Sciatica/Piriformis Syndrome
Sciatica/Piriformis SyndromeLearn to understand thefeeling and healing of your pain!by Jonathan FitzGordon
Cover Illustation: Gray’s AnatomyOther books in this series:Psoas Release Party!The Exercises of CoreWalkingAn Introduction to The SpineAlthough every effort has been made to provide an accuratedescription of posture remedies and their benefits, theinformation contained herein is not intended to be a substitutefor professional medical advice, diagnosis or treatment in anymanner.Always consult your physician or health care professionalbefore performing any new exercise, exercise techniqueparticularly if you are pregnant, nursing, elderly, or if you haveany chronic or recurring conditions.The authors are not responsible or liable for any injuriesoccurred by performing any of the exercises given or diagnosismade by a user based on the information shown within thisdocument.-2-www.CoreWalking.com
TABLE OF CONTENTSIIntroduction.4IIChapter 1: Some Body Basic.6III Chapter 2: The Sciatic Nerve.15IV Chapter 3: The Piriformis Muscle.19VChapter 4: The Psoas and the Piriformis.25VI Chapter 5: The Pelvis and the Lumbar Spine.29VII Chapter 6: Sciatica and Piriformis Syndrome.32VIII Chapter 7: Posture.40IX Chapter 8: Stretch vs. Relief.46XChapter 9: Options and Exercise.49XI Chapter 10: Conclusion.72Copyright 2013Yoga Center of Brooklyn, LLCwww.CoreWalking.com-3-
INTRODUCTIONYou shouldn’t live with pain. Because livingwith pain it is not really living. It’s not living to yourfullest. Often we get little pains and think, “Oh, I’lldeal with it later.” But when your car gets a flat tire,you get it fixed or it’s not going anywhere. How aboutyour one and only body? It deserves that kind ofconstant tuning up. This book will help tune up yourbody by providing information and tools to addressthe pain and debilitation of sciatica and piriformissyndrome and perhaps prevent you or your lovedones from ever dealing with either.We will give you an in depth look at all of theactors in the drama – your bones and muscles, thesciatic nerve, the piriformis muscle as well as thepsoas, your spine and pelvis. We’ll look at how theyare supposed to work and why they might not beworking well. We’ll explore how the body operatesfrom conditioned patterns and how these patternslimit our physical potential. Of course, we’ll alsoprovide tools and exercises for relief.However, this book is for more than those who havesciatica or piriformis syndrome. This book is for thosewho want to understand more about how the bodyworks, those who have grown up around individualswith sciatica and piriformis syndrome and don’t want-4-www.CoreWalking.com
to inherit these issues, and those who don’t want topass them on to their children. As we’ll discus, muchof our movement is learned behavior from those whoraised us. Think about it – often many members of afamily will say they have a bad back and the problem is inherited. Yet, what might be inherited is nota “bad” back but rather the movement patterns thatlead to pain in the back. So the conditioned patternsthat we develop during childhood and bring to adulthood are going to determine the quality of our lives.Your ability to understand and change those patternsdetermines what kind of body you have. Knowledgeof how the body works can help us break cycles ofdebilitation and pain for ourselves and those we love.You can change they way your body operates.We all deserve to understand how our body worksand how we can work it with it. You can choose tobe conscious and to make changes over and overagain to be your own healer. You can mindfully createnew patterns in your body that allow it to be thebeautifully operating piece of machinery and miraclethat it is. You can choose to fully live your life.www.CoreWalking.com-5-
CHAPTER ONE – SOME BODY BASICSWe’ll begin our exploration with how the bodyworks in terms of the muscular-skeletal system – yourmuscles and your bones. Then we’ll examine what thebody’s structure has to do with sciatica and how wemight find ourselves with sciatica.HOW DOES THE BODY WORK?Think about Pinocchio hanging from his strings.We’re actually a step above our man Pinocchio in thatour skeletal structure can hold us upright. Pinocchiomoves when the puppeteer pulls on his strings. Wemove when our nerves tell our muscles to move ourbones. Our bones hold us up and our muscles moveus, and our nervous system communicates this action.If this system is working properly, then our jointscan stay loose, fluid and free, much like Pinocchio’s.However, if our bones, nerves, and muscles aren’ttalking well to each other, we put strain on ourprecious (and expensive) joints like the vertebrae ofthe lower back.The muscular-skeletal system is an amazingpiece of machinery. If your body is stacked correctly(one bone on top of the other, one joint sitting wellinto the next), your bones, the skeletal system itself,can simply hold you up. Of course, the muscles do-6-www.CoreWalking.com
