What to do about my piriformis syndrome? Advice from a Physiotherapist
What is Piriformis syndrome?
Piriformis syndrome is a condition that affects both the muscles and nerves in the buttock region. Specifically, piriformis syndrome occurs when the piriformis muscle, which is located deep in the buttock region, spasms and causes buttock pain. This may or may not irritate the sciatic nerve, which can create further symptoms. This may include pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).
Piriformis Muscle Anatomy
The piriformis is a small, band-like muscle, located deep in the buttok region - specifically it sits behind the gluteus maximus. It originates from the sacrum and inserts into the greater trochanter of the femur (outer hip bone). This piriformis muscle is constantly working, and can work overtime in athletes such as runners. It has three main roles:
Rotation of the hip and leg
Balancing with one foot lifted off the ground
Stabilizing the pelvic region
The other important structure to be aware of in this region, especially when it comes to piriformis syndrome, is the sciatic nerve. The sciatic nerve exits the spine in the lumbar region, and travels down through the hips, buttocks, and down the leg.
The reason that the sciatic nerve is affected in piriformis is due to location - the sciatic nerve runs vertically directly beneath the sciatic nerve. In some people, the nerve can actually run through the nerve.
Who is at risk for piriformis syndrome?
We don’t actually know what exactly it is that causes piriformis syndrome. There are however certain risk factors that can put you at risk, these can include:
Muscle spasm within the piriformis muscle. This can occur due to irritation within the piriformis muscle itself, or from irritation of structures that are close by such as the hip or sacroiliac joint.
Injury or spasm in the area may cause the piriformis to tighten
Injury or spasm may also cause the piriformis muscle to swell
Bleeding in the area local to the piriformis muscle
Any one of the above factor may affect the piriformis muscle resulting in buttock pain, and may also affect the nearby sciatic nerve resulting in symptoms such as pain, tingling, burning, pins and needles or numbness in the gluteal region, posterior thigh, calf or foot.
What does piriformis syndrome feel like?
Typically, patients with piriformis syndrome describe pain or tenderness in the buttock region. This may or may not be accompanied by nerve pain down the leg. Some commonly described symptoms include:
A dull or sharp ache in the gluteal region
Pain down the back of the thigh, calf, foot. This pain may also involve sensations of tingling, burning, pins and needles or numbness
Pain after prolonged sitting
Pain after prolonged walking or running
Decreased range of motion of the hip joint compared to the other side
Pain going up or down stairs
Pain that can be referred to the hip joint
How do I prevent piriformis syndrome?
Keep gluteal muscles generally strong so that they can cope well with any exercises that you may regularly do
Stretching of the gluteal muscles regularly or as required based on how the region if feeling
Practicing proper technique for exercise and sporting activities
Undertaking fitness programs to develop strength, balance, coordination and flexibility
Gradually increasing the intensity and duration of training
Allowing adequate recovery time between workouts and or training sessions.
Drinking plenty of water before, during and after physical activity
Seek treatment at the beginning of any persisting gluteal and/or leg pain
What is the best way to manage piriformis syndrome? Can physiotherapy help piriformis syndrome?
The best immediate treatment for a spasming muscle is heat therapy. This involves placing a heat pad or heat pack on the affected gluteal region for 20 minutes. Some patients find that alternating this with 20 minutes of ice therapy can help to ease their symptoms as well. Repeat as needed every 2-4 hours. It is important to ensure you do not fall asleep with either the hot or cold therapy applied to the area as this may lead to skin burns.
You can also try some self massage by using a spiky ball or even a tennis ball. This can be completed in a sitting position on the floor/on a chair or up in a standing position against a wall. Place the ball between your gluteal region and the floor or wall, and press your bodyweight into the ball. You can slowly move the ball around the region and stop and hold when you find particularly tight or sore spots for 30-60 seconds. These spots are called trigger points, and should provide relief once released.
How can Physiotherapy treatment help piriformis syndrome?
First of all, a physiotherapist can confirm the diagnosis of piriformis syndrome, as there are many other conditions that can be going on with similar symptoms.
Once confirmed that it is indeed piriformis syndrome, a physiotherapist can help with providing relief of the tight muscle with soft tissue treatment. This may involve deep tissue massage, trigger point relief, or dry needling.
Rehabilitation stretching or strengthening exercises can also be taught and prescribed by a physiotherapist, which should help decrease the pain and prevent the recurrence of this condition.
If you have piriformis syndrome, you need to see a physiotherapist in order to get the best outcome, and limit your chance of recurrence. To make an appointment with our excellent sports physios, please call your nearest clinic, or book online. We look forward to helping you soon!
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