Before discussing sciatica treatment, let us answer the question: what is sciatica? The sciatic nerve passes through the piriformis muscle inside the hip on its way to the leg. Usually as a result of an awkward, unbalanced or sudden movement, the sciatic nerve becomes entrapped inside the piriformis muscle, causing a one-sided, localised pain in the hip at exactly that spot. The pain sometimes also radiates down the leg and can therefore be confused with a herniated disc. This condition is called piriformis syndrome, and it tends to become chronic. Rest, medication and a suitable exercise programme help some patients. The interventional pain treatment we use for sciatica treatment at our clinic is the piriformis injection.
PIRIFORMIS INJECTION
The piriformis injection — the scientific, reliable and most effective method in sciatica treatment — is the delivery of a combination of medications (steroid, local anaesthetic, hypertonic NaCl) into the piriformis muscle under imaging guidance. The aim is to reduce the swelling and inflammation in that area and to relax the piriformis muscle, thereby relieving the pressure on the sciatic nerve. No serious preparation is needed before the procedure. It is performed under local anaesthesia and takes 5–10 minutes. Side effects are almost never seen.
Appointments & practical information
How do I book an appointment?
You can send your appointment request via WhatsApp, by phone or through the contact form. Briefly describing your complaint and the times that suit you speeds things up; we respond as quickly as possible.
What should you bring to the consultation?
If available, bring your recent MRI and CT images, previous test and surgery reports, and a list of the medication you take regularly. This makes the assessment considerably easier.
What happens at the first consultation?
We listen to your complaints and history, perform a neurological examination and review your existing images together. Treatment options are then planned with you, taking your expectations and lifestyle into account.
Second opinion
If you have been diagnosed or advised to have surgery elsewhere, you can book an appointment for a second opinion with your existing images and reports.
Reach out for your questions and appointment requests. We reply as soon as possible.
Piriformis syndrome occurs when the piriformis muscle, located deep in the buttock, compresses the sciatic nerve that passes just beneath it (or sometimes through it). Even though there is no herniated lumbar disc, because the sciatic nerve is under pressure, it produces similar pain radiating into the leg. For this reason, in medicine it is called "Pseudo-Sciatica."
What Causes Piriformis Compression and What Are Its Symptoms?
It occurs when the muscle is overstretched, shortened, or goes into spasm. Sitting for long periods on a hard surface, carrying a wallet in the back pocket, sudden hip trauma, or excessive running training are the main causes. Its symptoms are a deep pain right in the middle of the buttock, an ache that increases when sitting, and numbness radiating to the back of the leg, down to the knee.
Does Sciatic Nerve Pain Radiate to the Leg?
Yes, the sciatic nerve is the longest and thickest nerve in the body. It begins at the buttock and extends down to the heel. When it is compressed by the piriformis muscle, the pain begins in the buttock and radiates as a "pulling" or "electric" sensation to the back of the thigh, the back of the knee, and sometimes down to the ankle.
What Happens If Sciatic Nerve Compression Is Not Treated?
When left untreated, the chronic pressure on the nerve can lead to weakness in the leg muscles and permanent numbness. In addition, because the patient changes the way they walk due to the pain, mechanical disorders that pave the way for a herniated lumbar disc and hip joint problems can develop over time.
What Is the Treatment for Sciatic Nerve Compression?
The treatment follows a stepwise approach. First, muscle relaxants and anti-inflammatory medications are given along with special stretching exercises. In cases that do not respond to these, interventional methods (dry needling, injections, or radiofrequency) come into play. Surgery is the very last option, rarely resorted to in piriformis syndrome.
What Is Piriformis Syndrome, and How Can It Be Distinguished from a Herniated Lumbar Disc?
The most important difference is the source of the pain. In a herniated lumbar disc, the pain begins in the spine and increases with movements of the lower back. In piriformis syndrome, however, there is usually no problem in the lower back; the pain is triggered by pressing on the muscle in the buttock or by turning the leg inward. For the differential diagnosis, a clinical examination and sometimes a hip MRI are necessary.
