The piriformis muscle is one of only three muscles connecting the legs to the spine (the psoas major and gluteus maximus are the others). It originates on the front or anterior portion of the sacrum at the base of the spine. It exits the pelvis and inserts on the greater trochanter of the femur, or leg bone. The greater trochanter is a bony knob on the outside of the femur that houses the tendons of many muscles. On the inside of the femur is the lesser trochanter that only has two inhabitants— the psoas major and iliacus.
Directly in front of the piriformis muscle, five nerve endings that emanated from the spine meet up to form two separate nerves, the peroneal nerve and the tibial nerve. These two nerves are encased in a sheath and this is the sciatic nerve. When the sciatic nerve reaches the back of the knee it will split again and the peroneal nerve and the tibial nerve will finish their journeys on their own.
It is important to make a distinction between sciatica and piriformis syndrome. They both involve sciatic pain but the condition known as sciatica usually stems from issues in the lower back, when part of the spine pushes on the sciatic nerve sending pain through the lower back and often down the leg.
The pain associated with piriformis syndrome originates deep in the butt when the piriformis muscle is chronically tight, or goes into spasms, or, for whatever reason presses on the sciatic nerve to create the pain and discomfort.
The pain sometimes remains localized but often travels down the leg as well.
The sciatic nerve is the longest nerve in the whole body and besides the piriformis where the peroneal and tibial nerves meet to form the sciatic nerve, it can be as large around as your pinky finger. This is why proper alignment of the pelvis plays such an important role in treating piriformis syndrome or sciatica. There isn’t a lot of room for the nerves to make their way through the muscles and endless connective tissues; and any misalignment can have far-reaching effects.
In so many cases healing begins with the proper diagnoses. It is important to understand exactly what you are dealing with if you want to heal in a lasting way.
Changing the way you walk to align the bones and use the muscles correctly creates space for the piriformis muscle and sciatic nerve, facilitating relief for sciatica and piriformis syndrome.