Pain in The Butt, A Guest Post

Pain in The Butt, A Guest Post from Dr. Allison Feldt, DPT, PT Owner and Physical Therapist of Body Motion Physical Therapy

You are having an irritating pain in the butt. It’s sharp, it could be going down your leg, and you just want to know, “what is this and how do I fix it”?  You have heard it referred to as sciatica or maybe you have also heard about some muscle called the piriformis. All you know is, you can’t sleep because of this deep ache. Standing up is irritating, sitting is bothering you, you’re shifting from one leg to the other to take the pressure off or just standing on the opposite leg all together. You have tried ice, ibuprofen, rest, maybe even some stretches that felt good. You aren’t quite sure what to type into the google search engine.

This is a very common scenario. Your friend may have told you, you probably have piriformis syndrome and your mom maybe diagnosed you with sciatica. I am going to bring some clarity to each diagnosis and give you some self-help tips.

Before we clarify each diagnosis, it is nice to know a little about the sciatic nerve. The sciatic nerve is a bundle of little nerves that are composed of nerve roots from L4-S3 (meaning the nerves that leave the spine below Lumbar Vertebrae Number 4 to Sacral Vertebrae Number 3). As the nerve leaves the spine, it travels underneath the gluteal musculature. The sciatic nerve traditionally travels underneath the piriformis muscle, where it is protected and safe from compression. However, in some folks the nerve actually pierces the muscle and goes right through the muscle and in others, it runs on top of the muscle. This means that if your anatomy is such that the nerve pierces the muscle or lays on top of the muscle the nerve is more exposed and susceptible to compression. The nerve then travels down the back side of the leg. This is some very basic anatomy just to give a little background on what can happen with each diagnosis.

Sciatica is a diagnosis that is defined as your sciatic nerve being impinged or injured at some place along the nerve.

The sciatic nerve can be injured or compressed at the level of the lumbar spine, through a disc herniation or simply through degenerative changes in the lumbar spine. There is also possibility that through pregnancy as the ligaments become more lax, there is more mobility and shearing that can happen through all the pelvic joints (including the sacrum) increasing the likely hood that the sciatic nerve could get irritated. The sciatic nerve can also be affected at the level of the piriformis muscle.

Piriformis syndrome is compression of the sciatic nerves but that compression is happening as it runs by (through, under or over) the piriformis, in the buttock. Piriformis syndrome often causes leg pain and pain is frequently worse with sitting. Piriformis syndrome can also begin in pregnancy because as the pelvis is widening the piriformis muscle can stretch, this stretch can cause compression of the sciatic nerve.

So sciatica or piriformis syndrome, it can be hard to tell? You probably could care less by now what it’s called, you just want some relief.

As you can see it, it could be difficult to tell where exactly the pain in your butt or leg is coming from and to accurately determine the root cause of your pain it is important you work of a Doctor of Physical Therapy who specializes in the pelvis. They can run some simple test to identify where your symptoms are coming from. They can also safely guide you back to doing the things you love to do without the nagging “pain in the butt.”

Treatment options are going to vary in your physical therapy experience because the therapist could identify other dysfunctions that are contributing to the symptoms. Overall, much of what will be needed to stop this pain will be increasing your core muscle strength. When I say core muscle strength, I am talking about how the transverse abdominis, multifidi, pelvic floor, diagram and hip muscles are coordinating to help stabilize your spine and pelvis.

It’s important that these are the muscles that are activated and coordinated to help reduce the pressure on your skeleton and keep you out of pain.

Here are four techniques that can positively reduce buttock pain, however if symptoms worsen or do not improve, seek professional help from a skilled Doctor of Physical Therapy. Visit www.bodymotionpt.com to book a free consultation today.

1. Self-Mobilization/ release of gluteal muscles: Take a lacrosse ball or a tennis ball, simply place it behind your buttock against a wall and roll around the gluteal musculature. Avoid the boney prominences like your greater trochanter or your iliac crest but you can roll around on these sore spots, holding for 30-60 seconds if you find a really tender spot. If this exacerbates your leg pain or causes numbness or tingling you would want to stop this exercise. This can be conducted 1x per day for 2-5 minutes per day. Its best to complete on both sides. Check out this video!