The piriformis muscle (PM) is an important posterior hip muscle. It is a muscle that has a role in hip external rotation, abduction, and stabilization. The piriformis is well known due to its role in the contentious ‘piriformis syndrome,’ a condition that can cause pain and dysfunction, not only in the general population but athletes as well.
Anatomy of the Piriformis:
The PM is a thick and bulky muscle. It starts from the anterior surface of the sacrum (tailbone) then passes out of the pelvis through the greater sciatic foramen attaching, via it’s tendon, to the the greater trochanter, which is part of the femur (long bone of the leg). There are many nerves and blood vessels that pass through the sciatic foramen, including the superior and inferior gluteal nerve and vessels as well as the sciatic nerve.
The primary difference between the PM and the other rotator (deep gluteal) muscles of the hip is the relationship it has with the sciatic nerve. Unlike other rotators of the hip, in most individuals (80 per cent) the sciatic nerve passes underneath the belly/bulk of the piriformis muscle. As a result of the large size of the piriformis and the room that it takes up in the greater sciatic foramen, it actually has the potential to compress the vessels and nerves that exit the pelvis.
Piriformis Syndrome occurs when there is an abnormal interaction between the PM and the sciatic nerve. This allows for an imitation of ‘true sciatica’ symptoms, where pain is felt in the back and/or buttocks with radiation down the back of the leg towards or into the foot of the affected side. It is estimated that piriformis syndrome is responsible for five to six per cent of sciatica cases, so it is important to rule out more common causes of sciatica such as nerve root impingement from a disc protrusion. In the majority of cases piriformis syndrome occurs in middle aged individuals and predominantly females (6:1 female to male ratio).
Piriformis Syndrome can, uncommonly, result of anatomical causes (primary piriformis syndrome, fewer than 15 per cent of cases) such as a split PM, a split sciatic nerve or an abnormal sciatic nerve path. More commonly, piriformis syndrome occurs as a result of precipitating causes (secondary piriformis syndrome) such as trauma or ischemia (lack of blood flow); where an inflamed, tight, or spasmed piriformis muscle compresses and irritates the sciatic nerve.
Most common symptoms reported in individuals who have piriformis syndrome include:
Buttocks pain (98 per cent of cases)
Radiating pain and tingling sensation from the lower back, groin, or buttocks descending the back of the thigh/leg (82 per cent of cases)
Calf Pain (59 per cent of cases)
Aggravation through sitting (especially when forwards leaning or crossing the leg over that of the unaffected side) and squatting
As with all treatments plans, the course of action will depend on the suspected cause of an individual’s piriformis syndrome (primary or secondary). In cases of Secondary piriformis syndrome, where the PM is inflamed, tight and/or spasmed, conservative treatment can help. Your local physiotherapist (or other health care practitioner) will create a treatment plan that focuses on manual therapy techniques (trigger point massage, active release techniques, etc.), stretching, gait adjustments, heat and a comprehensive home exercise program (including stretching and strengthening). Depending on the qualifications of your therapist acupuncture and/or dry needling may also be a treatment option. The overall goal of the treatment plan is to decrease tension in the PM and removing it as being the source of pain. The length of time an individual may experience piriformis syndrome is variable. Often the duration is brief, especially if proper treatment begins soon after symptoms appear.
If you think that you are experiencing symptoms of piriformis syndrome you can try the following stretching variations. Keep in mind that consulting with your local health care practitioner is always the best course of action; a physiotherapist can help determine the route cause of your pain and an appropriate treatment plan.
For more information or to book an appointment call 705-380-3312 or visit the website . Surge Physiotherapy is located at 33 King William Street, Suite 204, in Huntsville. Office hours are flexible with evening appointments available (3x/week). Email – firstname.lastname@example.org
Stephanie is a bilingual, Registered Physiotherapist with the College of Physiotherapist of Ontario and the Canadian Physiotherapy Association who is committed to providing a hands on, personalized approach to physiotherapy.
Stephanie, a native to the Huntsville community, developed a passion for health and wellness during her youth while competing in cross-country running, nordic skiing, and track and field. Stephanie has always had a strong caring nature and fell in love with the physiotherapy profession while volunteering at a physiotherapy clinic during high school and university.
Stephanie continued to build on her passion for health care by attending McGill University and completing her Bachelors of Science in Kinesiology. During her Masters in Health Science of Physiotherapy, completed at the University of Ottawa, she completed internships in orthopaedic clinics, hospitals, home care, and neurology centres.