Anthony Gurule  00:00

Hey what’s up guys, welcome back to the Live Loud Life podcast. For those of you who are new here, my name is Dr. Antonio, your host of the Live LOUD Life podcast. My wife and I, we own Live LOUD Chiropractic, we’re based here out of Lafayette, Colorado. And our big mission and focus is to help make stronger families to then in turn make stronger communities. We hope to help fill the gaps between the information that you’re getting from your providers, whether it’s clinician, a pediatrician, an obstetrician for prenatal/postnatal, whether it’s your nutritionist, or your your strength and conditioning coach or your personal trainer, it’s just being that sounding board. And that advocate for helping connect all the dots for those things that you’re maybe just not quite getting answers to. And we do have some specialties that we focus on primarily, but what we really want to help is just have that, at least initiate that conversation, and going through this diagnostic process of helping you find the right person, even if it’s not us. Because while we do work on a number of different conditions, whether that’s musculoskeletal neck pain, lower back pain, mid back pain, knee pain, hip pain, shoulder pain, you know, your kind of traditional thing, We also work extensively with prenatal postnatal, on pediatric issues from milestone tracking from your peds, lactation issues with your infants, how to work out safely and effectively and efficiently during pregnancy, as well as how to return to fitness during postpartum. So you know, there’s a number of different issues and things that we would love to be able to help you with. And if that’s something if any of those sparked your your curiosity or generated a question for you, please do not hesitate to reach out.

 

Anthony Gurule  01:52

But today where we’re going to talk about is one of my specialties. One of the things that I primarily love working on and focus a little bit more on in particular, which is lower back pain. And in this particular case, we’re going to be talking about the myths, myths plural, the myth of sciatic pain in particular, we’re talking about piriformis syndrome, or the piriformis muscle being the primary cause of sciatic issues. Now, for those of you who are watching this video, this podcast on YouTube, we have a number of different videos that talk about this issue that dive into a little bit more than anatomical considerations, which, if I remember to, and I will promise I will try to, is I will overlay some of the anatomy on this video as we’re speaking so that you can get a better understanding of what we’re talking about if you do not have anatomical knowledge. Because most of us, to be honest, we’ve seen a picture of the piriformis muscle and you know, a physical therapist or another chiropractor or someone pointed out and said this is what’s causing your issue because you’ll see the nerve going through it. And that’s really where things get mixed up and, and then all of a sudden we get stamped with this piriformis syndrome sciatic issue, and lo and behold, right, that’s what that’s what the cause is when really, it’s a lot more complex than that. It could be more complex, sometimes it’s a little bit more simple, but more times and a little bit more complex than just a muscle that’s tight that’s pushing on a nerve. So that’s where we’re going to be diving into today. So if you are someone who has suffered from piriformis syndrome, sciatica, or lower back pain with radiating pain down your legs, or anything around that, this video is definitely for you.

 

Anthony Gurule  03:42

So let’s back up here. How does, or where does the sciatic nerve, your “sciatica,” quote unquote, when you say you have sciatica? That is what it means it’s coming from the sciatic nerve. And where does the sciatic nerve come from?

 

Anthony Gurule  04:00

Well, breaking it down as simplistic as we can, you have your brain, your brain then goes down and goes into your spinal cord and then from your spinal cord, you have a bunch of nerves that come out. And those nerves come out of this space that is in between your vertebral bodies or your spine. So your spine is not one just stiff rod, there are multiple bones and joints within your spine and those stack on top of each other and there’s a little space called the parameter in between those two bones and that’s where the nerve comes out. You also have arteries and veins that go in and out of that space that go in and out that and kind of follow the same path. and then from there, those nerves Then branch out. Some of them combined together and you have these really intricate they’re it’s called the plexus is really intricate weave of nerves that then distribute to the rest of your body.

 

Anthony Gurule  04:59

And the reason why this is so elegant and great is that if you were to have damage at a single nerve root level or other areas, you have multiple innervation orientations, or spots that originate from, to help you maintain a lot of function sales. So for instance, when you’re looking at a lot of the the nerves that make up either your arm or your lower leg, you’re gonna have anywhere between two, three, and sometimes even four nerve roots that then come together to Then branch out and make a larger one. So if I had an injury, like a disc herniation, on the L3 nerve root, I still have innervations input from L4 and L5. So that allows me to maintain a lot of functions. So where I wouldn’t just be, it’s not just like one nerve root then goes out to one particular area. And if an injury happened, then it shut off, and you can’t do anything therefore moving forward. Right, so it doesn’t work that way. And that’s what’s beautiful about it. Now, that being said, the sciatic nerve is again, a conglomerate of a bunch of these nerves that come together, and it’s actually quite big. If you were to take your pinky finger, someone even say your index finger, right? That is about the size of your sciatic nerve as it exits your pelvis and then starts to make its descent down your leg. Now from there, it will then branch off again, to make additional nerves that go into different areas of your body. So that you just have again, this this wide, vast distribution to for not only sensory, but also motor function.

