PIRIFORMIS SYNDROME - A PAIN IN THE BACKSIDE!

Piriformis syndrome is a condition where the sciatic nerve is irritated by the piriformis muscle, causing hip and buttock pain. Piriformis syndrome is often mistaken for sciatica, although the sciatic nerve is affected in piriformis syndrome, true sciatica occurs due to a spinal dysfunction, such as a herniated disc or spinal stenosis.

The piriformis muscle is located deep within the gluteal area, it allows the hip to externally rotate and abduct.  The sciatic nerve normally passes under the piriformis muscle but in some people, it can pass through the muscle. This can predispose people to piriformis syndrome.

What causes Piriformis syndrome?

Primary piriformis syndrome can be caused by the position of the sciatic nerve in regard to the piriformis muscle, as referred to above.

Secondary piriformis syndrome occurs due to inflammation and/or spasm of the surrounding soft tissue, leading to compression of the nerve. This can occur through direct trauma such as an accident, or from a gradual tightening from overuse. Overuse of the piriformis muscle can occur from an increase in walking, running, cycling or standing for long periods. Direct compression can be caused from excessive sitting on hard surfaces or from having a wallet in your back pocket.

Piriformis Syndrome Symptoms

Common symptoms include:

·      Pain with sitting, standing or lying after 15-20min

·      Pain when getting up from a chair

·      Pain when walking

·      Pain and/or paresthesia (numbness, tingling, burning, pins and needles), radiating from the sacrum down the back of the thigh. Piriformis syndrome symptoms normally stop at the knee.

·      Sacroiliac pain on the opposite side

·      Pain that improves with movement

 Treatment of Piriformis Syndrome

Initial treatment to reduce acute symptoms may include:

·      Ice

·      Rest

·      Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

After the first 48 hours it is recommended to see your myotherapist where a treatment plan can be established.

·      Myofascial treatment

·      Appropriate stretches and strengthening exercises

Day to day management

There are some things you can do to help reduce the symptoms including:

·      Try not to cross your legs when sitting

·      Do not hip hike when standing

·      When sleeping on your side, ‘stack’ your legs on one another. Do not drop your hip over the other.

·      Try not to sit in a bucket type seat where your hips are lower than your knees.

·      Avoid running up and down hills

 Avoiding the above will limit shortening and/or overuse of the piriformis muscle