Hi, I wonder about a case of pain-in-the-butt, A.K.A. Piraformis syndrome, commonly referred to as Pseudosciatica because it mimics the symptoms of Sciatica from a bulging disk. It is, in fact an irritation of the same nerves but downstream at the Piraformis, which may be in spasm or otherwise injured. I think that plenty of people go to Orthros with this and are told that the disk showing up in the Xray is causing it, but no, everyone’s got some lousy looking disks and more testing is indicated. If you don’t like to sit anymore then it points less to Sciatica and there is testing that a Chiro or PT might do because symptom also can be caused by Sacroilliac problems (or both) and those tests can be found all over Utube. This problem is indicated by bringing the knee up to the opposite shoulder. I exacerbate it by doing things like Parvrita versions of triangle, half moon, parsvakanasan,as well as utanasana or padmasana, especially sitting. You get the picture. The literature says that a small percentage of people have their Sciatics going right through the Piraformis and are particularly prone to this. Otherwise, They say that it is a result of spasm in the Piraformis pushing on the nerves and tell you to stretch it, making more room for the nerve. Try Yoga, they say but when I do that it gets worse and anyway, it was likely caused by Yoga. That’s impossible, Yogis say. You just weren’t doing it with proper alignment. OK, but I’ve been working at it for 20 years. Resting it helps some but leaves everything tight begging more injury.
Assuming that this is Piraformis,(some assumption here) does anyone know the real mechanics of this damage, (the spasm thing sounds wrong) how can it be confirmed, investigated and what’s the best way to work with it?
Sorry to be so wordy. Namaste.
Bodywork does wonders for this. Massage, NMT, Acupressure, Structural Bodywork, Deep Tissue, etc. A therapist who is well versed in anatomy should be able to target your piriformis directly.
You can try the tennis ball trick yourself first. This video is good, but if stretching is aggravating your issue, I would do this with both feet on the floor.
bjje,
Have you seen a Doctor and been properly diagnosed or are you self diagnosed? If you haven’t seen a Doctor, I would recommend doing so. A more specific diagnosis would assist in helping you or at least guiding you.
YOu’ve been working at it for 20 years? You’ve been working at it for 20 years? What have you been doing? What asana’s?
IF, it is a tight piriformis, then yes, there are many asana’s that can help. One very important thing you must understand with the piriformis is that it is a very tightly wound muscle. IF your sciatic nerve runs through it AND it tight, then yes, you would mimic sciatica. But a herniated disc pressing on the sciatic nerve will also cause sciatic pain. (but curiously, not in everyone) And if it is due to a herniated disc, you could be aggravating it by some of the asanas you are doing during your practice. (I assume you do a home practice)
I am hoping that Pandara will share some of his wisdom regarding this topic. Calling Pandara!!! He has developed a sciatic routine that has been quite effective for his students.
I too have been plagued with sciatica. Mine is due to 2 herniated discs in lower spine. After being diagnosed via an MRI and getting a epidural cortisone injection, the sciatica was gone and I was able to go to PT. My PT group was awesome and tailored all my exercises to yoga. (which is not much of a stretch, as many of their exercises are yoga based) It has been 2 years now and for the most part, no sciatica.
My therapist gave me a set of golf balls. And BlueLotus, golf balls were a godsend over the tennis ball I was using! It was just 2 golf balls with a hex nut in between and then held together with sports tape. You roll over the golf balls sequentially going down about 1/4-1/2". It gives the piriformis a bit of a punch (like punching down bread that has risen) and allows it to relax enough for you to do some asanas to stretch it out.
One mistake many make when either doing pigeon, reclined pigeon, bottom part of Gomukhasana, firelog is that they only hold it for a short time. For the piriformis to begin to relax, you need to hold the above positions for AT LEAST 1 MINUTE.
With all of this being said, more information would be helpful including a diagnosis.
Thank you, lotusgirl, for the golf ball suggestion. I often find even a tennis ball feels too sharp for me, but I know that each person is different so now I have another suggestion for others.