 

Anthony Gurule  06:32

Now, where we want to go with this is understanding what are the main common injuries for nerves, right? The nerves just like any other soft tissue can be damaged, bruised or irritated. So for instance, most of us have felt this before you hit your funny bone, which is really your ulnar nerve, which goes behind your inner elbow. And when you hit it, you get a wide range of symptoms, most of these symptoms usually around like a numbness or tingling, some of which could be pain. And that and that is from direct pressure or input or impulse on the actual physical nerve itself. Now you can have an abrupt injury, if you will, if we call it an injury, an abrupt impulse on the nerve just as we described, which creates this immediate sensation and this immediate zing. Or you could have something that progresses a little bit slower over time. So it’s kind of like this slow occlusion of pressure that starts to be that starts to go on the nerve. Most of these, though, usually happen as a result of like trauma, if you will. And that trauma then has either direct response of pressure on it from a physical body itself, or it could be pressure from swelling, which is very common for like a disc herniation, or something like that doesn’t always have to be the disc that’s pushing on the nerve. But the acute injury then creates an inflammatory response. And then inflammatory response brings more pressure from fluid, and then that fluid, in turn then creates pressure on the nerve root itself. Now, again, you have to consider we had multiple levels that made up that sciatic nerve as it went down the back of our leg, the symptom that you feel, though, is down that same path. And it could be coming from any one of those levels. Now there are orthopedic tests, and different evaluations to help us determine to help us determine what level of nerve root or issue it may be coming from. There’s different ways for us to tease this out from whether it’s muscle test, sensory test, you could do more complicated, like EMG studies and things like that. And depending on the extent of the injury, would it would be beneficial to know but But oftentimes, it might not necessarily matter for us to specifically know what exact level we’re dealing with here to make progress. So you have to keep that in consideration.

 

Anthony Gurule  09:09

And this is why the conservative approach of understanding mechanism of injury and what things are making things worse, and what things are making things what things are making your symptoms better, are more valuable, in our opinion, to do first rather than jumping straight to diagnostic imaging, so on and so forth. Because you’re gonna get an array of different conflicting information that may or may not be pertinent to the actual case at hand. So you do have to take that in consideration.

 

Anthony Gurule  09:36

But what we’re talking about, now further is again, that direct pressure so when you’re now looking at the orientation of how the nerves go down through the pelvis, they they go through this sciatic notch which is this little notch, kind of near our sits bones, which sits bones being your butt bones like what you sit on and it through a going across that same sciatic notch from your sacrum to your femur is a muscle called your piriformis. Now, your piriformis is one of a few muscles that make up these smaller, external rotators that are that are essentially deep stabilizing muscles. And that sciatic nerve can weave through the muscle, but it basically is, you know, this kind of roof, if you will, that sits on it. And when you start poking around, with nerve related issues, you’re gonna get, you’re gonna see a lot of trigger points and a lot of different areas.

 

Anthony Gurule  10:42

So one thing that’s kind of a side note, which does add to the value of this conversation is, when a nerve is pissed off, the nerve has no ability to protect itself, it is sitting there on its own, it cannot protect itself, but it does influence as we know, through motor control and output, it does influence what the muscles do so if something is vulnerable, but yet it can manipulate and control the muscles around it, you’re going to see guarding, some relate this a spasm trigger point, so on and so forth, to help protect the nerve and muscles don’t know anything else. They don’t they don’t know how to do anything else. But squeeze, right, they can only shorten it, they can only squeeze. So when they get an impulse to protect something, they don’t know how to do anything else but squeeze and then they’ll develop a lot of trigger points and tightness. And when you push on those, depending on the innovation system, you’re going to elicit very similar ridicular or radiation patterns that your sciatic nerve will present as. And so what happens is people start poking around in the glute complex where the piriformis is, and the rest of external rotators are the glute medius, or the glute min. And they’ll be very tender. And sometimes they’ll radiate and create a radiating pattern that mimics what the sciatic nerve path would be.

