Piriformis Syndrome
What is it?
Piriformis syndrome is one of the less common causes of buttock pain and sciatica. The piriformis muscle is found deep within the buttock originating from the sacrum (tail bone) and attaching to the femur (thigh bone).
The piriformis muscle rotates and stabilises the hip joint. The sciatic nerve passes directly under (sometimes through) the piriformis muscle. Due to this anatomic relationship, the sciatic nerve can be compressed when there is tightness in the piriformis muscle. When this occurs, it is referred to as piriformis syndrome. This can be a result of piriformis injury, overuse of the piriformis, or repetitive strain or trauma.
Piriformis syndrome is common in sports or activities involving stress on the piriformis muscle, which may include: running (especially involving changes of direction), sprinting, jumping, squatting or lunging.
What are the signs and symptoms?
- Aching or pain deep within the buttock.
- There may be radiated pain into the back of the thigh, calf, ankle or foot.
- An increase in pain when stretching the piriformis muscle (taking your knee towards your opposite shoulder) or during intense piriformis muscle contraction (e.g. when running and changing directions).
- Pain exacerbation by sitting, climbing stairs, squatting and lunging.
- Reduction in range of movement of the hip, and tenderness in the piriformis muscle when pushed
How is it diagnosed?
A thorough subjective and objective examination from a chiropractor is usually sufficient to diagnose piriformis syndrome. Further investigations such as MRI scans or Ultrasounds can be helpful in assisting diagnosis.
How is it treated?
Most patients suffering piriformis syndrome heal well with appropriate treatment. This often involves massage and stretches.
The success rate of treatment for patients with piriformis syndrome is largely dependant on patient compliance.
Ignoring symptoms will likely lead to the problem becoming chronic. Immediate professional treatment in patients with piriformis syndrome is the key to a full, fast recovery. Once the condition is chronic, healing becomes a much slower process.
A gradual flexibility and strengthening program guided by a chiropractor restores condition to the piriformis muscle. This is essential to reduce the probability of future recurrence in patients with piriformis syndrome. Rehabilitation focuses on restoring normal piriformis flexibility with appropriate stretches, and soft tissue techniques to reduce tightness, and therefore compression of the sciatic nerve.
In the final stages of rehabilitation, a gradual return to sport is possible when guided by your chiropractor. This can begin once symptoms have cleared and appropriate strength and flexibility of the piriformis has been reached.
What is the prognosis?
With appropriate treatment, patients with piriformis syndrome will usually recover in days to weeks. In chronic cases, recovery can take significantly longer.
What factors contribute to its development?
• muscle tightness
• poor hip flexibility
• muscle weakness
• lower back injury
• excessive training
• poor biomechanics
• inadequate warm up
• poor core stability
• muscle imbalances
What treatments are involved?
Treatment to speed up the healing process is essential to ensure an optimal recovery and lessen the probability of injury recurrence.
Treatments implemented may include:
• soft tissue massage
• stretches
• muscle energy techniques
• joint mobilization
• neural mobilization
• ice or heat treatment
• education
• biomechanical correction
• progressive exercises to improve strength, flexibility and core stability
• activity modification advice
• technique correction
• devising and monitoring a return to sport or activity plan
What other interventions are there?
Despite appropriate chiropractic treatment, some patients with piriformis syndrome do not improve adequately. When this occurs, the practitioner can decide on the best course of action. This may include ultrasounds, CT scans or MRIs, pharmaceutical intervention, corticosteroid injection, or referral to appropriate medical authorities.
What exercises will help?
The following exercises are commonly used to assist patients with piriformis syndrome. You should be diagnosed and assigned these exercises by your chiropractor prior to beginning them. In most cases, they should be performed 3 times/day and only provided they do not cause or increase symptoms.
1) Piriformis Stretch Supine – Begin lying on your back. Use your hands to take your knee towards your opposite shoulder until you feel a stretch in the buttocks or front of your hip. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch without pain.