Hi everyone, the topic of today’s blog is piriformis syndrome.
Piriformis syndrome is an uncommon disorder that occurs when your sciatic nerve is compressed and/or irritated as it passes under, or through, the piriformis muscle – one of the deep muscles in your buttock.
The Piriformis muscle originates from the sacrum and runs laterally to insert onto the greater trochanter of the femur.
In a standing position with the hip extended, the piriformis muscle externally rotates the femur at the hip.
However when the hip is flexed, due to the muscles orientation, the piriformis reverses its function and becomes an abductor and internal rotator of the femur.
Piriformis syndrome is most commonly caused by the piriformis muscle overworking, becoming fatigued and then tightening, placing excessive pressure on the underlying sciatic nerve. Some of the reasons this can occur include:
· Women are 6 times more likely to be affected than men due to having a wider pelvis.
· Pelvis/hip dysfunction – poor lateral stability around the hip when we stand on one leg creates excessive sideways movement of the pelvis. This movement overstretches the piriformis muscle leading to fatigue and the development of trigger points.
· Poor core stability – inability to recruit the correct core muscles to stabilise our lumbopelvic region results in our body compensating by over engaging the gluteal muscles which leads to overuse.
· Over pronating or flat feet creates a biomechanical misalignment through our lower limb and hip. This results in excessive internal rotation of the femur which places the piriformis in a constant lengthened or stretched position.
· History of hip trauma or sciatic nerve pain, bulging discs or other spinal problems.
The symptoms experienced are caused by a spasm, tightening or trigger point within the piriformis muscle which results in Sciatic nerve compression. These symptoms can include:
· A deep ache through the buttock
· Tingling or numbness deep in the gluteal muscles, and pain radiating down the back of the thigh. Most likely on one side only.
· Pain can be triggered by applying firm pressure directly over the muscle, or activities such as prolonged sitting/walking, running, sitting on a car seat and climbing stairs.
· To avoid pressure and subsequent pain, one might adopt a lopsided sitting position with the sore buttock tilted up which can result in low back pain.
· Sometimes, in order to shorten the piriformis muscle and ease tension in the area we might adopt a change in our gait pattern where the foot is turned out.
Piriformis syndrome responds very well to conservative Chiropractic, physiotherapy and remedial massage treatment.
A well rounded treatment plan should involve:
1. Initially resting from the aggravating activity, especially if this activity is walking or running.
2. Releasing the piriformis and gluteal muscles using dry needling or deep soft tissue therapy.
3. Releasing any compensatory stiffness through the lumbar spine and hip flexor muscle groups
4. Carefully and progressively stretching the piriformis muscle to restore normal muscle length
5. Engagement in a progressive strengthening program for the deep core and lateral hip stabiliser muscles to minimise the risk of recurrence.
6. If thought to be the primary cause, foot orthotics may be indicated.
With severe or persistent pain, corticosteroid or botox injections or surgery are sometimes considered, however this should only considered after failure of a course of conservative treatment.
Some tips to help minimise the risk of developing piriformis syndrome include:
1. Don’t sit for extended periods. Every 45-60 minutes make sure you stand up and walk around to release pressure on the piriformis and gluteal muscles.
2. Maintain good strength through the deep core and hip muscles to ensure your lumbopelvic area remains stable.
3. Wear correct and supportive footwear during all exercises
4. Stretch the piriformis and hamstring muscles before and after exercises.
So that’s a brief overview of piriformis syndrome, if you experience any of the symptoms or discomfort as described above, seek advice from your healthcare practitioner as soon as possible.
If you have any questions or comments, feel free to email us at firstname.lastname@example.org and we’ll happily answer them for you.
If you think you might be suffering from piriformis syndrome and want relief today, call us on (08) 9486 8653 and we will arrange an appointment for you.