have some work to do. They need to be properlytoned to keep the bones well aligned in this stacking.But let’s define what muscle “tone” is. We think oftoned muscles as big, buff biceps and rock hard abs.Actually, tone is the base level of engagement of yourmuscle. Even when your muscle isn’t engaged, itstill has a certain shape. That’s tone. You don’t needhuge, contracted muscles for good skeletal (bone)alignment. Rather, you need muscles that are strongenough to do what you’re asking of them in helpingthe bones stack.One reason our muscles lose tone (i.e., becomeweak) is because we aren’t stacking ourselvesproperly to begin with. We sit in our joints, makingsome muscles work too hard and others not work atall. The muscles work in pairs, and these pairs workin a reciprocal fashion. When one engages (shortens)its opposite can stretch (lengthen). For example,let’s consider the opposites of the hamstring (themuscle at the back of the thigh) and the quadriceps(the muscle at the front of the thigh). When thequadriceps engages, then the hamstring stretches.Give it a try. Lift your knee in the air to the height ofyour pelvis. Put one hand on your quadriceps (thetop) and extend the leg. You should feel it engageor harden. Now do the same motion but placeyour hand at the back of your leg. You’ll fee yourwww.CoreWalking.com-7-
hamstring extend and stretch. This muscle balanceis going on throughout the body. So when we aren’tusing our muscles properly (or at all) then one musclewill get overworked (tighter) and at the same time itsopposite will grow weaker (lacking tone). Ida Rolf,the creator of Rolfing and a hero of mine, once said,“People always talk to me about strength or howstrong they are, but I always tell them that strength ismeaningless, balance is power.”Not stacking our bones properly leads to muscleimbalance, which then prevents us from stacking ourbones properly. It all gets very chicken and the egg –what problem came first?! The simple fact is that weare meant to have toned muscles and correct skeletalalignment, and they influence each other.Moreover, the muscle tone and skeletal alignmentimpact our nervous system. You can’t send a clear,quick message along telephone wires if the polesare fallen down. Similarly, the alignment of thebones determines the freedom of the nerve pathway.Remember the nerves tell the muscles how to move.When you don’t have good muscle tone and bonealignment, then the nervous energy of the body isrestricted. This means the nerves depend on muscletone so that they can communicate with those verymuscles. Now we’re really getting chicken andthe egg – we need everything to be working for-8-www.CoreWalking.com
everything to be working!Our posture is one of the places we often fallinto troubles with our bones, muscles and nerves;in particular, muscular imbalance shows itself inposture. We’ll address posture in more detail later inthe book. For now, it’s important to understand thatmany of us are not stacked properly. We tend to beshort in the back and long in the front. The musclesof our legs, lower back, and neck tend to be short andtight. Does it feel like that in your body? Tightnesswhen you bend over? Tension in the neck? Only theupper back tends to be loose because of tightnessacross our chest. This short and tight back body comesfrom the way we stand. Take a look at the diagramsbelow. Most of us feel like we’re standing like theone on the left. Unfortunately, we tend to stand likethe one on the right. We tuck our pelvis, which pullsdown the lower back and forces the femur (big thighbone) forward. Movement in one part of the body isalways reciprocated in another part. So the tuckingof the pelvis may lead to hyperextension of the knees(locking the knees backward past the straight line)and kyphosis (rounding) of the upper back, and also aforward thrust of the head.Check yourself out in the mirror. Over-exaggeratethe stance, but then see if you’re doing something likethis diagram on the right. Seeing yourself clearly andwww.CoreWalking.com-9-
