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Before we get into sciatica trigger points and how to treat them, we need to look at what sciatica really is. Sciatica is an old fashioned name for what is now called radicular pain, which is pain that arises from irritation or compression of the sciatic nerve.
There are three places where the sciatic nerve can be impinged or irritated.
The first is in the central spinal canal and that is caused by spinal stenosis, which is narrowing of the nerve canal.
Spinal stenosis can be caused by a three separate things which come together. These things are a disc bulging forward, a ligament called ligamentum flavum bulging forward and a overgrowth of the bones as the joints become worn. All of these three add together to reduce the space for the nerves as they run down the central spinal canal.
Then as the nerve it branches off an runs out the side of the canal, there are generally two causes of irritation.
The first cause is a disc prolapse, which is a big bulge in the disc that causes a tear in the disc wall so that the material inside the disc (the nucleus pulposus) comes leaking out and this causes intense inflammation.
The second cause is wear and tear in the joint, such that the bone overgrows and leaves insufficient space for the nerve.
Those are the spinal causes, and they’re quite common. What we’re talking about, though are trigger points as a cause of sciatica. This is caused by trigger points in the piriformis muscle.
The piriformis muscle runs across the sciatic notch. The sciatic notch is a bony arch in the pelvis, and the sciatic nerve runs underneath that arch and the piriformis muscle runs across it from the sacrum to the femur. When it’s very tight because of active trigger points, the muscle may compress the nerve.
This happens when the nerve has anatomic variation such that the nerve runs above the piriformis muscle. When this happens, the muscle contracting will actually squeeze the nerve against the sciatic notch, or the nerve may run through the muscles and will get squeezed when it contracts.
This causes ‘real’ sciatic pain, which is pain from the nerve being irritated. However, there are trigger points in muscles which mimic the pain of sciatica.
There are two muscles which mimic sciatic pain because their pain referral pattern is very similar to that of sciatic pain. The first is the piriformis muscle itself. When it has trigger points, it produces a pain that you feel deep in your buttock, and which run runs down the back of your leg.
More important is the gluteus minimus muscle, the smallest of the three gluteal muscles in the buttock. This is a muscle positioned over on the side of the buttock.
It’s a fan-shaped lateral muscle that arises from the ilium bone of the pelvis. It’s the deepest of the muscle gluteal muscles, and medius and maximus overlie it. The opening of the fan-shaped part of the muscle arises from the ilium, and then it comes down and inserts into the top of the femur – the thigh bone.
The gluteus minimus attaches into the femur with a very thick tendon. This muscle has two functions. This is common in all the muscles that occur around the hip and the knee.
The first function occur when your leg is not on the ground. Because gluteus minimus a fan-shaped muscle, when the central part of the muscle contracts, it’ll pull your leg out or abduct it. If the front of the muscle contracts, it will both abduct and pull very slightly forward. If the back of the muscle contracts, it will abduct and pull the leg slightly backward.
All of these are not terribly strong movements because it’s a relatively small muscle. Much more important than this function is what happens when you stand.
If you’re standing and the gluteus minimus contracts, it will stabilize the pelvis and stop the pelvis from dropping down slightly forward or down and slightly backward. It acts as a check rein and stabilizer..
This muscle has trigger points. It is a deep muscle, but the surprising thing is that the triggers coming from the front of this muscle create pain deep in your lateral hip or buttock. The pain then goes in a thin band down the leg, and this is the pain that mimics sciatica.
The thin band of pain that runs down the leg does an odd thing: it misses the knee, and starts again and carries on right down to ankle.
If the triggers arise in the back part of this fan fanship muscle, then you will feel pain deep in the side of the buttock, and towards the back of the buttock and this will run in a board band down the back of the thigh.
So this muscle creates a pain very similar to the pain you get the sciatic nerve is being compressed. In fact, it’s not, the pain is caused by trigger points and their pain distribution areas.
The way to tell the difference between trigger point pain and sciatica is that even though the pain occurs in the thin band, classic sciatic pain has a shooting quality. Nerve pain typically has a shooting, stabbing quality to it, whereas trigger point pain tends to have an aching quality.
The other thing to be aware of is that sciatic pain can turn on trigger points. If you’ve had sciatic pain for a while, you’ll often also have active trigger points.
The clearest differentiator is that because true sciatica comes from irritation or compression of a nerve, you will have tingling, numbness and other odd sensations associated with it.
Whereas with the trigger points you won’t have any other associated sensations.
To find these trigger points, you’ve got to go digging deep and you will find the trigger. When you’re right on it, the spot will be tender, and it will reproduce the pain pattern if the trigger point is active.
You can then treat it with ischemic self massage. You may find a myofascial release tool is useful here to reach the site of the trigger point. But again, if you’ve got someone whose either very fat or very muscled, the gluteus minimus will be hard to get to. In this situation, dry needling is the best option.
Once you’ve turned the trigger point off, you need to stretch it. Because the muscle is fan-shaped, you need to stretch the back, middle and front parts of the muscle.
You do this by lying on your side and extending the leg back, and then dropping it backward to stretch. Or extending the leg forward and dropping it forward to stretch.
Sleeping was sciatica is primarily a matter of trying to find a comfortable position. If you have true sciatic pain, (ie. coming from pressure on a nerve) Then finding the position of comfort can be tricky. You have to arrange your back into a position that feels comfortable.
Usually, it will be lying on your side. Strangely, lying on the side of the sciatica pain is often more comfortable. Most people find that lying on their painful side with a pillow behind their back and sometimes with a pillow between the knees is the most comfortable position.
But it’s hit and miss because you’ve got to arrange yourself so that you take pressure off the nerve as it goes through to the tight area in your spine. You’re trying to take pressure off the disc, so the disc is as comfortable as it can be.
If the sciatica is, in fact, pseudo-sciatica coming from the gluteus minimus, then lying on the painful side is still the best way to go. Putting a big pillow between your knees is also helpful because this will stop you from rolling over while you’re asleep. If you lie on your non-painful side without a pillow in, you’re stretching the muscle, cause your leg drops down and you’ll stretching the muscle in a way that will turn your trigger zone.
You want the muscle to be in a comfortable position with the minimum amount of tension.
One really worthwhile thing to do is to use some heat. When you get into bed, take any necessary painkillers, and then put a heat source on your hip. So treat the triggers, lie on the heat, do it a gentle stretch, and this is a good way to get more comfortable sleep with sciatica trigger points.