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 Stretching Help?nto flexion. Stretch ju If the cause is muscular, stretching the hamstrings, gluteals and deep hip rotators will very often prove effective. Because the Piriformis in particular is an abductor, stretching the hamstrings with the leg slightly adducted, (see stretch below) and stretching the abductors (also below) will also target this muscle effectively. It will often recreate the painful sensations in the client, so be gentle! The are some variations given below because both the hip abductors and gluteals span a large region. Given that people vary in bone size and structure, muscle attachment points and sites of pain (perhaps a trigger point within a muscle,) it makes sense to explore each stretch carefully. We will work through this in more detail in our workshops but for now, check the anatomy images below to see the regions spanned by the abductors and gluteals and the differences on body shape for example in the pelvis. Don’t have a StretchFit Combination station? You can see all of these stretches in my mat book titled “StretchFit, safe effective stretches for every body.” Click here for a link. If you are interested in looking at how pelvis varies in size and shape, and how it affects function I would recommend my book “The Pilates Splits”. Below is a sample image from the book (image 3). IMAGE 2
The Standing Straight Leg Lateral Hamstring • Standard: Any • Muscle Emphasis: Lateral hamstrings external hip rotatiors, calves, peroneals
A. How to stretch Align feet. Front leg is adducted. Anterior pelvic tilt, walk hands down ladder with spine in neutral, keeps hips square to line of rear leg.
B. How to contract Press stretching leg down toward floor.
C. How to restretch Increase hip flexion with spine neutral.
What to watch out for: • Posterior pelvic rotation.
Variation: Place stretching leg onto slant boad for greater calf involvement.
Standing abductors â€˘ Standard: Any â€˘ Muscle Emphasis: Hip abductors
A & B & C. How to stretch Stand parallel to ladder with outside leg behind. Lean hips directly away from ladder. Minimise lateral flexion of spine. Bend knee of inside/front leg.
C. How to contract Press outside leg away from ladder.
Standing abductors D
D. How to restretch Bend inside knee and lean hips further from ladder.
E. Variations Rotate hips forward and backwards.
Seated External Hip Rotators â€˘ Standard: Any â€˘ Muscle Emphasis: Glutes and external hip rotators
A. How to stretch Sit with leg externally rotated and abducted, level ASIS if possible photos A&B depending on ability.
B. How to contract Press foot down into seat.
C & D. How to restretch Level ASIS then 1) anterior pelvic rotation then 2) lean sternum toward foot then 3) straighten back leg.
Seated External Hip Rotators • Standard: Any • Muscle Emphasis: Glutes and external hip rotators
What to watch out for: • Posterior pelvic tilt with forward lean.
As the pelvis rotates anteriorly the insertions of piriformis and the obturator muscles depicted will be moved further from their insertions on the greater trochanter.
Seated Gluteals • Standard: Any • Muscle Emphasis: Glutes and external hip rotators
A & B. How to stretch
B. How to Contract
Sit with leg adducted, knee in line with naval, if possible take elbow across to knee and rest.
Press thigh down into seat.
C. How to restretch level ASIS, rotate pelvis and trunk toward stretching leg, reach arm around to grasp side rail, press hand down into seat, place armpit over knee.
What to watch out for: • Thoracic rotation instead of pelvic rotation.