Piriformis Syndrome

 

Piriformis Syndrome Stretches

 

 

Piriformis syndrome is a condition where the piriformis muscle, which is located in the buttock region, spasms (tightens and shortens) causing buttock or hip pain. The piriformis muscle can also irritate the delicate sciatic nerve which runs underneath the piriformis, running between the muscle and the pelvic bone. When this happens it can cause pain, numbness and tingling along the back of the leg and into the foot similar to sciatic pain. 

Piriformis Syndrome is a somewhat controversial diagnosis, and opinions vary from those who say that the condition is extremely rare to those who claim it is a relatively common disorder often overlooked. 

The piriformis muscle is a muscle that lies in the gluteal region, running across your buttocks. It is one of six muscles that make up the lateral rotator group to externally rotate your leg (turn it outwards).

 

Causes of Piriformis Syndrome

The exact causes of piriformis syndrome are unknown. Suspected causes include:

Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip 

Tightening of the muscle, in response to injury or spasm 

Swelling of the piriformis muscle, due to injury or spasm

Bleeding in the area of the piriformis muscle.

Any one or combination of the above problems can affect the piriformis muscle (causing buttock pain) and may affect the adjacent sciatic nerve (causing pain, tingling, or numbness in the back of the thigh, calf, or foot).

 

 

 

 

 

Symptoms of Piriformis Syndrome

Most commonly, patients describe acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Typical piriformis syndrome symptoms may include:

  • A dull ache in the buttock
  • Pain down the back of the thigh, calf and foot (sciatica)
  • Pain when walking up stairs or inclines
  • Increased pain after prolonged sitting
  • Reduced range of motion of the hip joint

Other signs and symptoms reported include low back pain, diminished muscle stretch reflexes, diminished muscle strength, loss of sensation, resting external rotation of the hip, pain on rectal or vaginal palpation and dyspareunia.

 

 Sciatic Pain From Piriformis Syndrome

Because of the close proximity of the sciatic nerve to the piriformis muscle, it is possible for some cases of Piriformis Syndrome to irritate the sciatic nerve, causing sciatica symptoms. Anatomical variation in the relationship of the sciatic nerve to the piriformis muscle is often cited as a necessary prerequisite to the development of the condition. Normally the sciatic nerve exits below the muscle but, in some people, the nerve or a portion of it actually passes through or above the muscle, making more likely to be irritated by the piriformis muscle. There is some research that suggests that these anomalous arrangements occur just as frequently in asymptomatic individuals as in those with a diagnosis of Piriformis Syndrome, suggesting that anomalous anatomical arrangement is not a precursor.

 

Diagnosing Piriformis Syndrome

Special tests for this condition include the Piriformis test, the Freiberg's test (internal rotation and extension of the hip), the Pace's test (hip flexion with added abduction), and the Beatty's test (tonic contraction of the piriformis muscle in the side-lying position).

It is noteworthy that some refer to the Bonnet's test as a specific provocative procedure for Piriformis Syndrome. This test is described in various ways, with one version performed in like manner to the Piriformis test. Another version involves the addition of internal hip rotation to the Straight Leg Raise (SLR) test. However, it has been demonstrated that the addition of the internal rotation to the SLR test has the potential to aggravate the patient's sciatica, regardless of the aetiology.

Radiographic imaging (X-Rays) for Piriformis Syndrome is reported to be of limited value. Magnetic Resonance Imaging and Computed Tomography may reveal enlargement of the piriformis muscle, anatomical variations and localised oedema of both the muscle and the sciatic nerve. In addition, these imaging technologies help to rule out serious pathological conditions.

Given that Piriformis Syndrome is a controversial clinical diagnosis, clinicians should always seek to rule out other and more serious causes of buttock pain and sciatica. On the other hand, it may be important to consider the possibility that this syndrome exists to avoid the over-diagnosis of lumbar disc herniation and unnecessary spinal surgery.

 

Piriformis Syndrome Stretches

There are a number of ways to stretch one's piriformis muscle. Two simple and effective stretches include:

Lie on the back with both feet flat on the floor and both knees bent. Pull the right knee up to the chest, grasp the knee with the left hand and pull it towards the left shoulder and hold the stretch. Repeat for each side.

Lie on the back with both feet flat on the floor and both knees bent. Rest the ankle of the right leg over the knee of the left leg. Pull the left thigh toward the chest and hold the stretch. Repeat for each side.

Each piriformis stretch should be held for 5 seconds to start, and gradually increased to hold for 30 seconds, and repeated three times each day.

As Piriformis Syndrome is mostly due to an overly tight piriformis muscle, these exercises can prove to be very effective as they release tension and help to relax and lengthen the piriformis muscle.

 

If you have any questions, or would like to share your own experience, please leave us a comment below.

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