Piriformis Syndrome
Piriformis syndrome is the compression of the sciatic nerve by the piriformis muscle To the
general public conditions that affect the sciatic nerve and refer pain down the back of the thigh are
often referred to as Sciatica. This term is not specific, because it may refer to inflammation
or compression in the lumbar spine, gluteals or at another point along the nerve.
Functions of Piriformis:
- Restrain rapid internal rotation of the hip eg: running
- Externally rotate the femur when the hip is extended or in neutral
- Horizontally abduct the thigh when the hip is flexed to 90 degrees
- Internally rotate the femur when the hip is fully flexed
Cause:
- Anomalies in the course of the nerve, such as penetration of the piriformis muscle
- Direct or indirect trauma eg: fall on the buttocks or MVA
- Inflammation or degenerative changes of the piriformis muscle, its fascia of adjacent
joints.
- Overuse with repeating bending and lifting, forceful rotation with weight on one leg,
squatting while holding a weight
- Postural and positional concerns. Hyperpronation tends to increase internal rotation and
adduction of the thigh during walking; the piriformis is overworked as it tries to control the
excessive rotation. Flexion contracture or hyperlordosis can cause tension in hip
stabilizing muscles. This usually occurs in the 3rd trimester of pregnancy due to the shift
in the centre of gravity. If muscles is placed in a shortened position for a prolonged
period, the piriformis becomes hypertonic and can compress the nerve. Eg: sitting with
knees abducted (often with ankles together); sitting on one foot; driving a car for
prolonged periods with a foot on the accelerator
- Anything that leads to or aggravates trigger points, which will in turn cause shortening of
the muscle such as sitting on a wallet in a back pocket
Symptoms:
- Usually unilateral. Compression of the sciatic nerve results in pain and paresthesia in the
posterior thigh, calf and sole of the foot. Sometimes accompanied by numbness in the
foot.
- Compression of the gluteal nerve causes buttock pain, with possible gluteal atrophy
- Active trigger points in piriformis result in pain in the low back, buttocks, hip and posterior
thigh.
- If both nerve entrapment and active trigger points, the pain is increased by sitting with
prolonged hip flexion, adduction and medial rotation, by arising from a seated position of
by standing. Usually aggravated by activity
- Pain often decreases with external rotation
Contraindications:
- No massage locally for 10 days after a cortisone injection
- No frictions are performed if the client is on anti-inflammatories
- Joint play, with hip and sacral mobilizations are avoided in the 3rd trimester, and
performed with caution with OA or with a degenerative condition affecting the hip or
sacrum.
Massage:
- Treat soft tissue and compensatory structures eg: such as hypertonicity and trigger
points, and from altered posture
- Decrease compression on the sciatic nerve, and reduce fascial restrictions
- Reduce pain, hypertonicity and trigger points
- Maintain range of motion
- Reduce edema if present
Treatment Outcome:
- A 60 minute treatment allows a thorough treatment of the lower body
- Initially, treatments are more frequent, ideally twice a week for a few weeks. Otherwise,
once a week for 4 – 6 weeks is recommended.
- If pregnancy is the cause, the condition will often resolve postpartum
- If the cause involves soft tissue, the prognosis is good, providing the client is complaint
with the self-care program.
Self-care:
- client can perform a self-stretch for the piriformis using a belt or rope
- strengthen weak muscles
- pillow between knees while sleeping on side to prevent excessive adduction of the hip
- frequent breaks to stretch or walk
- chiropractic adjustments may be necessary if there is sacroiliac joint dysfunction
*This is not intended for self-treatment. It is for information purposes only*
|