honestly is a big part of healing and healthy living.Try to catch your reflection while you’re waiting on astreet corner. Check out the people around you. You’llstart to see that short in the back and long in the frontis a very common stance.But don’t beat yourself up if you’re doing it.Like so many things, our culture has an aesthetic orhabit that is actually far from what is natural or goodfor us. From the time we are little, people tell us tothrow our shoulders back thinking this will makefor good posture. Look at mannequins or modelsin advertisements thrusting the pelvis forward toperhaps look thinner. What about our furniture?As couches and chairs get softer and deeper, wespend a lot of time sinking into ourselves instead ofmaintaining good bone alignment and the muscletone to hold ourselves up. These messages andpatterns affect how we carry ourselves. Essentiallywe’re falling down into our posture instead ofstanding up. In a way, we are devolving in ourphysical posture. We are losing the ability to stand upwith dignity and fully embody ourselves as humans.WHAT DOES THIS HAVETO DO WITH SCIATICA?Beyond the psychological affects of sinking downinstead of standing up, there are a series of chronic- 10 -www.CoreWalking.com
Illustation: Frank Morrispain issues confronting modern man due to this poorposture, poor muscle tone, poor bony alignment,etc. Sciatica and piriformis syndrome are amongstthe most common. There are actually two differentissues at play here. Sciatica is a bony alignmentissue. Something, like a slipped disc, is pressing onthe sciatic nerve sending pain down through the legand sometimes all the way to the foot. This is a nerveinjury. With piriformis syndrome, the piriformis isin spasm and it pushes on the sciatic nerve, whichpasses right under it. You also get that sciatica typepain with piriformis syndrome. Often people aren’tsure of the reason for their sciatic pain. In general, thewww.CoreWalking.com- 11 -
issue of shortness in the back body (the bad posturewe saw in that diagram above) contributes to bothsciatica and/or piriformis syndrome. Generallyspeaking, space equals health. So when we’re short inthe back body, we’re compromising the space there.This creates a cramped and then painful environmentfor the sciatic nerve.WHY WOULD WE GET SCIATICA?In the case of something pressing on the sciaticnerve, most often it is a slipped or herniated disc.We’re talking about the discs that live in betweenthe vertebrae of the spine, often referred to asintervertebral discs. These discs slip and degeneratefor all different reasons. First of all, genetics andimitation play a role. So a family can truly have abad back issue through many generations wherethe integrity of the spine is compromised. Discsalso become damaged because of trauma. There’sthe trauma of an acute injury, like a car accident.There’s also extended emotional trauma. Ourbodies remember everything, and we store tensionin our muscles. A history of emotional trauma isgoing to affect the physical structure of the body. Asmentioned, our posture can contribute to poor bonealignment and poor muscle tone, both of which canlead to slipped discs. Finally, diet and nutrition alsoa play a role in the development of our bodies, and- 12 -www.CoreWalking.com
health of the spine.You could also be experiencing sciaticafrom a bone pressing into the sciatic nerve. Certainconditions that we’ll discuss later can lead todegeneration of the spine that may result in bonepressing onto the spinal column or the root of thesciatic nerve. Also, the nerves at the base of thespine are vulnerable. The spinal cord stops growingin infancy, but the bones of the spine and rest ofthe body continue to grow. So the spinal cord endsnear the top of the lumbar spine and yet a bunch ofexposed nerve roots continue the journey towards thelower extremities. As a result of this, it becomes veryeasy for something to irritate one of these nerves.In the case of piriformis syndrome, there is amuscle pressing on the sciatic nerve. The piriformismuscle crosses over the sciatic nerve. So if thepiriformis muscle goes into spasm, then it will presson the sciatic nerve and create the same radiatingpain that you’d get from a bone or disc pressing onthe sciatic nerve. Muscles spasm for similar reasons– genetics, physical and emotional trauma, poorposture, diet and nutrition. We will get into thepiriformis muscle and its functions in much moredetail in chapter three. For now, it’s simply importantto understand that it too can cause sciatic pain.www.CoreWalking.com- 13 -
