What is Piriformis Syndrome? Signs and Symptoms Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running. Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica, however, are not due to piriformis syndrome. To watch the piriformis muscle work as an external hip rotator, click here.
Piriformis Syndrome Diagnosis There is no definitive test for piriformis syndrome. In many cases, there is a history of trauma to the area, repetitive, vigorous activity such as long-distance running, or prolonged sitting. Diagnosis of piriformis syndrome is made by the patientâ€™s report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle.
In some cases, a contracted or tender piriformis muscle can be found on physical exam. Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.
The Anatomy The sciatic and peroneal nerve, pictured in image one, is a thickest and longest nerve in the body. Sometimes both of these nerves pass the underside of the piriformis muscle before dividing (first picture on left), and sometimes they divide and only the sciatic nerve passes through the piriformis muscle (second picture above). Other times they both pass through the piriformis muscle before travelling down the back of the leg, and eventually branching off and ending in the top and the sole of the feet. (See third photo below). Compression of these nerves, particularly in the instances of pictures 2 and 3 above, can be caused by spasm of the piriformis muscle. IMAGE 1
How Can Pilates Help? First, establish that your client has piriformis syndrome. If so, in consultation with their physical therapist, commence a program of stretching, and then strengthening the entire gluteal region. Any type of abduction or extension exercise will strengthen the gluteal region. Click here to see abduction. Which exercise should I start with? Gentle, contract/relax stretching, with several days in between for recovery is a skillful way to start. Try the stretches below, and see how you or your client responds. Send information to their physical therapist too, and get the OK from them before commencing
Next, without lifting the bottom from the carriage, take the leg across the body
Lying Hamstring Stretch with Adduction
Lie on the reformer as pictured, and allow the carriage to take your leg into flexion. Stretch just to the point of mild tension.
You can see the piriformis muscle below, deep under the Gluteus Maximus
Hereâ€™s a perspective from below the reformer. You can see the piriformis muscle, and how it will be stretched, if the leg is taken across the body.
If You Want to Introduce a Contract/Relax Element to the Stretch, it’s Simple Hold the rope, or if you have a partner, have them hold the rope, and lightly press your leg back in the other direction. That is, away from center in a movement called abduction. • Don’t let the leg move, and press for 5 seconds. • After 5, stop pressing, relax, breathe in, and on a breathe out, take your leg a little further across your body. This could be toward the midline, or even past it. • Hold for 15 breaths before stopping.
Now Lets Try a Stretch on a Box First, sit on the box as pictured. As much as you can, try to level your hips, like in photo 2. Don’t force it-this is the stretch in itself for many. • Hold the position for 5 breaths. For a full descrition of this stretch refer to the book Innovations in Pilates Matwork for Health and wellbeing.
Try this approach for 3 to four weeks, practicing one of the stretches every second day, at least twice on that day. Practice it for the full length of time suggested. Gauge your progress, and relay that back to your Pilates teacher and Physical therapist. Therapy is an evolving process. No one knows how you will respond to their treatment, we only have the history of others as our guide.
To purchase the book go to the online store at: www.yinpilates.com Certified teachers can watch both stretches above on the video section of the website.