Dysfunction, The Trigger Point Manuals. They indicate that about 11% of cadavers have a sciatic nerve or segment of the nerve that pierces the piriformis. It’s just the way the body developed.
But here is a thought: If one did not always have the sciatica symptoms then perhaps massage to the piriformis–applied at a distance from the nerve–would help. Perhaps the symptoms came from tightness in the piriformis IF they came on later in life.
Linda, thank you again. I appreciate you sharing your experience and calling this to attention. It’s rare but since it does happen it’s good to know that there is a support group for people who cannot get relief from piriformis syndrome.
Kathryn
The Pain Relief Coach