And holding for a full minute is a great clarification. I once gave one of my (non-yoga)clients some stretches to do at home and neglected to tell her how long to hold each one. As we discussed it several weeks later turns out she had been holding each asana for LESS THAN ONE BREATH. lol, won’t make that assumption again.
And you’re quite welcome!
And you know what they say about assuming? lol
Are you a yoga teacher or massage therapist or both? (in reference to your statement about non yoga client)
I am a massage therapist and a yoga teacher. 
Thanks again, the assumptions come at the most unexpecting moments. lol
Beej,
You’re quite well-read on the topic. Sadly, far more than many yoga teachers. True, the sciatic nerve runs through the piriformis in about 15% of the population (a number in dispute, I am certain). Also true that when agravated it manifests in a sort of “false” sciatica as it leans on the sciatic nerve. True also that yoga can make it better or worse.
Let me start with the last one first. “Yoga” has become a brand name much like “tennis shoe”. You can use a pair of Route66’s from K-Mart or you can use a pair of Masai Barefoot Technology (MBT). Both are shoes. Both go on feet. You can walk in both. However they impact the body in radically different ways. Yoga is the same and that ship continues to sail down the canal as we tolerate (with our buying power) bestowing the title of Yoga Teacher in as little as 22 hours. As my teacher writes in his book, Fire of Love, “Yoga is everywhere, and nowhere at all”.
If you have been carrying this issue for two decades there are two very distinct possibilities. The first is that you are continuing a pattern of living that is empowering the issue. Maybe you sit for long hours. Maybe you lean to one side when you stand. Maybe you swing a club on a fairway 100 times a week. Maybe you run several miles with wonky mechanics. Who knows. And the second (which is always the answer in yoga) is that there is an energetic/emotional component which you are not aware of, facing, or addressing. In these case you can properly gyrate through a myriad of asanas and maintain your intimate relationship with your sciatic nerve all the while.
These things having been said, there are therapeutic methodologies of addressing your symptomology. However that would require a skilled teacher, a practice unique for you, and a commitment to the doing. My guess is you have one of these and not the other two. Some yoga teachers seem to believe that a static practice (usually the one they ascribe to, practice, and teach) is ideally suited for therapeutic issues. From what I have seen in my living and body and that of my students, this is simply an interesting story (anecdote).
Directly to your question(s)
It is confirmed by skilled assessment and palpation, investigated by self-exploration (read:awareness) then supported by a well trained teacher able to convey asana, pranayama, lifestyle, nutrition, applied philosophy, and meditation.
Sorry, I wasn’t being clear enough. I am not crying for immediate gratification relief from those who never saw me. The 20+ year thing was my working on alignment and the rest of Yoga, not the butt. Sure I have particular issues, a bit of scoliosis and that energetic/emotional thing,(sports that hurt me) but I have a good practice, great teachers and am on my path. When I have specific problems I back off on my hurt parts and do the rest. I do what I can to investigate this inside as I do. Teachers can be of some help but usually have limited biomechanical experience which is why I was looking around at Mukada’s site. What I am really asking to see is a list. From what I can tell so far, there can be a list of asanas that pick out the symptoms and point to Piraformis, Sacroiliac, etc. just like the PT would but they have no magical ability to know what to do, they just follow their program. Everyone is a hammer looking for their favorite nail. That’s not ethereal. The problem is that I can sometimes have a whopper of a pain in the butt and do a Yoga practice that should hurt but does not but neither does it help so that is a confounding factor. Myofacial release or massage does not help. Why? Is the muscle in spasm or is it merely stretched and damaged? is the muscle irrelevant? Why should that hurt the nerve and if so why should pressure help instead of hurt it more? I’ll start a thread on muscle spasm so we don’t muck up this one but I am asking a very specific question. How can I use my practice to do what amounts to a differential diagnosis of lower back problems and work toward fixing it? If we have to search for the few star teachers that might know pieces of this and design a program to treat the whole then we may have a long wait.
