Piriformis Syndrome

A very common reason a person can have pain in the hip, pain in the center of the buttocks, or pain down the back of the leg,  is due to a condition called the Piriformis Syndrome. The piriformis is a muscle which runs from the sacrum (a triangular bone at the base of the spine), to the outer hip bone (greater trochanter). The piriformis runs horizontally, with the sciatic nerve running vertically directly beneath it.

The muscles in and around the gluteal region help with three areas:

1.Rotation of the hip and leg;

2. Balance while one foot is off the ground; and

3. Stability for the pelvic region.

This muscle is a prime candidate for repetitive motion injury (RMI). RMI occurs when a muscle is asked to perform beyond it’s level of capability, not given enough time to recover, and asked to perform again.  The typical response from a muscle in this situation is to tighten, which is a defensive response of the muscle.

One of the symptoms of piriformis syndrome would be pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint producing bursitis. The bursitis is caused by an elevation of stress and tension within that joint. Another symptom suggesting piriformis syndrome would be pain directly in the center of the buttocks. Another symptom of piriformis syndrome would be sciatic neuralgia, or pain from the buttocks down the back of the leg and sometimes into different portions of the lower leg. The sciatic nerve is the largest and longest nerve in the body. It runs through the belly of the piriformis muscle and if the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, tingling and numbness.

Some of the causes of piriformis syndrome:

*Hyperlordosis (increased lumbar curve) which jams the lumbar facets putting pressure on the nerves.

*Fibrosis (due to trauma).

*Prolonged sitting.

*Vigorous physical activity, such as long-distance running.

*Stiffness, or hypo-mobility, of the sacroiliac joints.

*Over pronation of the foot, which causes the knee to turn inward, causing the piriformis to activate to prevent over-rotating of the knee. This causes the piriformis to become overused and tight, eventually leading to piriformis syndrome.

*Weak abductors combined with tight adductors.

The diagnosis is based on clinical findings, as there exists no confirmatory findings. In the Unite States approximately 90% of adults have had at least 1 episode of disabling low back pain (LBP) in their lifetime. Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome.

Dr. Goldberg Discusses Piriformis Syndrome

Piriformis Syndrome Treatment

In our office we can do a piriformis stretch, which takes pressure off the sciatic nerve, which relieves pain and also helps the piriformis to relax and recover. This muscle needs to relax and have increased blood flow to the area, encouraging it to heal more rapidly. To encourage fresh, oxygen-rich blood to the muscle is the most powerful means of getting the muscle to relax and function normally. In our office we do massage which is highly effective to accomplish this and also physical therapy, such as electrical  muscle stimulation. Also the patient can lay on SOT blocks which is a tremendous aid in relaxing all the muscles in the hips, low back and pelvis area. A lot of times patients think they have sciatica, but the pain is really coming from the piriformis. This is because piriformis syndrome can “mimic” sciatic pain, which can be severe.  So by treating the piriformis syndrome, we are able to get to the root cause of why they have sciatic pain. Also since usually inflammation in the area is involved we can recommend ice therapy, ten minutes on and ten minutes off, several times during the day.

Once the patient is out of the acute pain, we can then begin stretching of the hip muscles/piriformis. Some of these can be done at home. We start with gentle stretching, such as the cross-legged stretch while pulling up on the knees. As far as reducing the inflammation, the patient can be put on proteolytic enzymes, such as bromelain, which is natural and extremely beneficial with no side effects. Also black cherry juice can act as a natural anti-inflammatory.

Call Wellness Associates at:412-367-3778 for the diagnosis and treatment of Piriformis Syndrome. Health and Wellness without a prescription. Piriformis syndrome relief is only a phone call away.

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This entry was posted on Sunday, August 14th, 2011 at 7:52 pm and is filed under Ask The Doctor. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.