Does Piriformis Syndrome Cause Numbness and Pulling in the Leg?
It absolutely does. When the sensory fibers of the sciatic nerve are under pressure, a "tingling" and "numbness" occur in the leg, and when the motor fibers are under pressure, a sensation of "tightness" and "pulling" occurs in the muscle. These symptoms are almost identical to those of a herniated lumbar disc.
How Effective Are Injection Treatments for Piriformis (Pseudo-Sciatica)?
They are very effective. Local anesthetic, cortisone, or Botox injections administered into the piriformis muscle under ultrasound or fluoroscopy guidance immediately resolve the muscle spasm and free the nerve. In many patients, a single injection can completely put an end to chronic pain.
Is Radiofrequency Treatment Used for Nerve Pain Originating from the Piriformis?
Yes, especially in resistant cases, the pain signals on the sciatic nerve can be modulated using the "Pulsed Radiofrequency" method. In addition, we also make use of this technological method to stimulate and relax the muscle.
Does Manual Therapy Provide Healing in Piriformis Disease?
Manual therapy is quite beneficial for lengthening the muscle and releasing trigger points. Deep tissue massage and mobilization techniques performed by expert hands can ease the pressure and provide lasting relief.
Which Activities Should Patients with Piriformis Syndrome Avoid, and Which Exercises Should They Do?
Patients should not sit for long periods on hard surfaces, should not keep a wallet in their back pocket, and should avoid strenuous uphill running. The "Piriformis Stretching" exercises, in which the leg is crossed and pulled toward the chest, are the best remedy for this condition.
I Have Numbness and Pulling in My Leg, Do I Have Sciatica?
Numbness and pulling that travel down the back of the leg indicate that the sciatic nerve is under pressure at some point. However, to determine whether this pressure is in the lower back (herniation) or in the buttock (piriformis), it is essential for an expert doctor to perform functional tests.
Where Does Sciatic Pain Occur?
The pain begins in the lower part of the back or right in the middle of the buttock. It can be felt along the line running from the buttock crease downward, to the back of the thigh, the hollow of the knee, and from there along the outer side of the leg down to the ankle.
What Is the Difference Between a Herniated Lumbar Disc and Sciatica?
Sciatica is not a disease but the name of a nerve. Saying "I have sciatic pain" indicates that this nerve is compressed somewhere. A herniated lumbar disc compresses this nerve "at its point of origin" (in the spine), whereas piriformis syndrome compresses the nerve "along its path" (in the buttock).
Why Does Sciatic Pain Increase at Night?
At night, when the body enters a state of rest, blood flow slows down and the inflammation is felt more distinctly. In addition, incorrect positions during sleep can cause the muscles to tense and the pressure on the nerve to increase, waking the patient with pain.
What Helps Sciatic Pain?
In the acute phase, short-term rest and anti-edema medications are beneficial. In the long term, nerve stretching exercises, heat application (to relieve muscle spasm), and, if there are causes such as a herniation or slippage, interventional treatments directed at these are the best solution.
Does Sciatic Nerve Compression Resolve on Its Own or Is Surgery Required?
Mild cases can resolve on their own with the right exercise and lifestyle changes. However, if there is a risk of nerve damage or if the pain has become chronic, non-surgical interventional methods are applied. In sciatic nerve compression, surgery is only necessary in structural conditions such as a resistant herniated disc or advanced spinal canal narrowing.
What Are the Treatments for Sciatic Nerve Compression?
Medication therapy, physical therapy, piriformis injections, epidural injections, radiofrequency, and in very rare cases surgical release procedures are the main components of the treatment for sciatic nerve compression.
Which Doctor Should I See for Sciatic Nerve Compression?
The most competent branch for the anatomical and surgical diagnosis of nerve compressions is the specialty of Brain and Nerve Surgery (Neurosurgery). A neurosurgeon can most clearly determine whether the pain originates from the lower back or from within the muscle.
