Got a shoulder problem?
“It’s your rotator cuff”!

Got a hip problem?
“It’s bursitis”

Got sciatica”?
“It’s the piriformis!”

“Sciatica” a term used to describe pain that may either radiate down the posterior lower extremity or remain localized to the gluteal region with no correlating findings on imagery of the spine. This leaves the default diagnosis: piriformis syndrome. Practically since my first semester in PT school (August 1981) I’ve heard the same things that are still taught today: due to its anatomical relationship with the piriformis, the sciatic nerve can become entrapped and irritated when the piriformis spams (i.e., “gets tight”). You can stretch all you want. It may help… temporarily. It commonly returns in short order. massage, e-stim, ultrasound, if they help it again is temporarily. It commonly returns in short order There are even extreme cases when a “piriformisectomy” is surgically performed!!! Seriously???? WTF? Talk about permanently annihilating hip function! It’s not like there won’t be lifelong fallout from that.

OK. Let’s think about this. While this anatomical situation appears to be unique in that the sciatic nerve runs through or under a specific muscle, muscular compression of nerves occurs everywhere all day. ALL major nerves are deep to muscular tissue! All are compressed when we lift a weight… or ourselves from a chair! Envision the tension requirements of the posterior hip musculature in a powerlifter squatting or deadlifting 500, 600, 700 pounds. The far more musculature than just the piriformis is compressing the sciatic nerve! Now consider that if the piriformis alone was under enough constant tension to create a problem that wasn’t a regular occurrence in a squat when all the geographically associated muscles are compressing the sciatic… why isn’t the that hip in a constant and irretrievable position of externally rotation.

Is tension the cause, or is it a symptom??!!

Stop blindly assuming!

Start questioning unfounded traditional beliefs with reason and skill thought!

Stop treating symptoms!

And if treating the symptom feels better, and they’re off the ledge, then we have bought some time to look for the cause.