Do you suffer from sharp or aching pain in your buttocks that becomes worse when you move your hip?  Do you have pain, tingling, or numbness down the back of your thigh, calf and foot?   You may be suffering from Piriformis Syndrome.

This blog will explain what Piriformis Syndrome is, what causes it and what you can do to fix it.

 

What is the Piriformis?

The piriformis muscle is one of your hip muscles located deep in your backside. It is a flat, band-like muscle that connects your low back to your hip.

 

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What does the Piriformis actually do?

The piriformis muscle is responcible for:

• moving your hips (think turning leg and foot outward)
• stabilising your hips while walking and standing
• plays an important role in standing upright and balance

It is often involved in everyday tasks such as standing from sitting, getting out of bed and stepping out if your car.

 

The Sciatic nerve and the Piriformis

The sciatic nerve starts in your low back, exits through your pelvis and runs down your leg to your foot. As the nerve passes out through your buttock area, it runs directly under the piriformis muscle. This is where problems can begin.

 

What is piriformis syndrome?

“Piriformis Syndrome” is the name we use when you are experiencing sciatic pain that is being caused by the piriformis muscle irritating the nerve as it passes out from your buttocks and down your leg.

The pain can be identical to the sciatic pain you feel from other problems such as bulging discs or spinal stenosis.

Scientifically we know that less than 5% of all cases of sciatic pain are caused by the piriformis muscle. That’s why an accurate diagnosis is so important before any treatment is started.

 

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What are the symptoms of piriformis syndrome?

The common symptoms of piriformis syndrome are:

• Pain in the buttocks that worsens with hip movement
• Pain, tingling or numbness into the buttocks especially after long sitting
• pain, tingling or numbness down the back of the thigh, outside calf and foot
• tenderness over the greater sciatic notch
• Aggravation of the pain through sitting
• Pain when first getting out of bed
• Pain in the pelvic joint on the opposite side
• Difficulty walking

 

Piriformis Syndrome and chiropractic

The aim of chiropractic treatment is to find the actual cause of your symptoms. Once we have an accurate diagnosis, we can design the best treatment program to get you well again.

If your piriformis muscle is causing your sciatic pain, the most common treatment is specific piriformis exercises to restore the normal range of motion to your pelvis and spine. This treatment is aiming to regain normal function to region, relax the muscle and remove the irritation of the sciatic nerve.

 

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How is piriformis syndrome diagnosed

There is no definitive test for piriformis syndrome.

Diagnosis is based on the following:

Medical history

• pain location and type of pain
• what positions and movements aggravate your symptoms
• what positions and movements relieve your symptoms
• past trauma to the region
• what treatments have been tried so far and with what success

Physical exam

The most reliable test for Piriformis Syndrome is called the FAIR test. This stands for (flexion, adduction, internal and rotation). Watch this video on the supine (faceup) version of this test, which can also be performed with the patient lying on their side.

Other findings that can indicate Piriformis Syndrome are:

• sharp pain on palpation of the piriformis muscle
• Pressure on the muscle aggravating the symptoms down your leg
• Specific hip movement aggravating your symptoms
• Reduced or painful hip movement

 Diagnostic tests

• X-rays and other spinal imaging studies cannot detect the sciatic nerve being irritated by the piriformis muscle, they are taken to exclude other conditions such disc injuries, spinal stenosis or spinal degeneration which can cause the same symptoms
• an injection of anaesthetic with or without steroids into the muscle which reduces your symptoms indicates piriformis muscle syndrome

 

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Why is Piriformis syndrome hard to diagnose

Fact: Piriformis Syndrome is responsible for less than 5% of patient cases with buttock and leg pain.

Fact: Nearly all people with buttock and leg pain will have a tight piriformis on examination.

Whenever your low back is not working well, regardless of the cause, your brain will tighten the muscles in the region to protect the area. Most patients we see with low back and leg pain will have a tight piriformis muscle as a part of their brains protection reaction. It is not the cause; it is just the compensation response.

This is why getting an accurate diagnosis of what’s actually causing your symptoms is so important.

 

What causes piriformis syndrome

The most common causes of piriformis syndrome are:

• low back restriction or imbalance
• a tightened or spasmed piriformis muscle
• sacroiliac joint restriction or imbalance
• hip joint restriction or imbalance
• excessive running or sitting

Any one, or combination, of the above problems can irritate your sciatic nerve.

