Pyramidal Syndrome Or False Sciatica, What Does It Consist Of?
Pyramidal syndrome is also called false sciatica because it causes symptoms that are mistaken for low back pain. It occurs due to an overload of the pyramidal muscle that ends in contracture of the same, with the consequent compression of the sciatic nerve.
This pathology is more frequent among women and its highest incidence occurs around 40 and 50 years. However, it can appear at any age. In fact, although it is associated with runners and athletes, poor posture is another possible source.
The difference between pyramidal syndrome and real sciatica is very important. Both the complications and the treatment will be different in relation to whether it is one entity or another.
What is the pyramidal syndrome or false sciatica?
The pyramidal muscle is a small anatomical structure found in the pelvis. It receives this name because it is shaped like a triangle, which begins in the sacrum and extends to the femur. It is part of the gluteus and is responsible for the external rotation movement of the leg.
The sciatic nerve, for its part, has a path that takes it to the leg, contacting this muscle. In fact, there are people with a particular constitution, in whom the nerve crosses the pyramidal muscle. So much so, that the space that remains between both structures is very small.
In pyramidal syndrome, the muscle increases in size and compresses the sciatic nerve. This increase may be due to muscle overload, for example, due to exercise. Also contractures are guilty.
On the other hand, in true sciatica, the nerve is compressed in a real way in the upper part of its course, generally with contact on the vertebrae of the spine. Sciatic pain is more permanent, insidious, and persistent.
As a difference, the pyramidal syndrome or false sciatica tends to be somewhat transitory. As it is a muscle contracture or overload, time resolves it. But in low back pain, herniated discs are the main cause, and therefore they become chronic.
What are the symptoms of pyramidal syndrome?
The pyramidal syndrome manifests with pain in the buttock and leg. Sometimes it extends into the groin or around the hip. However, the pressure on the muscle must be very high for it to spread.
In sciatica, on the other hand, the pain spreads and radiates away from the point of origin, all the way to the foot. In the pyramidal syndrome or false sciatica the discomfort is more localized, on the buttock.
In addition, there is often some swelling in the area. This will be perceived from the outside as an enlargement in some region of the buttock, sometimes as a palpable cord that increases pain when it comes into contact with a chair, for example. In extreme situations, even the rubbing of clothing is painful.
The pain usually appears when walking or sitting for a long time. One of the most typical signs of pyramidal syndrome or false sciatica is that the person who suffers from it cannot cross the affected leg over the other.
In order to establish the diagnosis, it is important that the doctor gathers the characteristics of the patient’s pain through a series of questions that he asks. It is difficult to establish by imaging the presence of alterations in the pyramidal muscle.
However, tests may be ordered to rule out real sciatica. Magnetic resonance imaging and X-rays confirm the existence of alterations at the lumbar level or along the path of the nerve.
How is false sciatica treated?
The pyramidal syndrome or false sciatica is usually treated with physical therapy. It is recommended to perform stretching and exercises that improve muscle contractures. It is also important to correct your postures, especially when sitting.
Analgesic and non-steroidal anti-inflammatory drugs can be taken to relieve pain. In the event that these measures do not work, injections of corticosteroids or botulinum toxin in the muscle area have been used as a trial, still with controversial results.
There are few cases that require surgery. However, the final decision will be made by a specialist. The first steps consist of ruling out other pathologies that may be behind the symptoms, and start the approach conservatively, with physiotherapy and lifestyle changes.
