What is Piriformis Syndrome?

The piriformis muscle starts from the lower end of the spine (sacrum to be precise) and ends at the upper end of the thigh bone.  Though it is a small muscle compared to the glutes, the muscle is active every time we move. As a result, it is prone to overuse or incorrect use.

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; however, in about 15% of the population, the piriformis consists of two muscle bellies with the sciatic nerve passing between them.

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.

Injury to the piriformis muscle may occur from a trauma or repetitive poor biomechanics. This gives rise to compression of the underlying sciatic nerve. 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 patterns such as lumbar spine disc herniations and stenosis (narrowing) of the spinal canal. Many patients will come in with a diagnosis of piriformis syndrome but, in my experience, examination often reveals another source for their complaint.

What causes Piriformis Syndrome?

Injury to the piriformis muscle may occur from trauma or repetitive poor biomechanics. This gives rise to compression of the underlying sciatic nerve. In the majority of cases, piriformis syndrome sufferers will not recall an inciting trauma.

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 overstretch the piriformis muscle. This perpetual loading of an overstretched piriformis may cause microtrauma and inflammation that can irritate the 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

It is important to distinguish between piriformis syndrome and other potential causes of sciatic nerve radiation patterns such as lumbar spine disc herniations and stenosis (narrowing) of the spinal canal. Many patients will come in with a diagnosis of piriformis syndrome but, in my experience, examination often reveals another source for their symptoms.

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 stairs, or running.

The runners are more prone to piriformis syndrome. Tight or inflamed piriformis compresses the sciatic nerve to causes tingling and numbness in the buttocks.

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

In few cases, patients may also present with a limp while walking. This is because of shortening of limb due to piriformis tightness.

Physiotherapy for Piriformis syndrome

Treatment will involve a thorough examination of the lumbar spine, pelvis, hip and surrounding musculature. Although the piriformis muscle may be the source of pain, any one of these structures may be a primary driver of the condition. Piriformis syndrome is best managed by correcting faulty biomechanics around the hip and spine. 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 deep palpation over the buttock will indicate spasm in the muscle and/or presence of trigger points. A detailed biomechanical assessment by your phyiotherapist will pick up any gluteal muscle imbalance around the hips.

A highly 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 muscles. Running with knees closed together or landing with knees inwards indicate hip muscle weakness or lack of adequate technique.

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:(045) 874 682

or email us at info@physioclinic.ie[/vc_column_text][/vc_column][/vc_row]