 

Anthony Gurule  12:08

And this has been studied extensively and janitor val is kind of the the the innovator of trigger point research and knowledge where they elicited saline injections into certain  hyper responsive loci in the muscle, which would be trigger points. And then they had people map out where they felt the symptoms. And then you see these these distributions along the leg. So if you ever type in like trigger points, you usually see like a leg or a region or a body part. And you’ll see all these red dots. Those are all the areas which an individual within the study indicated that they felt symptoms, usually pain or something like that, right. And so then when you’re poking on where the piriformis muscle would be, which would again be very hard to determine where the piriformis specifically lies, and I can get the landmarks of the sacrum in the greater trochanter and go into the middle. But keep in mind, you have also other muscles there, such as operator internists, external, glute med, so on and so forth. So for me to be able to take my thumb through all that meaty layer of your butt muscle would be very hard for me to say the piriformis is this one. And this is the one that’s causing the pain because it’s tight and I’m recreating your symptoms, right. And that’s how piriformis syndrome gets diagnosed. It is this piriformis muscle is tight, and your sciatic nerve runs through it. And thus, when we push on it to elicit more pressure on the sciatic nerve, we recreate your symptoms, and that’s the cause.

 

Anthony Gurule  13:44

Now, one thing I will agree with, if you will, within this is the palpation diagnostic process if a nerve is irritated, for instance, if I hit my funny bone, that ulnar nerve, and it’s already irritated, and I go back with my finger and rub on it, it’s already sensitive  into the point where I would be able to recreate that pain a lot easier. So if you’re palpating in the area, and the sciatic nerve is already irritated, for whatever reason, then you’re going to be able to elicit a similar response. That doesn’t mean that it’s the  piriformis muscle that’s going to be squeezing on and causing the exact issue. Other ways the sciatic nerve could be aggravated, would be from a potential disc injury or an inflammatory response up near the lumbar spine putting pressure on a nerve root and then that nerve root through that track of the sciatic nerve is also hyper sensitized. Right. You can also see in a stretch injury we’ve seen individuals who assume that they are stretching their hamstring, go through a stretching protocol when in turn they’re actually putting more stress on their sciatic nerve through the branches throughout and they hypersensitize the nerve that way. This is through straight leg, supine straight leg raises, other things like that in which we can differentiate hamstring tension, calf tension versus sciatic nerve tension. And then other than that, we see what we what some refer to as like snags, and snags, meaning the nerve itself should have an ability to slide throughout our body. So if you’ve ever heard of nerve flossing, this is where this comes into play. And essentially, if for whatever reason, and typically we see this kind of in a very small, a hyper sedentary population, and when we say this, a lot of times people assume this is not them. And this will be a sep- that we talked about physical guidelines, activity guidelines, in a couple of previous episodes, which I encourage you to go check out.

 

Anthony Gurule  15:49

Most of us are more sedentary than we think–we sit at a desk for six to eight hours a day with minimal micro-breaks. But yet we do an hour of exercise a day. And we assume that that’s enough. Realistically, when you look at even if you were to track with your overall step counter, we are not that active throughout the day. And when when you’re sitting in, when you’re primarily in a city pattern, you create a lot of tension around the hips, and a lot of the musculature around the hips and the connective tissue in which, which includes ligaments and connective tissue and muscles right, in which the nerve is encompassed through. And it doesn’t have that sliding capability. So if you have a nerve that’s supposed to be able to glide and slide as you move, because you’re not moving enough, that creates this tension within that nerve. And thus then you can elicit symptoms again, right. So a lot of what stretching is also believed to be doing outside of hopefully elongating our tissues and making them more extensible is allowing us to be more aware and accustomed to the nerves stretching. you can’t go from you know, do you know the stiff rubberband and assume that you can just stretch and we’ll be fine, you have to work it over time. And all of a sudden the nerve, which is just a connective tissue, we’ll have a better idea of being able to stretch a little bit. And it won’t be as sensitive to that. But in addition to that, you’ll see the convergence factor of nerves moving being able to be more efficient. So a lot of this comes down to again, just having supple and mobile soft tissue that allows things to glide and slide well. So those are just again, a few of the reasons why the sciatic nerve might also be irritated.

 

Anthony Gurule  17:28

But what we wanted to highlight is again, the fact that the piriformis is such a small role and factor into the whole hip complex as itself into the whole lumbar plexus and sciatic nerve. You know, area that the majority and I would be confident to say the absolute, absolute majority, 99.9. And I’m making that statistic up, but 99.9 of the time, it’s most likely not your piriformis is most likely not piriformis syndrome, it’s your piriformis isn’t so tight, just because you can’t get into a pigeon pose, which again, piriformis in that position is one of a few muscles that are being stretched in pigeon pose just because you can’t get in the pigeon pose doesn’t mean your piriformis is so tight. And that’s what’s causing your sciatic issues. Now, will it help for you to address a deep pigeon stretch and doing trigger point work in your hips and stretching? 100%. 100%. But you don’t get confused that just because you did something correlation not equal causation, just because you did something and you got a positive response, that does not mean that you fix the actual issue as to why it was coming through.