In all of these situations, whether it is muscle orbone or disc pressing on the sciatic nerve, the key tohealing is to change your habits. Those with chronicpain have an immediate incentive to seek solutionsin changing their habits. Others may have pain everyso often, but they too should change their habits toprevent the situation from continuing or growingworse. Perhaps you always seem to get injured in thesame place or the same side. Maybe you’ve been tophysical therapy that has been effectively only for theinjury to recur again at a later date. Those who havehad surgery should definitely examine their habits tocreate new, healthy patterns. Or perhaps you are notin pain but recognize these postural issues in yourselfand know people in your life with sciatica. For allof us, it is vital to our health and healing that weconsider the nature of the ways in which we move,get injured, and recover. How you live, move, andcare for yourself will determine the quality of yourlife.- 14 -www.CoreWalking.com
CHAPTER TWO: THE SCIATIC NERVEYour nervous system runs the show. The centralnervous system, comprised of the brain and spinalcord, receives and sends information through theperipheral nervous system, the nerves that radiatefrom the spinal cord through the rest of the body.Almost all of the body’s nerves have to pass throughholes in the spine to make their journeys. This makesthe alignment of the spine key to a successfullyfunctioning nervous system, as discussed.Let’s explore the nerve at the heart of this book –the sciatic nerve.WHERE IS THE SCIATIC NERVE?The sciatic nerve, also known as the ischiaticnerve, is the longest, widest single nerve in the body.It’s the yellow nerve in the diagram on the left. Atits largest point, it’s as big around as an index finger.Take a moment to look at your index finger. It’s prettyincredible to have a nerve this large moving throughus. It deserves respect.It begins in the lower back, and it is actuallymade up of five nerves that come out of the rightand left hand side of the lower spine. You have acurve in your lower spine, and this area is referredto as the lumbar spine. The lumbar spine includeswww.CoreWalking.com- 15 -
five vertebrae (L1 – L5). Below thelumbar spine is the sacrum. Thesacrum also consists of five vertebrae(S1 – S5). However these sacralvertebrae begin as unfused (like therest of the spine), and then once weare standing and walking they fusetogether making more of a plate. Thenerves that make up the sciatic nervecome out of the bottom two lumbervertebrae (L4 and L5 and the topthree sacral vertebrae S1, S2, and S3).These five nerves cometogether out of L4, L5, S1, S2, and S3to form two nerves, the tibial and the peroneal. Thesetwo nerves are incased in one sheath and togethermake the sciatic nerve. From the lower back, thesciatic nerve runs through the buttock and extendsall the way down the back of the leg to the toes. Atthe back of the knee those two nerves, the tibial andperoneal, divide. You can see this in the diagramabove. The peroneal travels sideways (laterally)along the outside of the knee to the upper foot. Thetibial continues to travel downward to the feet, and itinnervates the heel and sole of the foot.Illustation: Gray’s Anatomy- 16 -www.CoreWalking.com
WHAT DOES THE SCIATIC NERVE DO?With a nod to the above section, the sciatic nervehelps attach our torso to our legs. Specifically, itconnects the spinal cord with the outside of the thigh,the hamstring muscles in the back of the thighs,and muscles in the lower leg and feet. More thanphysically connecting the legs to the body, the currentof the sciatic nerve essentially connects your legs toyour brain.As a nerve, it is the electric current that makesthe muscles work. It also transmits back to the brainwhat you feel in the leg. Simply put, the sciatic nervesupplies sensation and strength to the leg. Thismeans that we need the current of the sciatic nerveto be running cleanly for us to use our legs well. Italso provides the reflexes of the leg. Your reactions,feelings, movements in the legs all come from thesciatic nerve as it communicates with the brain. Ifyou have a bad connection from the battery of the carto the headlight, then the headlight wouldn’t work.These connections, like the sciatic nerve, keep usrunning.When you are suffering from sciatic pain, it meansthat the nerve isn’t running cleanly through the body.It is being impinged. Thus, in addition to the pain,you are also not getting clear messages from thewww.CoreWalking.com- 17 -
