What is Piriformis Syndrome? It is a common disorder caused by compression to the sciatic nerve by Piriformis muscle. Manifestations are pain, tingling and numbness in the buttocks and along the path of the sciatic nerve`s descend.
Along with general information about the syndrome itself, today we will be discussing it`s symptoms and the ways of treatment.
But what is Piriformis muscle? Piriformis muscle is a flat, pyramidal shaped muscle, located in the pelvis region. It`s function is to rotate the hip, along with several other muscles. The sciatic nerve passes through piriformis muscle, separating it in two. It is possible that trauma, hemorrhage , or spasm of the piriformis muscle can lead to Piriformis Syndrome.
Piriformis Syndrome Pathophysiology
This specific condition can be somewhat elusive, so it is often overlooked but can also be overdiagnosed. From my experience, reasons can be inconsistent description in literature or a simple oversight due to the rareness of the condition.
This syndrome can be caused by overuse of the Piriformis muscle or some sort of repetitive trauma. Acute trauma is often associated with Piriformis syndrome, strong blow to the buttocks region can cause hematoma and scarring of the surrounding muscles, affecting sciatic nerve leading to this disorder.
I can add congenital factors to the “causes” list. In certain cases there is an anatomical anomaly in relations of the sciatic nerve and piriformis muscle, that can set this syndrome in motion.
Indications of the already present syndrome are pain, in the buttocks, posterior portion of the upper, and sometimes, lower part of the leg. The pain increases as the person performs physical activity, such as sports, riding bicycle, walking for long periods of time, swimming etc.
So, as i`m sure you already know, pain is ever present. But pain as such, can be associated with many other conditions so we have to be more specific about it`s origin, location, duration and some other aspects. One of the more common symptoms with Piriformis muscle syndrome is pain that presents itself after person stands for 20 minutes or more, sits or even is lying down with out changing position.
After those 20, or in some cases 30, minutes person starts to complain about the radiating pain in their buttocks area (and we know that that is the place where piriformis is located). Pain will often spread to sacrum and descend down, to the posterior side of the thigh, usually stopping somewhere close to the knee area.
In most cases pain will actually get worse when they retain their position, and they will feel better if they engage in a light walk. But remember, light walk, rapid and forced movement can do you harm so just take it easy. Movement is not the only thing that can worsen the pain, actual getting up and sitting back down can be very uncomfortable and painful, so i would advise you to get some assistance (you can use some apparatus or ask family member, friend etc).
Various difficulties during walking can occur, such as foot drop or antalgic gait. Antalgic gait is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase. Numbness of the foot can also be present. accompanied by sacroiliac pain. Pain that usually does not go away completely when changing positions. Alongside with the pain, people often experience tingling feeling and muscle weakness.
You can perform a piriformis syndrome test yourself easily and identify the weakness, you just need a partner, you can grab a friend or a family member.You can do it like this: lie to the side (choose one,it does not matter with side you decide to start with) and have your friend push down on your leg while you try to resist him/her.
Now do the same, but lying on your opposite hip. If you feel any weakness in your legs with regards to each other there is a good chance you have a problem with your piriformis muscle.
Aside from the pain your your lower back and extremity, headache can present itself as another symptom. You may also get neck pain, i know headache and neck pain are pretty common for loads of conditions but when you combine them with all the above symptoms you will get a complete picture.
So all this being said, Piriformis syndrome is a serious disorder that can affect the quality of your life, so my advice to you is- if you notice some of these symptoms and feel like something is wrong go see a doctor, you have nothing to loose. If you feel pain while doing your usual, daily activity pay a visit to your doctor. It may be nothing, but if you feel something is wrong go with your gut.
I`ve seen many people, sick or hurting, that refuse to go to the hospital. And i always tell them the same – Do not take your health for granted! We are fragile, and our bodies need constant care and attention especially when we are dealing with some abnormal processes, preventing our body to function properly.
So what to do when the pain starts? As i`m sure you will agree, ice comes to mind first. And it`s not a surprise, ice will help cool down inflammatory process (if it is present) and help relax your muscle. It is not a bad idea to lay down in a comfortable position and place the ice on the painful area.
You can also incorporate a gentle massage, massage never hurt anyone and is especially effective with all back pain problems, including Piriformis syndrome. But if you don`t like cold, you might find heat to be more suitable.
If this is the case you can improvise and find the best solution- sometimes a simple warmed towel can do the trick. If you are an athlete then you know the importance of stretching, and if you are not- you will quickly find out!
