Piriformis Syndrome
Piriformis Syndrome
A few months ago I wrote a blog post on Piriformis Syndrome which, at the time, started getting a lot of online attention. Today I have rewritten and expanded that blog post into it’s own page to help more people find and benefit from it.
Today we will answer several common questions.
What is Piriformis Syndrome?
What causes Piriformis Syndrome?
Can I self manage it?
What else it could be?
Can treatment help?
What is Piriformis Syndrome (PS)?
A quick google search will find you this answer.
Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle also can irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot.
Piriformis Syndrome is a common problem that, in my view, may be over-diagnosed. It is often mistaken for pain originating not from the piriformis muscle but rather from one of several nerves in the gluteal region, including the Sciatic Nerve, Posterior Femoral Cutaneous Nerve, and Cluneal Nerves.
Piriformis Syndrome is also sometimes called ‘deep gluteal syndrome’, ‘extra-spinal sciatica’ or ‘wallet neuritis’.
What causes Piriformis Syndrome?
There are many ways to acquire a problem with the piriformis muscle. Some of the most common are:
Excessive Sitting - Spending long periods sitting keeps all muscles at a static length. This can cause muscles to become tighter over time. In the case of the piriformis, when it gets tighter it can irritate the sciatic nerve.
Muscle Weakness - The piriformis muscle is involved in hip external rotation, abduction and extension. Weakness in the gluteus maximus, gluteus medius and gluteus minimus can cause you to overuse the piriformis to make up for the lack of power in these muscles.
Poor Gym Training - often overlooked in the gym are the muscles that don’t show in mirrors. Like the piriformis. Many gym-goers training in a narrow range of straight movements and neglect to train rotary movements. In some cases, training external rotation of the hip can strengthen and lengthen the piriformis muscle.
Diagnosis of Piriformis Syndrome is usually a clinical one. Typically, a thorough history and a physical examination of the muscles around the hip will be enough to make the diagnosis.
If we are still uncertain, we use several tests to confirm the diagnosis, such as:
Pace Sign
Straight Leg Raise
Freiberg Sign
FAIR
These tests all help understand if the piriformis is involved. The more of these tests that are ‘positive’ the more confident the diagnosis.
How can I self-manage it?
See a professional! The key to getting better is correct diagnosis.
With that said, if you do have a diagnosed problem with your piriformis you may benefit from the following advice.
Most advice for Piriformis Syndrome aims to do 2 things.
Lengthen the piriformis muscle
Relax the piriformis muscle
Below is a helpful infographic from Spine-Health.com that shows four helpful exercises. Click on the image to be taken to their site.
My preferred at-home exercise is a modified pigeon pose.
This exercise is recommended as part of the ATG System by Ben Patrick (Kneesovertoes Guy)
The above video is no longer listed on YouTube so you’ll need to click the image above to view it.
In my view do not need a gym bench to get started if you can get your knee and ankle onto a flat surface like a couch or mattress. If you do struggle getting to this position, put pillows under your knee to raise it up and start there instead.
A few years ago I made a video explaining how I recommend to patients to stretch this muscle.
Remember the golden rule: it must be pain-free when you do any of these exercises. Feeling stretch is okay, but pain is not.
For most people 5-10 repetitions is enough to feel the benefit of this move.
What else could it be?
In a clinical setting Piriformis Syndrome is a diagnosis of elimination. In most cases, the examination findings that are positive and suggestive of PS can also be positive in other conditions too.
When I am asked what else could it be I usually suggest the 3 structures I treat most often when I find Piriformis Syndrome symptoms.
Sciatic nerve
Posterior Femoral Cutaneous Nerve
Lumbar Spine
The sciatic nerve can become adhered to the piriformis or another group of muscles collectively known as the ‘deep rotators of the hip’. When this happens the sciatic nerve can experience compression or stretching during some movements and may become inflammed or symptomatic. The sciatic nerve can also be painful if pathology of the lumbo-sacral spine is suspected.
The posterior femoral cutaneous nerve (PFCN) is another nerve located at the back of the hip and can be symptomatic. Pain is ususally limited to the back of the thigh and doesn’t typically give pain in the lower leg or the lumbar spine.
When the pain comes from the lumbar spine, it may involve the discs, nerve roots, joint capsules or muscles. If these structures are involved it can be more concerning and should be evaluated by a professional.
Can treatment help?
In my opinion, yes absolutely!
Our treatment plans for Piriformis Syndrome can involve:
Shockwave Therapy
Soft Tissue Therapies
Chiropractic Adjustments for the Lumbar Spine and Pelvis
The Soft Tissue Therapies we use at Southside are unique treatment techniques that directly target the sciatic nerve, posterior femoral cutaneous nerve and piriformis. Use a combination of pressure applied by hand and movement to break up fibrous adhesions between structures in the body to promote movement and reduce pain.
Shockwave Therapy can be used to treat these adhesions as well as the piriformis muscle and some surrounding ligaments.
Adjustments to the lumbar spine and pelvis promote free and easy movement.
If you’d like to see if we can help you, please click the ‘book now’ button and we’d be more than happy to see you in our clinic.
Sources
I draw heavily on my own personal, professional and clinical experience to write these articles but in researching this topic I consulted the below websites.