brain to the leg and back again. You aren’t using yourincredibly powerful legs in an optimal way. Beyondthe pain, sciatica is debilitating for your physicalmovement. We’ll discuss this in more detail in chaptersix.WHAT IS THE SCIATIC NERVE’S RELATIONTO THE PIRIFORMIS MUSCLE?So those five nerves come together out of L4, L5,S1, S2, and S3 to make the sciatic nerve. They cometogether right on the front of the piriformis muscle.Basically the sciatic nerve is born at the piriformismuscle. But things can get even closer between thesciatic nerve and the piriformis. Remember howthe sciatic nerve is actually two nerves – tibial andperoneal – that live in one sheath until they split atthe back of the knee. In about 15% of the population,these two nerves split before they join up, so tospeak. The peroneal segment will pass through thepiriformis while the tibial runs in front of it, andthen they will join up together to form the sciaticnerve. For some, this will never be an issue. But if thepiriformis goes into spasm, then those individualswill feel sciatic pain. Because the peroneal segment isgoing through that muscle, there’s no real “cure” forthat, only a management of the pain by calming downthe piriformis. Obviously the piriformis is intimatelyconnected to the sciatic nerve; so let’s take a closerlook at this important muscle.- 18 -www.CoreWalking.com
CHAPTER THREE:THE PIRIFORMIS MUSCLENow we’ll give the piriformis muscle the attentionthat it is due as a player in sciatica.WHERE IS THE PIRIFORMIS MUSCLE?The piriformis muscle is a flat, pyramidal shapedmuscle. It’s in red in the diagram onthe left. One end of the piriformisconnects to the sacrum. Again, this isthe bottom portion of the spine wherethe vertebrae gradually become fused.The piriformis connects to the anteriorIllustation: Gray’s Anatomysacrum (the front). From there, thepiriformis muscle passes through thepelvis and then goes out via the greatersciatic foramen (opening). This is anopening in the pelvis that allows thesciatic nerve and the piriformis to travelfrom the spine to attach to the legs. As they maketheir journey through the pelvis, the sciatic nerve runsunder the piriformis (and sometimes through thepiriformis as discussed before). Obviously, with thisclose contact, the piriformis muscle can squeeze andirritate the sciatic nerve in this area. The other endof the piriformis connects to the greater trochanter,which is the bump on the outside of your thighbonewww.CoreWalking.com- 19 -
(femur). You can feel this bump on the outside of thebody if you dig in deep enough on the outer leg at thetop.WHAT DOES THE PIRIFORMIS MUSCLE DO?The piriformis muscle is one of the externalrotators of the hip and leg. External rotation is whenyou turn your leg out, away from the center of thebody. Think ballerina or Charlie Chaplin. Also, thepiriformis helps in abduction (moving the leg awayfrom the body) when your hip is flexed (eg, when youdraw your knee in towards your chest, somethingwe do on a small scale every time we take a step).So if you wanted to have a seat cross-legged on thefloor, you would use external rotation, hip flexionand abduction. Anyone who has suffered any of thesesymptoms knows that getting out of a car is no fun.Getting out of the car is a very common use of thepiriformis muscle – you lift the leg (flexion), turn itout (external rotation), and move it away from thebody (abduction). If you have sciatica or piriformissyndrome, you would probably feel it here. Thepiriformis muscle is working in fully glory!The piriformis not only helps you to do theseeveryday actions but also stabilizes the hip joint whileyou do them. As discussed, the piriformis attaches atthe greater trochanter (outside of the big thigh bone)- 20 -www.CoreWalking.com
and the anterior sacrum (inside the lowest part of thespine). Where your sacrum meets your pelvis, youhave a sacroiliac joint (SI joint) that essentially createsthe singular pelvis by connecting the two hip bonesto either side of the sacrum. There are two tracks orgrooves that allow for a tiny bit of movement withinyour SI joint. This allows for a stable yet moveablepelvis provided each piriformis (right and left) isequal in balance and tone. When one or both of thepiriformis muscles are short or tight, it inhibits the SIjoint on that side leading towards a host of problemsthat include sciatica and piriformis syndrome.Further, the piriformis’ tone and balance affectsthe performance of the deep gluteus muscles in manyactions like moving the leg away from the body androtating it in/out. We have three gluteal muscles – thebig one (gluteus maximus) and two deeper glutes(minimus and medius). It’s these deeper glutes thathave a close relationship with the piriformis; theylie underneath it. They both abduct the leg (moveit away from the body) and rotate it (internally andexternally). If the piriformis muscle isn’t workingwell, then the deep gluteal muscles underneathit can’t fully execute their actions either. Your legmovements will accordingly be compromised.The piriformis, this tiny muscle, affects themovements of your legs, hips, and spine, not towww.CoreWalking.com- 21 -
