Piriformis syndrome is known as a deep gluteal disorder.
Compression of the Sciatic nerve in the buttock is often thought to be related to the piriformis muscle or other structures in the deep gluteal space. The defining feature is this compression is that it is NOT primarily from the discs or lumbar structures.
It is a diagnosis mainly indicated by history taking (posterior hip pain, radicular pain, and difficulty sitting for 30 min), physical examination (tenderness in deep gluteal space, positive seated piriformis test, and positive Pace sign), and imaging tests (pelvic radiographs, pelvic MRI, and spine MRI). Yet it remains a controversial condition.
Although often referred to as piriformis syndrome it should be considered that there are other structures that maybe contributary.
A differential means of testing is that the symptoms are often present in the absence of low back pain, there is a good range of spinal movement and that movements or palpation of the lumbar spine do not reproduce the pain.
What is the piriformis
The piriformis muscle is a flat small muscle located deep in the buttock lying under the the large gluteus maximus. It is believed that the piriformis muscle irritates or compresses the sciatic nerve due its contracture and / or spasm. This results in pain, numbness and tingling along the back of the leg and into the foot, similar to that felt with true sciatic pain. Thus it mimics lumbar disc sciatica and is sometimes also referred to as ‘pseudo sciatica’ .
What may cause it
Piriformis syndrome is usually the result of a number of things involving an overload of the local muscles in the area. This condition is often aggravated by prolonged and /or repeated movements such as sitting, kneeling, stair climbing, ladders, squats and running.
Poor technique and hip control during the leg exercises such as lunges, squats and running may also contribute. The spasm or contracture of this muscle could be a secondary response to irritation of the low back or pelvic (SIJ) joints and is often seen in pregnancy or sitting on your wallet. Leg length discrepancies have also been indicated in some cases.
Treatment generally involves stretching of the local muscles, manual therapy, activity modification and a then graded strengthening program as symptoms settle if this is required
For pain and symptomatic relief, the best treatment is to have the piriformis muscle loosened up. This can be done through massage, dry needling, or muscle energy techniques. Once the muscle is loosened, it is thought the sciatic nerve can pass more freely through the buttock musculature instead of getting tethered.
Contrary to what many people think is logical, stretching the hamstring does not help and often worsens symptoms. This is because the nerve is trapped under the piriformis muscle and stretching the hamstring creates a tug-of-war effect on the nerve as it ends up being pulled on by the buttock and hamstring in opposite directions.
Once the muscle has been loosened, the movement pattern or aggravating posture causing the problem needs to be identified and corrected with patient education. Depending on the underlying cause, exercises often include correction of the pelvic posture and strengthening of the stabilising buttock muscles, sciatic flossing and neurodynamic mobilisation
The physio team at Hindmarsh and Fitzroy Prospect Physiotherapy understands the syndromes that often arise from sports and physical activity. We know how to apply the correct techniques for the diagnosis so we can help you return to your active lifestyle.
It is important to note that these treatment methods are tailored to your lifestyle and upon consultation with the physiotherapist an adequate treatment plan can be administered.