Updated: Aug 22, 2019
The piriformis is part of the deep rotator group of muscles in the hip complex and is often blamed rightly or wrongly in the incidence of " sciatica" type symptoms.
From the literature it would appear that it may be responsible for sciatic nerve type problems in under %10 of sufferers.
What's a Piriformis?
The piriformis is part of the deep group of rotator muscle in the hip and is latin for pear (piri) shaped (formis).
There have been different variations identified in the anatomy of the muscle and how it interplays with the sciatic nerve. The available evidence suggests that the anatomy of the piriformis does not play a large part in the development in symptoms assocaited with this condition, however the jury is still out on this due to the lack of good evidence.
What are the symptoms involved in Piriformis syndrome ?
The tell tale signs are as follows:
Tight or cramping sensation in the buttock and/or hamstring.
Gluteal pain (in 98% of cases).
Reproduction of buttock, leg pain, pins and needles or even numbness when palpating the region associated with the piriformis muscle.
Often symptoms can reproduced with sitting, especially with a wallet in the back pocket.
Any activity or test that increases compression through the deep muscle of the hip. It can be that stretching or tennis ball release can actually aggravate symptoms.
In the clinic we may find that testing the lumbar spine may be fine when assessing the client, yet the hip is more sensitive to testing.
Why does it cause so much pain ?
The following are potential reasons why this syndrome can occur:
1. It's a response of the muscles becoming very overactive due to weakness in some of its neighbouring rotators or extensors of the hip. Possibly the "core " muscles of the lumbar spine.
2. Entrapment or irritation of the nerve in the
space, (greater sciatic foramen), as it passeswhere the piriformis lies,(piriform fossa), or is irritated within one of the variations of the piriformis anatomy.
3. Mechanical Sacro iliac or lower lumbar spine issues that need to be addressed with exercise based therapy.
How do we treat Piriformis treatment ?
From a physiotherapy perspective this is a condition that responds well to a combination of manual therapy, exercise based rehabilitation and altering activity to reduce the symptoms.
Self release techniques:
Despite the counter intuative nature this can be a good combination for mild to moderate forms of piriformis. It goes against what we think is occuring in the hip but it can be useful for symptomatic relief.
Using a spiky ball / lacrosse or tennis ball to decrease the tone and tightness in the trigger points at the hip.
Followed by stretching the hip across the body:
Figure 4 stretch:
Always nice to encourage some neural flossing to keep the nerve healthy.
A combination of training the core muscles and deep rotators of the hip seems to be an effective path for long term resolution and prevention. This is especially important in those participating in sport.
See more here for hip strengthening:
In the initial acute phases we tend to find that a combination of altering aggravating postures and finding positions of ease in lying can be very important.
Lying on the unaffected side with 1-2 pillows between the knees can take a degree of compression and sterch off the hip.
From a treatment perspective quite often the following have shown to be effective:
Trigger point release and acupuncture
Manual therapy to the lumbar spine and sacro iliac joint
From a medical perspective medicatons prescribed include non-steroidal antinfammatory drugs, muscle relaxants and neuropathic agents
For more severe or non responsive cases the following has been suggested:
Injecton of local anaesthetc to the piriformis muscle has been shown to be as successful as a combined injecton with glucocortcoid. Interestingly Botulinum toxin (Botox) injectons return superior results compared with other injectons, but cost and availability limits clinical applicatons.
If you have any questions feel free to drop us a line, alternatively you can book in for an assessment if you have any concerns and want to get rid of that pain in your butt