Stretching, and movement in general is, according to the latest research, healthiest “thing” we can do for our body. World health organization actually says that insufficient movement is the number one threat to the people`s health, ahead of alcohol and cigarettes!
That is a mind blowing information, least for me.Insufficient movement weakens the heart and blood vessels and reduces hormon productivity. Movement is single most efficient stimulant for the proper functioning of our body. And movement will strengthen your muscles and aid you in your fight against piriformis syndrome.
But dont forget to stretch, stretch when you get up, when you go to bed, before any physical activity and after, it will only do you good. I advice you to use movement to you advantage but not just any movement.
It is advised that you consult your chiropractor and develop a whole set, or plan of exercises and movement patterns. They must be controlled, because when such a delicate condition is diagnosed, you must be careful and not risk worsening your condition. So always listen to your doctor, and pay attention to what he/she is saying. As far as the medications go, there is no one specific drug that will make Piriformis syndrome go away.
Piriformis Syndrome Stretches
When thinking about Piriformis syndrome stretches, you need to access your level of physical fitness and schedule your stretching routine accordingly. You need to start out slowly, and gradually progress to more complicated movements. This is why I`ve decided to share with you a few stretches you can start out with:
First exercise: Lay down on the floor (make sure you have a mat), flex your legs at the knees, with your feet flat on the ground. Next, cross your legs so that your left ankle is placed on the right leg`s knee. Now, push your knee away from you using your left arm. Repeat the process with the other leg (look at the picture below for graphics illustration). Hold the stretching position for 15-30 seconds and repeat 4 times per cycle, 4 cycles a day.
Second exercise: Get in a push up position and slide your right knee in line with your left shoulder. Rotate your leg in such a way, your ankle is on the floor. Then start pressing your hips down and feel the stretching in your hips and upper leg region (look at the picture below). Hold the position up to one minute, repeat 4,5 times a day.
Fourth Exercise: Pull up a chair and sit down. Cross the “affected” leg over, and make sure that the ankle is resting on the knee of the opposite leg. Bend in the hips and feel the stretch in the back of your thighs. You can also hold this position for about 30 seconds and repeat 4-5 times.Third Exercise: You will need a stool, 10-20 inches high. Place the heel of your injured leg to the stool and bend in the hips towards the stool. As you are stretching you will feel a slight stretch in the back of your thigh. Depending on your comfort level, hold the position for up to 30 seconds and repeat the exercise 4-5 times.
Yoga Exercise: One of the best yoga exercises for piriformis syndrome is, so called, pigeon pose, you can look at the video below and try the exercise out:
Since pain is usually related to some inflammatory process, doctors usually prescribe non-steroidal anti-inlammatory medications that can help decrease inflammation in the painful area. Patients usually take ibuprofen or naproxen.
Electrotherapy can someti, the mes be involved, for electrical stimulation can help reduce muscle spasm and in some cases reduce pain. Last resort i want to mention is surgery. I am not a big fan of invasive procedures but in some cases it will provide the necessary relief. There are couple options actually:
- First option is to cut the piriformis tendon
- Second option is to cut thru the actual muscle, and remove a small portion of it
- Third option is a newer and less invasive method, where certain medications and injections are applied that can resolve Piriformis pain in a few treatments
Home Based Treatment System
There has been a lot of effort lately to develop a home based, safe and easy to use system of exercises that will address piriformis syndrome and help the people who are struggling. As a result of those efforts, a brand new book arose called Piriformis Syndrome Crusher. It is a step-by-step guide with exercises divided into three levels- beginner, intermediate and advanced.
If you are ready to fight, this book will serve you as a guide and a general on your battlefield. It will give you guidance and motivation when you need it the most and help you live your life free of pain. Find out more here- PIRIFORMIS SYNDROME CRUSHER.
- Calve, Galland, De Cagny (1939) “The Antalgic Gait”. Pathogenesis Of The Limp Due To Coxalgia. Vol. XXI http://jbjs.org
- Klein (2012). “Physical Medicine and Rehabilitation for Piriformis Syndrome Treatment & Management” . Rehabilitation Program . http://emedicine.medscape.com
- Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 (2007) “NINDS Piriformis Syndrome Information Page” . http://www.ninds.nih.gov
- “Piriformis Syndrome (Hip/Buttocks Pain) ”
- “The Piriformis Syndrome” (1997)