Many people visiting Stretch suffer from what’s been diagnosed as sciatica or piriformis syndrome. So what is piriformis syndrome and sciatica? Well according Sports Med Web (1997) piriformis syndrome is a condition whereby the piriformis muscle is affected to such an extent that it begins to irritate the sciatic nerve. The sciatic nerve generally speaking is one of the main nerves that innervates from the lumbar spine, down through the back of the legs to the toes. An irritation to the sciatic nerve via the piriformis can lead to referred pain up into the lower back or down the back of the legs and into the toes.

The Piriforms is one of the 6 deep external rotator muscles of the hip. Being the most prominent and superficial of the 6 rotators, the performance of the piriformis is integral for sound hip and pelvic biomechanics and function. Due to the nature of modern society external hip rotation is not a consistent part of our everyday biomechanics unless we are trying to “do the twist” on the dance floor for example. So as a result of this some of the external rotator muscles of the hip become dormant and even atrophy (degenerate). This makes the job of the piriformis extremely challenging because it is forced to do the job of 5 other muscles plus its own. As a result of this the piriformis becomes tight and tired, thus unable to function efficiently and effectively.

The sciatic nerve runs very close underneath the piriformis or in 15% of cases, literally runs through the middle of it (Sports Med Web, 1997). So as one imagine an overworked piriformis would begin to impinge upon the sciatic nerve causing localized pain, numbness, tingling and/or sciatica. These symptoms can prove to be extremely debilitating making everyday activities such as sitting or standing very uncomfortable.

So what can be done?

First, the hip and pelvic regions need to be decompressed. This can be down using Active Isolated Stretching protocols designed specially for these areas. The accuracy of these stretches designed and implemented by Aaron Mattes allow the therapist to stretch and open up each of the 6 individual external hip rotation one at a time, allowing maximum blood flow into these areas which is vital for optimum recovery.Once the length is reestablished in these muscles on both sides the symptoms should begin to subside.

Then, the muscles in the hips and pelvis need to be rebalanced. Muscle imbalance is one of the main contributors to problems such as these, as well as postural distortion.

Clearly the other 5 external hip rotator muscles need to be strengthened in order to support the piriformis. Once this happens the pressure on the piriformis may not be so great as to cause it to tighten and impinge upon the sciatic nerve.
Not only is it important to treat the symptoms where this problem is concerned but also the cause. The cause is the muscle imbalance in the hip and pelvic regions and if this isn’t remedied then the symptoms could return.

Active Isolated Strengthening is a treatment method developed by Aaron Mattes to do just that, rebalance muscles. Like the stretching, the strengthening places major importance on pinpointing individual muscles for strengthening. This accuracy allows for optimum rehabilitation.At Stretch we are well versed in both forms of AIS designed to prehabilitate and rehabilitate your injuries, ailments and postural distortions.