Why Generic Physical Therapy Doesn’t Work for Piriformis Syndrome?

“Physical therapy is more a pain in the butt than sciatica.” Author Unknown

Okay, so I did make up that quote above. But it truly tells of my experience with physical therapy and sciatic nerve pain.

So one particular doctor thought physical therapy would help me kick this pain in the sciatica. And although I appreciated his forethought in that physical therapy is better than medication, surgery, chiropractors, and most other stuff doctors prescribe, but it still wasn’t quite what I needed.

When I walked into meet the physical therapist, he noticed right off that I had a limp to my walk due to the sciatica pain. He then examined my posture, flexibility, and then determined I had a leg length discrepancy. So he thought this was the primary reason for my sciatic pain and decided to send me home with a bunch of exercises to do for 45 minutes per day.

I wanted the pain gone, and if it required 45 minutes per day, then so be it. So I did the stretches – a combination of hamstring, glute, groin, and quadricep stretches. And guess what, after a few weeks of this rigorous regimen (that was eating into my social life) the stretches really did work, at least for a while. I was able to return to running and basketball and ultimate, or whatever I played, with relatively little or no nerve pain.

So for the longest time, I thought these stretches were the prescription for my sciatica. Anytime I would feel pain I would do hamstring stretches, because he had told me I had tight hamstrings.

However, I later started questioning, if I had a leg length discrepancy, why didn’t I stretch one side more than the other? And then, although my sciatic nerve stopped hurting for a few months, my groin muscle starting hurting. Not like I had pulled it, but a more dull pain like it was tired.

When I discovered the 10-Minute Sciatica Relief Program, I realized why the generic set of stretches that the physical therapist had prescribed me only worked temporarily, and later caused the pain to come back worse than before. The physical therapist was going in the right direction with his prescription of stretches, but he wasn’t quite there yet. Two things were wrong with the physical therapy he had me doing:

1. I was only doing stretches. Now I’ll be the first to say, stretching is definitely good. In fact, I don’t think the general population stretches enough after sitting for long periods of time. We need to do more stretching. However, for people like you and I, who have a muscle imbalance that is causing a structural condition leading our piriformis muscle to tighten and and pinch the sciatic nerve, stretching CANNOT be the only solution. You need to combine stretching with STRENGTH BUILDING. Think about it this way, if you stretch all your muscles day after day, yes you will feel better. However, your muscle imbalances aren’t going away in the meantime. So after you do those stretches, your imbalanced muscles are pulling your pelvis out of line again, and negating all the stretching you did. So stretching is great for quick, temporary relief. But in the long term you need to combine stretches with resistance exercises that build muscle to correct the root of the cause of your sciatica pain – muscle imbalances.
2. I was doing the wrong stretches. Although I did have tight hamstrings, they were tight because of my structurally incorrect pelvis, what we call Downward Pointing Pelvis. So in fact, in doing hamstring stretches, I was making my condition worse. Instead of stretching my hamstrings, I needed to be stretching my quadriceps/hip flexors and STRENGTHENING my hamstrings. That’s why I never felt full relief, because I was getting short term pain relief by stretching my hamstrings, but making my Downward Pointing Pelvis condition worse in the long run. Doh!

Again, I wish I knew then what I know now. But c’est la vie!

- Bryan

Founder of the Back in Action Institute and 10-Minute Sciatica Relief Program