mention the health of your sciatic nerve. The toneand balance of your piriformis (on each side) istremendously important to the body and yourmovement. One reason we lose tone in the piriformisis bad posture. A large majority of people stand andwalk with their feet turned out (again, shorteningthe back body). Anatomical neutral, which wouldhopefully be our default posture, has the feet parallel.This gets to the basic design of the body and ourposture, which we’ll discuss throughout. The shinbones are designed to be parallel and move straightup from parallel feet that stand fairly close together.The leg bones above the knee angle out to join thetorso at the hip. This parallel stance of the feet createsthe ideal resting position for the piriformis. You canfeel this when standing. With the feet parallel thebuttocks can be broad and untucked more easily. Ifthe feet are turned out the piriformis is automaticallyshortened into a contracted state. If this is younatural posture and walking pattern your piriformisis slightly contracted 24/7, which compromises themovement of the legs, hips, and spine.- 22 -www.CoreWalking.com
Finally, the piriformis is also one of only twomuscles connecting the upper and lower body. ThePsoas is the other one, and we’ll discuss it next.Again, like the sciatic nerve, the connection aspect isa big deal. We need these connectors to be physicallyhealthy for us to move well but also for us to feelgrounded and stable as we move through the world.In chapter 6, we’ll look at piriformis syndromeand what happens when the muscle spasms. Nextwe’ll address how the piriformis and psoas worktogether for our physical and emotional health.www.CoreWalking.com- 23 -
CHAPTER FOUR:THE PSOAS AND PIRIFORMISThe psoas is the topic of the first book in our ebookseries. It has come up in this book a few times alreadybecause of its importance. Let’s explore it more withrelation to the piriformis and sciatica.WHAT IS THE PSOAS?First, a quick review of the psoas (or anintroduction if you haven’t read our psoas ebook). Inour opinion, the psoas is the most important musclein the body. It is the main hip flexor. As mentioned,flexing is when we draw the leg closer to the chest.We do this action on a small scale each time we stepthe foot out in front of us. Therefore, the psoas is themain muscle for walking.The psoas is also the main muscle for trauma.Anytime you are afraid, you flex. Notice what- 24 -www.CoreWalking.com
happens when you’re startled or fearful, you flinchand flex. That’s the nature of the beast. You’re goingto play possum (play dead) or you’re going to fightor you’re going to run. All of these three actionsinvolve flexion, a shortening of the body. When youplay dead, you curl up and the psoas draws the kneesin to the chest. When you fight, you crouch, and thepsoas helps you get small. When you run, you takeyour feet in front of you and the psoas moves themforward. When the fear responses kicks in, the psoasgoes into action.There is nothing wrong with the fear response.It’s a natural part of being a human being! However,issues arise when that fear response doesn’t goaway. If we don’t release that flexion, then yourpsoas becomes tight and that continued tightnesscommunicates to your brain and nervous systemyou’re in danger. Basically you stay stuck in fightor-flight. This happens to many of us whether we’restuck in daily anxiety or experiencing post-traumaticstress after a specific incident. Thus releasing thepsoas is an extremely important piece of emotionalhealth and also physical health. Releasing the psoasalso helps the health of the piriformis, as the twoare inseparable partners in the dance of the movingbody. Let’s look more at how these two muscles worktogether.www.CoreWalking.com- 25 -