 

What else can cause the same symptoms?

There are several other problems than can cause exactly the same symptoms.

The most common ones are:

• a bulging or herniated disc
• lumbar spine dysfunction
• spinal degeneration
• hip pathology or injury
• sacroiliac joint injury/dysfunction
• spinal stenosis

This why an accurate diagnosis is so important before any treatment is started.  For more information read our blog.

 

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Piriformis Syndrome treatment

Piriformis Syndrome can be treated three ways. You can visit your chiropractor or other health professional, visit your doctor for medical treatment or treat it yourself at home.

Health Professional treatment

Allied Health professionals such as chiropractors, exercise physiologists, physiotherapists and masseurs can treat piriformis syndrome.

Treatment consists of:

• restoring good spinal and pelvis movement
• deep-tissue massage
• designing stretching exercises for the piriformis; low back, hips and hamstrings
• specific low back strengthening exercises

Medical treatment

This is provided by general practitioners and medical specialists.

It usually consists of:

• non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen
• injections with a corticosteroid or anaesthetic
• mild electric current, such as a tens machine
• injection with botulinum toxin to relieve muscle tightness
• muscle relaxants
• surgery may be recommended as a last resort

The goal with all of these treatments is to control the spasming of the muscle while the treatment from your chiropractor or other health professional is trying to remove the cause of your symptoms.

 

Home treatment

The most common home treatment for piriformis syndrome is stretching.

 

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Piriformis stretch

There are many different piriformis stretches available to you. We have included three basic ones here for you to try.

Standing Piriformis Stretch

• place your leg on top of a table top as shown
• lean slightly forward, using the table for balance, until you feel a stretch in your piriformis
• you can lean forward keeping your spine straight to increase the stretch
• hold for 30 seconds, gradually leaning further forwards to increase the stretch (repeat 2-3 times)

Sitting piriformis stretch

• sit at the edge of the chair with your feet flat on the floor
• place your right ankle on your left thigh close to the knee as shown
• place your left hand on your right heel and your right hand on your right thigh area as shown
• gently push your knee toward the floor
• to increase the stretch, gently lean forward while keeping your spine straight
• hold the stretch from 30 seconds to 2 minutes, depending on your comfort level

Supine piriformis stretch 

• lie on your back with both feet flat on the floor and both knees bent
• rest the ankle of your right leg over the knee of the left leg as shown
• slowly pull your leg toward the opposite shoulder
• be careful not to twist or lift your back
• held for 5-10 seconds
• repeat 2-3 times on each side

 

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Piriformis Home Massage

Massage is also useful for piriformis syndrome. Here are two massages you can easily do at home.

Foam Roll

• cross your affected leg on top of your other knee as shown
• lean slightly towards your affected side and find a tight spot
• hold 30-30 seconds on the tight spot
• find another tight spot in the same area and repeat

Massage Ball

A massage ball allows you to put more direct pressure on the muscle but be careful when applying pressure to not overdo it.

• begin in a seated position on the ground with the opposite knee bent
• position a massage ball under the problem muscle
• rotate in a circular motion for 20 seconds

 

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Ice and heat

Both ice and heat can be used on the piriformis. Heat helps to relax the muscle and reduce pain whilst ice can help reduce the swelling.

The rule of thumb is that if it’s an acute injury use ice, if a chronic injury heat will be of more use.

For more information, read our blog on ice and heat.

 

Lifestyle changes

There are many things you can do at home to help your recovery.

The most common are:

• avoid prolonged sitting
• reach to your optimum weight
• spinal exercises
• avoid running or exercising on hills or uneven surfaces
• avoid positions that trigger pain such as sitting or certain activities
• maintain good posture

How to sleep with piriformis syndrome

Sleeping can be difficult with piriformis syndrome. It is important to lie in a position that is most comfortable for you and doesn’t result in excess pain to the area

If sleeping on your side is more comfortable make sure that you have a pillow between your knees. This helps prevent rotation through your pelvis and hips.

 

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Conclusion

If you have buttock and leg pain you may be suffering from prirformis syndrome. Make an appointment today to see if chiropractic can help you.

Our website contains a lot more information about spinal conditions such as low back pain, sciatica and bulging discs. There are also strengthening and flexibility exercises for your low back that you can do at home.

We hope you have found this blog helpful. Please leave a comment below and tell us what you think.