By Laurence Schubert APAM
What is Piriformis Syndrome?
The piriformis is a muscle located in the buttock and is part of the deep external rotators of the hip. The gluteal region has many different muscles all contributing to movement and stabilisation of the hip. The piriformis muscle originates from the posterior sacrum (near tail bone) and attaches to the greater trochanter (bony area lateral hip). Its main function is external rotation, abduction and partial extension of the hip.
When the piriformis muscle is irritated or compressed, this is known as Piriformis Syndrome.
What are the symptoms of Piriformis Syndrome?
Patients will experience pain and possibly neural symptoms such as numbness, paraesthesia and burning. These symptoms will generally be felt in the buttock and can radiate down or up, generally down the pathway of the sciatic nerve. It is common that patients will experience symptoms going down the lateral and posterior aspect of the lower limb and can reach as far as the foot. Pain may be aggravated during activity such as walking, squatting or any single leg stance tasks. It is likely pain will be felt upon palpation of the area, stretching of the glute and prolonged sitting.
What causes Piriformis Syndrome?
Piriformis syndrome is often caused by microtrauma to the buttocks, leading to inflammation of soft tissue, muscle spasm and resultant nerve compression. Muscular spasm of the piriformis can be caused by direct trauma, lumbar/SIJ pathologies or overuse.
Above are all secondary causes, however on rare occasions there can be primary causes of piriformis syndrome. Some patients may have anatomical variances or anomalous sciatic nerve pathway. E.g. the sciatic nerve may pass through the muscle belly of the piriformis, causing increased risk of compression.
Could it be something other than Piriformis Syndrome?
Absolutely it can be. Piriformis syndrome is easily compromised with lumbar involvement. Therefore, it is important you obtain a correct diagnosis to investigate the lumbar spine as this is commonly involved in presenting cases of piriformis syndrome. Many other conditions also masquerade as piriformis syndrome such as greater trochanteric pain syndrome, lumbar radiculopathies, SIJ dysfunction, lumbar spinal stenosis.
How do you manage piriformis syndrome?
Initially piriformis syndrome should be managed conservatively for up to 3 months, if little improvement occurs then referral to specialist surgeon may be necessary. In the first few weeks of treatment the aim will be to settle down the pain and allow regular day to day function. Modify activity levels and NSAIDs may be useful initially. Physiotherapy will focus on soft tissue mobilisation and trigger point release therapy. This has been shown to effectively reduce pain in the acute phase of the injury. Following this, a series of rehabilitation exercises may be needed. It is likely the patient will need strengthening and control exercises to reduce pain and prevent the injury from occurring again.
To get you started:
To get you started:
Gentle piriformis/glute stretch > 15 seconds x 5.
Tennis ball self-release > place a soft ball underneath your buttocks and gently sit on the ball where the sore spot is. Hold for 15 seconds in each spot.