Treatment for Hip Related Sciatica (Piriformis Syndrome & Deep Gluteal Syndrome)

 
Hip Pain, hip related sciatica, Treatment

There are a considerable number of options in the treatment for hip related sciatica.  In most cases, conservative treatment with the right Hip Pain Professional (such as a Physiotherapist or Exercise Physiologist) is all that is needed.  In some rarer occasssions less conservative options may need to be considered.

If you are not sure what exactly the terms “hip related sciatica”, “piriformis syndrome” and “deep gluteal syndrome” are then check out our previous blog on what and where these are, and how they can occur.

Both this and our previous blog are a must read anyone with buttock pain +/- pain into the low back, upper thigh or leg.

1. Education:

  • Understanding what the problem is and what types of positions and activities are likely to irritate the sciatic nerve, can help significantly in controlling the symptoms of hip-related sciatica.

2. Exercise:

  • Exercise may be used to assist in reducing pain and improving function associated with Deep Gluteal Syndrome via a number of mechanisms:
    • Improvement in mobility and blood flow of the sciatic nerve
    • Optimisation of health of the muscles and tendons of the deep gluteal space. This might involve various stretching or strengthening exercises.
    • Improvement in control of pelvic position during dynamic movements

3. Manual Therapy:

  • Manual therapy provided by a health professional can in some cases be useful. This may temporarily reduce tension in the muscles of the deep gluteal space and increase blood flow through the region. Exercise and education will usually be required to achieve longer term changes. A Hip Pain Professional can help you.

4. Medications:

  • Particular medications that aim to calm nerve irritability may be prescribed by your doctor to help control pain, maintain activity levels and assist with sleep.

5. Injections:

  • Your doctor may also suggest an injection to assist with diagnosis and/or pain relief. Injecting local anaesthetic around the sciatic nerve in the buttock may, if pain is relieved, assist in determining if this is the problem area. A cortisone (corticosteroid) injection may also be provided to reduce inflammation and pain associated with irritation of the sciatic nerve in the deep gluteal space.
6. Surgery:
  • Surgery is always a last resort for management of Deep Gluteal Syndrome. All other measures should be exhausted prior to a surgical intervention. If all else has failed and the issue is having a substantial impact on pain levels, function and quality of life, surgery may be offered.
  • Wherever possible, surgery is usually best performed endoscopically, through small incisions and with tiny cameras¹.This reduces recovery time and changes of post-operative scar tissue².
  • Surgery may aim to release strong fibrous bands or occasionally lengthen the piriformis muscle.
  • Surgery always carries risks, does not guarantee full resolution of symptoms and the recovery from these surgeries can be prolonged. This is why it is important to ensure all other avenues have been explored first.
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Need Help? Find a Hip Pain Professional

References

  1. Byrd, J. (2015). Disorders of the Peritrochanteric and Deep Gluteal Space. Sports Medicine and Arthroscopy Review, 23(4), pp.221-231.
  2. Harris-Hayes, M. and Royer, N. (2011). Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review. PM&R, 3(11), pp.1055-1067.e1.

Authors

This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.

Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.

Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.

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Check Out More You Can Read on this Area at HipPainHelp:

Anterior Hip Pain: scroll down and read more about the front (anterior) of the hip joint and how different structures can be involved in pain at the front of the hip.

Hip Flexor Pain and Iliopsoas Pain (Hip and/or Groin Pain): The muscles that sit at the front of the hip are called the hip flexors and act to lift your knee towards your chest (flexion). It is these muscles that can be involved with hip flexor pain. Learn about the hip flexors including iliopsoas muscle and their relation to pain.

Femoroacetabular Impingement Syndrome (FAIS) – what is it and what are the causes: Learn about the differences between FAI and FAIS, and what might be the cause of this condition. This is another condition that may result in pain at the front of the hip.

Causes, Affects & Exercises for Lordosis to Reduce Hip and Back Pain:Learn how tilting the pelvis forward may affect your hip flexor muscles

What is the Best Good Posture for Hip Pain Relief: Is there any one good posture that could best help with hip pain relief is not such an easy question to answer!

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Don’t miss our next blog……

Check out our next blog series

Over a series of 3 blogs we will look at Hip dysplasia, what it is, what are the different types of dysplasia, the symptoms, causes, and possible treatments.

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