Piriformis syndrome is a condition that involves the piriformis muscle, a small muscle located deep in the buttocks near the hip joint. The piriformis muscle
plays a role in the external and internal rotation of the hip, the stabilization of the pelvic region and femoral head in the acetabulum.
Piriformis syndrome occurs when the piriformis muscle becomes tight, inflamed, or irritated, leading to compression or irritation of the sciatic nerve. The sciatic nerve is the largest nerve in the body and extends from the lower back down through the buttocks and into the legs.
When the piriformis muscle puts pressure on the sciatic nerve, it can result in symptoms such as:
Pain: Typically, there is pain in the buttocks and can radiate down the back of the leg. The pain may be sharp, burning, or tingling in nature.
Numbness and tingling: Along the path of the sciatic nerve, there may be sensations of numbness, tingling, or pins and needles in the buttocks and leg.
Weakness: Some individuals with piriformis syndrome may experience weakness in the affected leg.
Piriformis syndrome can be caused by various factors, including overuse or repetitive activities that put strain on the muscle, injury, prolonged sitting, muscle imbalances, or anatomical variations (see below). It is more common in athletes, runners, and individuals who engage in activities that involve repetitive hip movements.
Diagnosis of piriformis syndrome can be challenging as its symptoms may overlap with other conditions such as herniated discs, spinal stenosis, nerve tethering (see below) or sciatica. Physicians may use physical examinations, medical history, and imaging tests to rule out other causes and arrive at a diagnosis. There is no definitive test for piriformis syndrome. Diagnosis of piriformis syndrome is made by the patient’s report of symptoms and by physical
exam using a variety of movements to elicit pain to the piriformis muscle.
Treatment for piriformis syndrome typically includes a combination of conservative measures such as rest, ice or heat application, physical therapy, stretching exercises, and anti-inflammatory medications. In some cases, corticosteroid injections may be used to reduce inflammation and relieve pain. In severe or persistent cases, surgery may be considered, but it is relatively rare.
The Anatomy –
The sciatic and peroneal nerve, pictured below is the thickest and longest nerve in the body. Sometimes both nerves pass the underside of the piriformis muscle before dividing (first image on left), and sometimes they divide and only the sciatic nerve passes through the piriformis muscle (second image). Other times they both pass through the piriformis muscle before travelling down the back of the leg, and eventually branching off and ending in the
top and the sole of the feet. (See third image). Compression of these nerves, particularly in the instances of pictures 2 and 3, can be caused by spasm of the piriformis muscle.
How does the muscle compress the nerve?
The compression of the sciatic nerve by the piriformis muscle is a mechanical action. The exact mechanism by which the piriformis muscle compresses the nerve is not fully understood, and there may be multiple contributing factors. However, there are a few proposed mechanisms that could explain how the compression occurs:
Muscle Tightness: When the muscle tightens, it can put pressure on the sciatic nerve, which runs very close to or in some cases, through the muscle.
Muscle Spasm: In some cases, the piriformis muscle may go into spasm, causing it to contract forcefully and compress the nearby sciatic nerve.
Anatomical Variation: The sciatic nerve and the piriformis muscle have a close anatomical relationship in some individuals.
As described above, in some people, the sciatic nerve may pass through or underneath the piriformis muscle rather than beside it. If the piriformis muscle is tight or spasms, it can put direct pressure on the nerve. Inflammation: Inflammation of the piriformis muscle can occur due to injury or overuse. Inflammation can cause the muscle to swell, leading to pressure on the sciatic nerve. The combination of tightness, spasms, anatomical variation, and inflammation can lead to irritation and compression of the sciatic nerve, resulting in the symptoms associated with piriformis syndrome, such as pain, numbness, tingling, and weakness in the buttocks and leg.
If it is established that your client does have piriformis syndrome, a stretching program can be very effective. As mentioned above, it may need to be combined with strengthening of the gluteal muscles in the region. The following stretches need to be explored with care. Stretching at least 3 days per week will be important for the first 4 to 6 weeks in order to get the symptoms under control.
Seated Hip Stretch
HOW TO STRETCH:
– Hook elbow around opposite knee
– Lift chest
– Keep sit bones on box
HOW TO CONTRACT:
– Press knee away from armpit
HOW TO RESTRETCH:
– Pull the knee further to the armpit
– Arch spine
– Twist spine towards the stretching hip
Major muscles stretched
– Deep rotators
The gluteus medius, minimus, piriformis and obturator internus all insert onto the greater trochanter. When you flex and externally rotate the hip/femur and lean away from it, you will surely feel the stretch in all of them.