Cheers.
Understood.
However it may be relevant to note that the protocols followed by P/T are not unique to persons while the ones followed by therapeutically trained yoga teachers should be. In yoga we know that no two conditions are alike and therefore no two tests or no two resolutions can be alike. Some things work and some things don’t. Some things work FOR YOU and some things don’t. They may not be the same things that worked for my sciatica.
For me the answer(s) or list you are requesting was actually part of the yoga (again, for me). It was the process. Sure, I often wanted a test or a diagnosis or a defining moment. But the “aha” moments were few and far between and they didn’t come from others.
As a yoga teacher I don’t diagnose. That is a slippery slope for obvious reasons, both legal and ethical. But I do look at symptoms and offer that which works to support in addressing those symptoms. So we try some things and see what gives it relief. And we try some things and see what lights it up. But we have to try some things. Anyone who tells you that they equivocally know what it is and how exactly to treat it should be carefully examined.
So it sounds like one cannot use asanas to identify or suggest the causes of back problems and one must only rely on the services of professionals. It is incorrect for me to query about what may have worked for others, thinking that it might be useful for myself.
BJJE
Hi BJJE,
I’m joining the club. I have back pain for few years and no luck with diagnosis. Each professional has own theory (physio, chrio etc.). I’m no expert on asanas, but I don’t think they would be useful in differential diagnosis of the back pain. As I watched physiotherapists at work (and my friend is a physio) they have lots of very specific techniques to isolate possible causes and check whether thats the case. I think asanas engage too big groups of muscles to pinpoint more fine causes of pain.
[QUOTE=bjje;50808]It is incorrect for me to query about what may have worked for others, thinking that it might be useful for myself.[/QUOTE]
I think it is very correct (in statistical sense). If you would ask what is the probability of success of applying in your case a therapy that helped 90% of other people - is it more likely that it will help you or not? I think yes - and that’s the reason why medicine is so effective. We respond in similar way. I understand that there is a variability in responses/circumstances but to abandon a possible treatment just because “we are all different” would be foolish.
I don’t know if you read about trigger points (http://www.trisoma.com/trigger-point.html). One girl from this forum send me info on those. Another element on my list…
[quote=bjje;50808]So it sounds like one cannot use asanas to identify or suggest the causes of back problems and one must only rely on the services of professionals. It is incorrect for me to query about what may have worked for others, thinking that it might be useful for myself.
BJJE[/quote]
Two very profound questions. Thank you for your thoughtfulness.
No, yes, and no.
Asana is a tool and as is the case with any powerful tool it is very safe and effective in the hands of a “professional” but incredibly chaotic in the hands of a neophyte. So yes a well trained teacher can use asana as an assessment tool and I share this both from my experience of being helped by a master teacher and in helping others (not as a master teacher, of course). It is however just assessment and that is an exploratory rather than finite process.
It is absolutely fine to inquiry of others. However I personally, in that process, would hold three things in my consciousness; a) that worked/did not work for them, b) I am unique, and c) the answer to the physical questions are always emotional etchings.
Great discussion.
My take on it is that yes, a teacher who has had many years of experience practicing yoga may better understand the benefits and subtle quirks of the poses, and how to work with others who want to explore them.
At the same time, you know your body better than anyone, and you have the unique opportunity to explore and test it through trial and error. You don’t necessarily need an experienced guide to have this experience and to come away with an understanding of what makes pain go away and what aggravates it.
There are many ways to approach sciatic pain, such as doing stretches that are designed to target the piriformis, strengthening the internal rotators of the hip (which act against the piriformis) and best of all, doing a sequence that opens up all of the tight muscles that cross the hip joint, since others will be playing a significant role in the sciatica.
My point is that your body is a sensitive instrument, and you and you alone are able to play around with asanas, adjusting them in subtle ways to suit your body, and using pain and release as your guides (when you feel pain, your body doesn’t like what you’re doing, when you feel release, it does).
You can be your own healer, if you take the time to explore and listen closely.