Piriformis Syndrome Treatment and Assesment

Lets begin with what is piriformis syndrome?

In the simplest terms, piriformis syndrome results from the compression (entrapment) of the sciatic nerve by the piriformis muscle. The piriformis is a slender, band-like muscle that is located in the buttocks near the top of the hip joint. This muscle is important to the functioning of the leg because it stabilises the hip joint and rotates the thigh away from the body when it contracts.

The sciatic nerve is a long, thick nerve that passes beside or through the piriformis muscle. As it passes down the back of the leg, it divides into smaller nerves that travel into the foot.

There are two variations of entrapment. The first variation takes place below to the piriformis muscle and above the gemellus muscle. Entrapment in this area is likely due to a myospasm or contracture (tightening or shortening) of either of these two muscles. The second variation is when the sciatic nerve pierces the piriformis muscle. In this case, myospasm and/or contraction of the piriformis muscle can lead to pain along the back of the thigh to the knee, loss of sensation, or numbness and tingling into the foot.

 

Piriformis syndrome symptoms

Piriformis syndrome usually begins with some combination of pain, tingling, or numbness in the buttocks, but symptoms can be severe and may extend down the entire length of the leg. This particular syndrome can often mimic its more notorious counterpart, sciatica syndrome. The main difference between sciatica syndrome and piriformis syndrome is the cause. Sciatica is directly due to a lumbar disc pressing on the sciatic nerve, not the piriformis muscle.

What both of these syndromes have in common is that they both affect the sciatic nerve and can produce pain, numbness, and tingling below the knee and into the foot. Some of the common symptoms include:

• Pain that is often aggravated by sitting, squatting, or walking
• Affected leg is externally rotated (toes point out) when relaxed
• Low back pain
• Deep aching in the buttock and thigh on the involved side

Treatment

During the 1st Coronovirus lockdown here in the uk during spring fo 2020, I spent a lot of time doing some personal devlopment and signed up for many course, one of these was the NASM CES (Corrective Exercise Specialist) and I really do love how the “attack” issues, and it fits perfectly for this situation and for any others your come across too.

NASM Corrective Exercise Continuum

 

Step 1: Does the client demonstrate knee valgus (go to Step 2a) or knee varus (go to Step 2b)?

Step 2a:

• Inhibit
  • Piriformis
    • For the knee valgus client, use the foam roller to reduce feelings of tightness in the hip and to help mobilize all the tissues. Even the most active person stills sits more than they should, which can dehydrate all the tissues of the posterior hip. Thus, keep the leg extended and relaxed to allow more tissue displacement.
  • Adductors: Hold tender spots for 30-45 seconds. 
• Lengthen
  • Adductors: 30-45 second hold 
• Activate
  • Gluteus max: 12-20 reps 
  • Gluteus med: 12-20 reps 
• Integrate
  • Lateral tube walking: 10-15 reps each side 

Step 2b:

• Inhibit
  • Piriformis: Cross target leg over to “open” the hip. Hold tender spots for 30-45 seconds. 
• Lengthen
  • Piriformis: 30-45 second hold 
• Activate
  • Gluteus max: 12-20 reps 
  • Adductor complex 
• Integrate
  • Ball wall squats with a medicine ball between knees: 10-15 reps

References

Chaitow, L., & DeLany, J. (2008). Clinical application of neuromuscular techniques: The lower body. Vol 2. Philadelphia, PA: Elsevier.

Clark, M., Lucett, S., & Sutton, B. (2012). NASM essentials of corrective exercise training. Burlington, MA: Jones & Bartlett Learning.

Koes, B.W., van Tulder, M.W., & Peul, W.C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313-1317.

Neumann, D.A. (2010). Kinesiology of the musculoskeletal system: Foundations for rehabilitation. (2^nd Ed.). St. Louis, MO: Mosby Elsevier.

Reynolds, L.W., & Schrattenholzer, T.F. (2007). Piriformis syndrome. Pain Management, 2(834-836.