 

Anthony Gurule  18:38

That is dealt with primarily through the diagnostic process of understanding how it came on in the first place. What are the movements that you’re doing? Where are the range of motion limitations that might be adding more load to a certain area? But again, it’s most likely not your piriformis muscle causing your sciatic, your sciatica, or your sciatic nerve pain or numbness or tingling down your leg? So then the question would be well, what else was it? Well, we again, we highlighted a couple of the potential things that could be what is your particular cause? I don’t know you have to go through an evaluation and assessment. If you don’t have someone to do that for you, we’d be happy to team up with you and we can set up you know, online consultation or an in person session to help you deal with that. But we see time and time again, movement helps tremendously. That’s why we’re not discounting the pigeon stretch and the trigger point work and just going through general movement. we know that helps.

 

Anthony Gurule  19:32

and those that have this sciatica, and one thing I did not mention, which is critical to understand, is acute versus chronic.  So many more of these cases are chronic. sciatica issues like I’ve had sciatica since high school which is a patient recently that just comes to mind and realistically through his occupation, very sedentary so the so the referral stuff that he’s having down his legs, it’s not really true sciatica. it only goes just past the hip. And it’s very dependent on hip movement as opposed to like some of the other diagnostic or differentiation movements that we’ve done.

 

Anthony Gurule  20:09

And what we simply started with was just a movement mindset of starting to do supported squats, and hip hinging, and just loosening up that whole posterior chain. Lo and behold, everything has gotten better. And yet his belief was that because he was told by a physical therapist back from high school is that his piriformis was too tight. And that was the cause. he always just that was piriformis syndrome and that he wasn’t able to ever stretch it out or release it out. And that was the Doom factor for him and constantly having sciatic pain. So this sciatica in any nerve related issue, needs proper diagnostics, consultations, workshopping of understanding triggers, causes of pain or increasing the symptoms, because it’s gonna be very hard to get out of those if you don’t know what those triggers are. But more specifically, finding the specific thing that helps alleviate the nerve pain, whether that’s opening up the foramen through an opener that allows perforation and signaling to go through. whether that’s anti inflammatories, depending on the extent of how acute the injury is. whether that’s flossing–nerve flossing exercises to make that nerve excursion smoother, if you will.

 

Anthony Gurule  21:28

So I see it more as (and I’m not saying a cop out because it’s the other, the other provider Whoever didn’t necessarily know anything else.) But we see this more or less as kind of a cop out diagnosis. We did a recent podcast on you know, how Fibromyalgia is diagnosed, which essentially is an exclusion criteria just like hey, we couldn’t figure out anything else. Right. sciatica. You know, they’ll do a couple orthopedic tests to try to determine but there may be inconclusive, it’s just like, ah, you know, your hip’s tight. I’m not quite sure what the cause is, it’s most likely your piriformis muscle because we poked on the end, and it’s tight, right? That’s usually how this is laid out. And that is really just not a service to you as a patient or a client.

 

Anthony Gurule  22:15

So I hope this was I hope this was helpful. Again, if you if you’ve been told you had piriformis syndrome before, or you have a tight piriformis and that’s causing you sciatica, I think this is a very important video for you to go through and send to, you know, a loved one, a family member or friend who’s who’s been complaining about this as well. Because in what we’ve seen, and in in our mind, it gives a lot more confidence about what you can do in the future. Because if you think it’s a tight muscle, and you’re still having symptoms, and you’ve just been stretching the hell out of it, you’re not getting anywhere, that’s super frustrating. You’re like, Well, shit, that’s what it is, you know, I’m not going to be able to change it. And when you have a different lens and perspective about what’s actually going on, it gives you a lot more. It really helps empower you to be able to do more about this.

 

Anthony Gurule  23:00

We appreciate you tuning in guys. Again, we’re Live LOUD chiropractic here in Lafayette, Colorado. If you’re local, we’d love to connect with you and help you with your aches and pains to help you live a fuller life to help you feel stronger, more confident about your movement. If you’re not local, we do offer online consultations because we want to again, be be in a role and a position to empower you, even if it’s just a consult to help you navigate what that next step would be. A lot of people don’t have that. And if we can do that for you, we’d love to be able to help out. So be sure to like and subscribe to our YouTube channel or podcasts. You can also find us on Instagram where we’re doing much more shorter pieces of content but still very valuable and useful to parents, to families. To you know if you’re a prenatal if you’re postnatal, if you have little ones at home, we’d love to be able to share that content and that information to help you live a loud life. Until next time, guys.