Piriformis Syndrome: Sciatica-Like Pain
Piriformis syndrome is a clinical condition which involves the piriformis muscle being in a state of chronic contraction, spasm or tightness and therefore contributing to the development of associated back pain, gluteal discomfort and sciatica like pain.
If the sciatic nerve becomes irritated it may also produce tingling or numbness along the sciatic nerve distribution through the leg, ankle and foot. In anatomical terms the piriformis muscle is a small muscle that is situated deep within the buttock below the gluteus maximus muscle. The major role of the muscle is to assist in rotating the hip or turning the leg and foot outwards.
WHAT MAY POTENTIALLY CAUSE PIRIFORMIS SYNDROME?
Piriformis syndrome is relatively common in individuals who spend prolonged periods of time sitting, motor vehicle drivers as well as runners or recreational athletes. Any activity or exercise that places the piriformis muscle under strain may lead to piriformis syndrome. The associated inflammation and tightness within the muscle may contribute to pressure upon the sciatic nerve. Interestingly, some individuals are born with their sciatic nerve either behind, on top or throughout the piriformis muscle. Depending upon the location this may increase your chances of experiencing piriformis syndrome. Other less common causes that we encounter in clinical practice include individuals who place their wallet in their rear pocket, those who sit with their legs crossed as well as having weakened hip musculature.
SYMPTOMS OF PIRIFORMIS SYNDROME
It is very common for people suffering from piriformis syndrome to present with symptoms such as moderate to severe tenderness and sensitivity in the buttock area. Upon palpation this may refer pain down the back of the leg into the hamstring muscles and sometimes the calf muscles. It is common for practitioners and individuals to confuse piriformis syndrome pain with hamstring injury due to the close relationship of the hamstring origin and the piriformis muscle. Typical symptoms are quite similar to a number of other lower back conditions such as sciatica, disc herniation, degenerative arthritis and mechanical lower back pain.
Common symptoms may include (but not limited too):
- Pain in the lower back and buttock regions that may refer to the leg, foot and ankle
- Changes in walking or running pattern
- Difficulty sitting for prolonged periods of time due to buttock pain
HOW IS PIRIFORMIS SYNDROME DIAGNOSED?
The diagnosis process for piriformis syndrome is to rule out other more serious conditions that present quite similar such as a disc injury. A comprehensive lumbopelvic examination can be performed by musculoskeletal therapists a Chiropractor. During this examination various tests and screening measures will be conducted to assess the lower back and pelvis.
PIRIFORMIS SYNDROME TREATMENT
Piriformis syndrome responds extremely well to conservative treatment. A combination of home based exercises and clinic based therapy provides sufficient and prompt recovery:
Chiropractic management of Piriformis Syndrome is dependent upon the age at which it is detected and the severity. If it is determined that Chiropractic treatment may be beneficial for you there are a variety of techniques which may be used:
Specific Manual Spinal Manipulation is the most commonly used therapeutic tool for Chiropractors and is commonly referred to as an ‘adjustment.’ This technique involves repositioning a joint which may assist with improving overall spinal curvature, flexibility, improving joint alignment, relaxing the muscle tension, reduce pressure and resulting in reduction in pain
Joint mobilisation (gentle stretching) is a more gentle therapy that is often used during acute phases of where or for those who dislike manual adjusting
Activator Technique (hand held instruments) used to facilitate enhanced joint movement and is suitable for all individuals and different level of severity
SOT Pelvic blocking (mobilisation of pelvic joints) to facilitate the joint movement in the pelvis, and sacrum joints relieving the piriformis muscle tension
Soft Tissue Therapy (STT) to the buttock muscular and connective tissue structures to assist with reduction of pain and increase in mobility
Physiological therapeutics such as Ultrasound, Shockwave therapy and low level (cold) laser treatment to assist with reducing inflammation
Massage for muscular tightness and tension is common for sufferers of Piriformis Syndrome due to the abnormal strain on the muscle. Specific massage and muscle releasing techniques are ideal for improving muscle tension and therefore relieving pain
Flexibility & Strengthening Exercise prescription may be helpful in later stages of treatment, when the inflammatory process has subsided. The focus becomes on prevention and strengthening of the muscle group in normal function.
PIRIFORMIS SYNDROME & CHIROPRACTIC RESEARCH
The most common clinical symptoms experienced by individuals suffering from piriformis syndrome appear to include buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with movements that enhance piriformis muscle tension. Hopayian, K. (2010). The clinical features of the piriformis syndrome: a systematic review. European Spine Journal, 19(12); 2095 – 2109.
Alternative or complementary treatment approaches such as Chiropractic care for piriformis syndrome appear helpful in managing and resolving associated pain and dysfunction. Tonley, J. et al. (2010). Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement re-education: a case report. Journal of Orthopaedic & Sports Physical Therapy, 40(2); 103 – 111.