HOW DO THE PSOAS ANDTHE PIRIFORMIS WORK TOGETHER?The psoas and piriformis are the only two musclesthat connect the legs to the spine. They work like astirrup, providing a downward pull on the sacrum(the bottom of your spine). The psoas pulls from thefront and the piriformis pulls from the back. Theyessentially strap the upper and lower body together.The psoas and piriformis took on thisimportant role when we stood up! As quadrupeds theweight of the spine falls easily into both the arms andthe legs. When stand upright, we use the hamstringand the now uber-important gluteus maximus, andthe psoas and piriformis are working to hold us upin a balanced way. These two muscles while notnecessarily dormant in the quadruped are now calledon constantly to hold us up successfully.As with all muscles, we want tone in the psoasand piriformis. Strong enough to move us but notoverly contracted or tight. Moreover, because theywork together, we need a balance between thesetwo muscles. In fact, the tone and balance of thesetwo muscles goes a long way to determining thesuccessful upright posture.- 26 -www.CoreWalking.com
WHAT DOES THIS HAVE TO DO WITHSCIATICA?As we’ll keep shouting from the rooftops, a goodupright posture will prevent (and heal) sciatica. Interms of the psoas and piriformis, this requires thembeing balanced as stirrups on the sacrum. Again, thismeans not too contracted. The psoas and piriformisrequire a certain amount of tone to stay in place.However, they do not want to place themselvesor hold themselves in position. This action wouldrequire over contracting and tightening you up andpulling you out of that good upright posture. Instead,the psoas and piriformis depend on a holy trinity ofmuscle groups to keep them in the right place. It is thetone of the inner thighs, pelvic floor, and abdominalsthat keeps the psoas and piriformis aligned. If thesethree groups are toned, then your psoas and piriformisare going to live in perfect alignment. Now becausemany of us do not use our inner thighs, pelvic floorand abdominals successfully, we tend to be weakin these areas and thus over working our psoasand piriformis. This pulls us out of alignment. (Andwith a nod to the emotional state, this over workingsends a message to our nervous system and brain tobe in fight-or-flight.) So for many reasons, we willbe providing exercises at the end of the book to bothrelease our psoas and piriformis and will be providingexercises in our following ebook on the spine towww.CoreWalking.c
the pain and debilitation of sciatica and piriformis syndrome and perhaps prevent you or your loved ones from ever dealing with either. e will give you an in depth look at all of the W actors in the drama – your bones and muscles, the sciatic nerve, the piriformis muscle as well as
724.3 Sciatica M54.30 Sciatica, unspecified side M54.31 Sciatica, right side M54.32 Sciatica, left side OR M54.40 Sciatica with lumbago, unspecified M54.41 Sciatica with lumbago, right side M54.42 Sciatica with lumbago, left side Exercise: Write down your 20-30 most com
syndrome were considered to have probable piriformis syndrome and were referred for open MR imaging–guid-ed piriformis muscle injection. Real-time open MR imag-ing ensured that all injections were delivered into the pir-iformis muscle and that any leakage of injectate from the piriformis
discrepancy, piriformis myofascial pain syndrome, following vaginal delivery, and anomalous piriformis muscle or sciatic nerve. In this paper, we describe piriformis and bromyalgia syndrome in a -year-old young lady, an o en missed diagnosis. We also focus o
confirmed as the initial treatment for piriformis syndrome is conservative. Surgical release of the sciatic nerve and sectioning of the accessory belly of the piriformis muscle may be considered in refractory cases (2). In conclusion, an accessory belly of the piriformis muscle is a rare but im
Can compress the sciatic nerve and can cause piriformis sciatica (link) or piriformis syndrome Over stretching often increases over activity or facilitation and leads to increased pain or sciatica. Iliopsoas (iliacus
Piriformis Syndrome 12 What is Piriformis Syndrome? 13 How Does Piriformis Syndrome Happen? 13 Special Considerations with Clients 14 Prevention and Pain Management 14 How Do I Build the Perfect Glutes? 16 Can’t I Just Squat and Lunge? 17 Your Bes
724.3 Sciatica M54.30 Sciatica, unspecified side (M54.31 and M54.32 right or left) OR M54.40 Sciatica with lumbago, unspecified (M54.41 and M54.42 right or left) How do I find the ICD-10 code? Look up 724.3 using GEMs-M54.30 Look up “sciatica” in the ICD-10 index -M54.3 Now find it in the tabular list -
Vol.10, No.8, 2018 3 Annual Book of ASTM Standards (1986), “Standard Test Method for Static Modulus of Elasticity and Poissons’s Ratio of Concrete in Compression”, ASTM C 469-83, Volume 04.02, 305-309. Table 1. Dimensions of a typical concrete block units used in the construction of the prisms Construction Method a (mm) b
