Dynamic neurological compression (sciatic nerve)
Understanding this condition
The sciatic nerve is the largest nerve in the body. It descends from the buttock into the thigh, passing through or alongside a deep muscle called the piriformis. In some individuals, this nerve can be compressed at this level during certain movements or positions: this is dynamic compression of the sciatic nerve, sometimes called piriformis syndrome.
Unlike sciatica of lumbar origin (herniated disc), the compression here occurs at the buttock level, outside the back.
Symptoms
Deep pain in the buttock that travels down the leg, sometimes to the foot. It may be accompanied by tingling, numbness, or an electric-shock sensation.
Characteristic feature: pain is aggravated by prolonged sitting (steering wheel, bicycle, desk), walking uphill, or certain hip rotation movements. It may ease on standing or walking a short distance.
How can it progress?
Untreated chronic compression can lead to persistent nerve suffering, with continuing pain and, in some cases, sensory disturbances or muscle weakness in the affected territory.
The diagnosis is often delayed because patients are initially treated for lumbar sciatica, which is not the true cause.
Treatment options
Specialist physiotherapy (piriformis stretching, neural mobilisation), anti-inflammatory drugs, and ultrasound-guided injections are sufficient in the majority of cases.
When compression is confirmed and symptoms resist well-conducted treatment for several months, endoscopic neurolysis can free the sciatic nerve from its adhesions by releasing the compressive piriformis fibres. This is a minimally invasive procedure. A specialist consultation establishes the precise diagnosis and guides treatment.