False sciatica is a type of back pain that affects the lower spine.
This lower back pain is accompanied by symptoms that mimic sciatica without actually being so. Hence, it is called false sciatica or pseudosciatica.
These symptoms usually include, in addition to lumbago, pain in the buttocks and legs.
For this reason, it is very common for both ailments to be confused.
Knowing the causes and specific characteristics of false sciatica symptoms is key to distinguishing them and initiating the most appropriate treatment for each case.
What is false sciatica?
False sciatica is what pyramidal syndrome is popularly known as.
This syndrome tends to appear when there is an overload or contracture of the pyramidalis or piriformis muscle.
It’s a small, triangular muscle located in the gluteal region. It originates in the sacrum (the lowest part of the spine) and inserts into the femur.
Its main functions are to assist in external rotation and abduction of the hip. That is, it is needed to rotate the legs outward and separate them from the body to the sides.
It also plays a key role in stabilizing the pelvis during leg movement.
If the piriformis muscle is overworked for any reason, it compresses the sciatic nerve and pain occurs in the buttocks, back, and lower extremities.
Likewise, an injury or certain anatomical variations of the muscle can also cause pyramidal pain.
Symptoms of false sciatica
In false sciatica, the symptoms are similar to real sciatica.
Beyond pain in the glutes, lower back, and legs, piriformis syndrome also often causes the following discomfort:
- Numbness and tingling in the gluteal area.
- Difficulty and pain when sitting, which worsens in this position. Also, when crossing the legs.
- Discomfort when walking.
- Pain in the groin and hip.
- Inability to play sports.
False sciatica often mimics the symptoms of true sciatica. However, it is a distinct condition.
The main causes of pyramidal syndrome
Pyramidal pain or false sciatica can occur for various reasons, the most common being:
- Sport
Excessive or high-intensity exercise can cause piriformis pain. For example, long-distance running, lifting heavy loads, or wearing inappropriate footwear.
Muscle injuries in sports can also cause this condition if they affect the gluteal region.
- Bad posture
Poor posture habits at work and in everyday activities can also cause piriformis syndrome. For example, spending too much time sitting.
That is why it is so important to prevent a sedentary lifestyle at work and in general.
- Anatomical alterations
Deviations or deformities of the spine, such as scoliosis or in the pelvis, can cause false sciatica.
Piriformis syndrome can also be caused by lower limb dysmetria and having valgus knees, that is, deviated inward and with a tendency to come together.
- Traumas
A strong blow to the gluteus can also cause the appearance of pyramidal syndrome.
Pyramidal syndrome or sciatica?
When severe pain occurs in the lower back and lower extremities, it is common to first think of actual sciatica.
Mainly because this condition is much better known and more common than pyramidal syndrome.
However, the particularities of the pain it causes help distinguish false sciatica from real sciatica.
The key is where the pain originates.
In piriformis syndrome, the pain is concentrated in the central buttocks. From there, it radiates to the back and legs, sometimes reaching the knee.
In sciatica, however, the pain begins in the lumbar spine and spreads to the buttocks and lower limbs.
In true sciatica, the pain may radiate to the feet, while this is not usually the case with false sciatica.
Another difference with pyramidal syndrome is the cause of the nerve compression.
In the case of sciatica, the most common cause is the presence of a herniated or protruding disc (initial phase of the hernia).
Sciatica can also occur due to wear and tear due to age, or genetic predisposition.
This condition is also especially common in people with osteoarthritis and rheumatoid arthritis, as well as in pregnant women.
As for pyramidal syndrome, the main cause is usually an overload or muscle contracture in the gluteal muscle.
If necessary, beyond a physical examination by a specialist, an MRI or other imaging tests may be performed to confirm the diagnosis.
In the case of pyramidal syndrome, anatomical alterations are not usually observed, so this type of test is generally performed to rule out sciatica.
Treatments for false sciatica
To relieve the pain caused by false sciatica, it is essential to treat the contracture, overload, or injury that is causing it.
To achieve this, treatment for piriformis syndrome is usually initiated in a step-by-step manner. That is, more conservative procedures are first started, and if these don’t work, more interventional ones are considered.
- Drugs
The drugs of choice for false sciatica are anti-inflammatories and muscle relaxants.
- Cold and heat therapy
Cold and heat treatment for pain can help relieve the pain of false sciatica.
Applying cold can help reduce localized inflammation, while heat can help relax the muscles.
- Postural hygiene
One of the main causes of false sciatica is poor posture, so it is essential to have good postural hygiene to prevent back pain .
- Physiotherapy
Physical therapy for piriformis syndrome can include various techniques, from deep therapeutic massage to muscle stretching exercises and osteopathic maneuvers.
Treatment with ultrasound or TENS (transcutaneous electrical nerve stimulation) may also be indicated.
- Infiltrations
If the above treatments fail to reduce buttock pain and other symptoms, injections are often used.
These can be corticosteroids and analgesics, as they achieve an anti-inflammatory effect and immediate pain relief.
Another option is botulinum toxin injections to temporarily block nerve activity in the compressed muscles.
- Surgery
Surgery for piriformis pain is only reserved for cases that do not respond to other treatments.
Surgical intervention for false sciatica consists of tenotomy (total or partial cutting) of the muscle and release of the nerve.
This surgery is performed by endoscopy or guided ultrasound.
Always see a doctor immediately if you experience sudden, severe pain in your back, buttocks, or legs, accompanied by weakness or numbness.
Also, if there is difficulty controlling the feet or walking, and the bladder and bowel movements cannot be controlled.