Piriformis Syndrome

 

Anatomy:        watermarked piriformis

The Piriformis muscle originates on the anterior surface of the sacrum and inserts at the greater trochanter of the femur. It’s primary action is to laterally rotate the hip. When the hip is flexed, it abducts the hip.

 

 

 

Piriformis Syndrome:

While Sciatica is most commonly associated with herniated disk , similar symptoms can be a result of Piriformis Syndrome. There is some controversy surrounding the diagnosis of Piriformis Syndrome because “there is little evidence available regarding the best methods to diagnose and treat it” (Morgan, Does Piriformis Syndrome Exist?, 2013). In his article Unraveling the Complexities of Piriformis Syndrome, Whitney Lowe (2017) acknowledges the controversy surrounding PS but also writes, “there is strong evidence to suggest that not only does this condition exist, but it is often under-recognized as a cause of gluteal and lower extremity pain and dysfunction”. Assessment of Piriformis Syndrome is based on knowledge of anatomy, client history, and physical examination. The FAIR Test and Pace abduction test can help assess whether a client may have PS.

Sciatic Nerve: “Nerve roots exit the spinal cord” starting at L-4 through S-3 and merge with the sciatic nerve (Yeomans, Sciatic Nerve Anatomy, 2015). The largest and longest nerve in the body, the sciatic nerve passes through the hip region and deep to the piriformis muscle. For the majority of the population it exits inferior to the muscle before continuing down the leg and into the feet and toes. If the sciatic nerve is compressed or irritated, a person can experience motor and/or sensory impairment such as muscle weakness, numbness, tingling in the leg, foot, and/or toes (Yeomans, 2015).

Though Piriformis Syndrome usually involves compression of the sciatic nerve, other nerves that reside nearby can become compressed. The posterior femoral cutaneous nerve is a “sensory nerve supplying the posterior aspect of the thigh” (Lowe, 2017). A person with pain or other sensory sensations such as tingling, numbness that extends only to knee may have a compressed posterior femoral cutaneous nerve. It and three other nerves (sciatic, inferior gluteal, and pudendal) could become compressed between the ps and the sacrospinous ligament (Lowe, 2017). As the inferior gluteal nerve is a motor nerve for gluteus maximus, weakness with this muscle could be a symptom with nerve compression. It’s possible for the superior gluteal nerve to be compressed or trapped by a hypertonic piriformis muscle at the Greater Sciatic notch. A motor nerve,  compression is likely to result in weakness of the gluteus medius and gluteus minimus muscles (Lowe, 2017).

Sitting for long periods as well as overuse with activities such as running can cause the muscle to become hypertonic, causing motor or/and sensory impairment. Calcification in the muscle due to a blow or fall can contribute to Piriformis Syndrome (Lowe, 2017). According to the authors of Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach, ps is most commonly caused by macrotrauma: a one time traumatic event such as a fall or blow to the buttocks that can lead to inflammation or muscle spasm.

Treatment for Piriformis Syndrome can include stretching as well as massage using stripping techniques and static compression to treat myofascial trigger points.

Note that low back pain with numbness, shooting or radiating pain is cause to see a medical doctor for diagnosis before seeking any kind of treatment.


Stretches For Piriformis and Glutes
Get more from your stretch with mindfulness, intention, and breath

watermark sitting fig 4

 

Stretch 1:
Begin by lying supine on a mat. Cross one leg over the other to make a figure four. Bring yourself up so that your hands are on the floor, fingers pointing back behind you. Keep your back straight in order to feel the stretch. I like to feel as though my foot, ankle, lower leg is rotating towards me while my knee is easing back in the opposite direction.

Stretch 2: 
Lay supine on the floor, legs stretched out. Bend one leg and bring it up in a flexed position. Take the opposite hand and place it on the knee of the flexed, raised leg and draw your leg straight across to the opposite side. Imagine the face of a clock underneath you with the number 6 in the direction toward your pelvis and the 12 toward your head. If you are stretching the right leg, you would be moving towards the number 3. Left leg would be towards the number 9. Your shoulders stay on the floor. As you move across, your hip can leave the floor and follow the movement. Come back to center. Draw your leg across and up towards the opposite shoulder. Your shoulders and hips stay on the floor. Come back to center. If you have the flexibility and it feels like a ‘good’ stretch, change hands so that the same hand clasps your knee and the opposite hand clasps around the lower leg or ankle. Take this stretch in the direction towards your head (12 o’clock). Explore the stretch and find out what works best for you.
Stop the stretch if you feel any pain, numbness or burning type sensations.

References