Chiropractor Treatment for piriformis at Naas Physio Clinic

What is Piriformis Syndrome?

The piriformis muscle is a muscle that underlies the glute muscle (glute max). The muscle runs from the sacrum at the lower end of the spine and moves across towards the back of the hip.  Though it is a small muscle compared to the glutes, the muscle is active every time we move. The piriformis muscle acts to turn the leg outwards.

The sciatic nerve runs from the lower back down the back of the leg to the knee. In most people the sciatic nerve runs under the piriformis muscle and so, in theory, it can cause some symptoms down along the course of the nerve. A deep localised buttock pain may arise due to piriformis muscle injury & this may be associated with symptoms of sciatica if the underlying sciatic nerve is irritated.

Pain in the piriformis muscle can arise due to repetitive poor biomechanics. In the majority of cases, piriformis syndrome sufferers will not recall an inciting trauma. It is important to distinguish between piriformis syndrome and other potential causes of sciatic nerve radiation, the main one being a lumbar spine disc herniation.

Many patients will come in having being diagnosed with piriformis syndrome but, in my experience, examination normally reveals another source for their complaint.

What causes Piriformis Syndrome?

Injury to the piriformis muscle may occur from trauma or repetitive poor biomechanics.

Some researchers have found piriformis syndrome to co-exist with weak hip abductors (muscles moving the leg out). Weakness in the hip muscles causes faulty mechanics around the hip joint while walking or running. It may cause the femur (thigh bone) to move in or rotate internally more than normal. This may create abnormal forces on the piriformis muscle. This perpetual loading of an overstretched piriformis may cause microtrauma and inflammation that can irritate the underlying sciatic nerve.

Constant low back pain can change the biomechanics around the pelvic area. This may cause the piriformis to function abnormally resulting in pain and muscle spasm

Symptoms of Piriformis syndrome

Piriformis syndrome, resembles sciatica and can occur on either or both sides.

Typically, the pain of piriformis syndrome is located deep in the buttock and may radiate to the hip or down the back of the thigh to the knee. Deep pinpoint tenderness over the centre of the buttock is often present.

You may feel increased pain while sitting or squatting, climbing the stairs, or running.

Runners are particularly prone to piriformis syndrome. A tight piriformis muscle can compresses the underlying sciatic nerve to causes tingling and numbness in the buttocks.

Women are more prone to this syndrome as compared to men (6:1) because of differences in pelvic shape and size. Women, for example, have a wider pelvis.

Physiotherapy Treatment

Physiotherapy treatment starts with an examination of the lumbar spine, pelvis, hip and surrounding musculature. Although the piriformis muscle may appear be the source of pain, any one of these structures may be a primary driver of the symptoms. During examination, the physiotherapist may perform certain specific tests to confirm piriformis involvement. The tests will help to indicate muscle tightness or weakness. Pain during testing over the buttock will indicate spasm in the muscle. A detailed biomechanical assessment by your physiotherapist will pick up any muscle imbalance around the hips that are causing the pain.

A skilled sports physiotherapist will also check out your running and landing techniques to identify any flaws that may be a source of overload to the glute & piriformis muscles. Running with the knees knocking inwards may indicate hip muscle weakness or poor running  technique & may be a driver of pain.

The physiotherapy sessions will comprise of myofascial release techniques to lengthen the muscle & alleviate pressure on the underlying nerve. This is usually followed by piriformis stretching and sciatic nerve mobilisations. This technique helps to improve the gliding of the nerve between the muscle bellies. Improved mobility is followed by strengthening of the hip muscles. This is followed by correcting any running or landing faults like excessive inward movement of the knee.

Contact the Physio Clinic, Naas & Newbridge on: (083) 1960 344

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