Piriformis Syndrome
by Jason Mould, MCPT
The piriformis is a muscle that travels behind the hip joint. It is a relatively small muscle compared to the other muscles around the thigh and hip. Its function is to aid in the external rotation or turning out of the hip joint. The muscle and sciatic nerve cross each other behind the hip joint. The sciatic nerve is the largest nerve in the body and supplies the lower body with motor and sensory function.
by Jason Mould, MCPT
The piriformis is a muscle that travels behind the hip joint. It is a relatively small muscle compared to the other muscles around the thigh and hip. Its function is to aid in the external rotation or turning out of the hip joint. The muscle and sciatic nerve cross each other behind the hip joint. The sciatic nerve is the largest nerve in the body and supplies the lower body with motor and sensory function.
Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve. This can result in pain deep in the buttocks, and referred pain down the sciatic nerve or “sciatica”. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle. It is thought that acute or chronic injury causes swelling of the muscle and irritates the sciatic nerve, resulting in sciatica. Patients with an atypical course of the nerve through the muscle are particularly prone to this condition.
Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, athletes are not the only members of society that are affected by piriformis syndrome. A large proportion of cases are reported in people who are sedentary. Causes can very, but for the most part they include exercising on hard surfaces, like concrete; exercising on uneven ground; beginning an exercise program after a long lay-off period; increasing exercise intensity or duration too quickly; exercising in worn out or ill fitting shoes; and sitting for long periods of time.
Diagnosis is difficult due to the fact that there are no tests to accurately confirm the presence of piriformis syndrome. However tests like MRI, x-ray, and nerve conduction studies are important to rule out other problems that may be present. Once a diagnosis has been made, treatment usually begins with stretching exercises and massage, and avoidance of contributory activities, such as running and bicycling. Some clinicians recommend formal training, including the teaching of stretching techniques, massage, and strengthening of the core muscles to reduce strain on the piriformis. Stretching exercises should not only target the piriformis, but may also include the hamstrings and hip muscles, in order to reduce pain and increase range of motion.
To treat piriformis syndrome the R.I.C.E. principle (rest, ice, compression, and elevation), should be implemented as close to the onset of pain as possible. This should be continued for the first 72 hours of the outbreak. Following this will offer you the best chance for recovery. Patients may also find relief from the application of ice and heat. Ice can be helpful when the pain starts, or immediately after an activity that causes pain. Alternating heat and ice is often helpful and increases the circulation to the area. Continue stretching the piriformis little bits throughout the day. Once most of the pain has been reduced, it is time to move on to the rehabilitation phase of treatment. The main component of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.
Prevention is crucial when it comes to dealing with piriformis syndrome. There are a number of preventative techniques that will help to prevent piriformis syndrome.
Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, athletes are not the only members of society that are affected by piriformis syndrome. A large proportion of cases are reported in people who are sedentary. Causes can very, but for the most part they include exercising on hard surfaces, like concrete; exercising on uneven ground; beginning an exercise program after a long lay-off period; increasing exercise intensity or duration too quickly; exercising in worn out or ill fitting shoes; and sitting for long periods of time.
Diagnosis is difficult due to the fact that there are no tests to accurately confirm the presence of piriformis syndrome. However tests like MRI, x-ray, and nerve conduction studies are important to rule out other problems that may be present. Once a diagnosis has been made, treatment usually begins with stretching exercises and massage, and avoidance of contributory activities, such as running and bicycling. Some clinicians recommend formal training, including the teaching of stretching techniques, massage, and strengthening of the core muscles to reduce strain on the piriformis. Stretching exercises should not only target the piriformis, but may also include the hamstrings and hip muscles, in order to reduce pain and increase range of motion.
To treat piriformis syndrome the R.I.C.E. principle (rest, ice, compression, and elevation), should be implemented as close to the onset of pain as possible. This should be continued for the first 72 hours of the outbreak. Following this will offer you the best chance for recovery. Patients may also find relief from the application of ice and heat. Ice can be helpful when the pain starts, or immediately after an activity that causes pain. Alternating heat and ice is often helpful and increases the circulation to the area. Continue stretching the piriformis little bits throughout the day. Once most of the pain has been reduced, it is time to move on to the rehabilitation phase of treatment. The main component of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.
Prevention is crucial when it comes to dealing with piriformis syndrome. There are a number of preventative techniques that will help to prevent piriformis syndrome.
- Warm up well. Your goal needs to be to increase blood flow, especially to the hip complex, as well as to loosen up those stiff leg muscles.
- Rest, Rest, Rest. Your muscles won’t work at optimal levels without rest, and you will be heading for a certain injury.
- Strengthen the muscles in the hips, buttocks, and lower back.
- *** Stretch. This is the most important one. You need to be proactive with stretching and develop a structured routine that stretches not just the piriformis, but the hips, and back as well.
- Sit with one leg straight out in front. Hold onto the ankle of your other leg and pull it directly towards your chest.
- Lie face down and bend one leg under your stomach, then lean towards the ground.
