Piriformis Sybdrome

How can the piriformis muscle cause sciatic pain?

The piriformis muscle is found within the gluteal region. It originates from the sacrum (the base of the spine) and meets the femur (the thigh bone). Its action, along with seven other muscles, is to externally rotate the hip. The action of the piriformis muscle can be described as crossing your legs to rest the ankle on the opposite knee.

Piriformis syndrome is a neuromuscular condition. It is a reported cause of lower back pain and sciatica secondary to sciatic nerve entrapment in the piriformis muscle. It is usually due to an abnormal condition of the piriformis muscle, such as hypertrophy, inflammation or anatomic variations, caused by various conditions.

Why does the piriformis muscle cause sciatic pain?

There are two types of piriformis syndrome: primary and secondary. Primary causes of piriformis syndrome are due to anatomical abnormalities, such as a split piriformis muscle or a split sciatic nerve. Secondary causes are due to trauma, overuse or compression. Trauma will result in inflammation of the soft tissue structures, along with muscle spasm, which can result in sciatic nerve compression. Sitting for long periods of time on hard surfaces can also cause damage to the piriformis muscle.

Symptoms of piriformis syndrome

  • Pain can be sudden or gradually develop
  • Increase in pain after sitting for longer than 15 to 20 minutes
  • Pain over the piriformis muscle and its attachments to the sacrum and the greater trochanter
  • Difficulty walking
  • Pain and/or paraesthesia radiating from the buttocks in the posterior thigh and stopping at the knee
  • Numbness in the foot of the affected side
  • Asymmetrical weakness in the affected limb
  • Difficulty walking
  • Pain crossing legs when seated

How can Osteopathy help with piriformis syndrome?

There are a number of forms of treatments that an osteopath can use to help with this condition. This can include soft and deep tissue massage, muscular energy techniques, joint mobilisation, myofascial release techniques and even acupuncture!

At home, an osteopath may advise the application of hot and cold hydrotherapy to the area where the client is feeling the pain or discomfort. This will help to decrease inflammation surrounding the piriformis muscle, as well as increasing local blood supply and therefore promoting tissue healing.

Static stretches can also be prescribed, which involves passively stretching the muscle to its end range and then holding it there. To get the maximum benefit of the stretch, it should be held for a minimum of 30 seconds.

Strengthening exercises of the surrounding musculature may also need to be prescribed. However, each osteopathic treatment is tailored to the individual and the presentation of the condition.

References

Hopayian, K., Song, F., Riera, R., Sambandan, S. (2010) The clinical features of the piriformis syndrome: a systematic review, European Spine Journal, Dec. 19(12):2095–109. Epub 2010 July 3 Review.

Jawish, R.M., Assoum, H.A., Khamis, C.F. (2010) Anatomical, clinical and electrical observations in piriformis syndrome, Journal of orthopaedic surgery and research, Jan. 21;5:3.

Tonley, J.C., Yun, S.M., Kochevar, R.J., Dye, J.A., Farrokhi, S., Powers, C.M. (2010) Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement re-education: a case report, J Orthop Sports Phys Ther, Feb. 40(2):103–11.

Boyajian-O’Neill, L.A., McClain, R.L., Coleman, M.K., Thomas, P.P. (2008) Diagnosis and management of piriformis syndrome: an osteopathic approach, Journal of the American Osteopathic Association, 8 Nov. 108(11):657–64.

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