If you have been suffering with sciatica, persistent buttock pain, or hip issues, your piriformis muscle could be the culprit. Here is what you need to know.
Piriformis syndrome is caused by an abnormal condition of the piriformis muscle and the sciatic nerve. It frequently goes unrecognized or is misdiagnosed. Piriformis syndrome can “masquerade” as other common problems, such as intervertebral discitis, lumbar radiculopathy, primary sacral dysfunction, sacroiliitis, sciatica, and trochanteric bursitis.
Located deep in the buttock, the piriformis muscle attaches from the bone at the bottom of your spine (called the sacrum) to the top of your leg bone (called the femur). When contracted, it helps to rotate your leg outward, extend your leg laterally, and flex your hip. The piriformis muscle’s main purpose is to provide postural stability when standing and walking.
The sciatic nerve originates in the lumbar spine (spine in your low back) and runs along the piriformis muscle before traveling down the back of the leg to your toes. In as much as 22% of the population, the sciatic nerve pierces the piriformis muscle, splits the piriformis muscle, or both, predisposing these individuals to piriformis syndrome.
If the piriformis muscle becomes spasmed, inflamed, or both, it can irritate the sciatic nerve and cause sciatica.
CAUSES OF PIRIFORMIS SYNDROME
Piriformis syndrome is most often caused by trauma to the buttock, overuse or misuse of the hip muscles, or direct compression of the muscle. Things such as falling on you buttock, excessive walking or running, or sitting on a wallet, can be obvious causes of piriformis syndrome. As a chiropractor, other (less obvious) causes that I look for are misalignment of the spine and pelvis, muscular asymmetry or weakness in the pelvic, hip and/or core musculature, and flat feet.
SYMPTOMS OF PIRIFORMIS SYNDROME
Increasing pain after sitting for longer than 15 to 20 minutes
Pain in the buttock
Pain in the back of leg
Numbness or Tingling in the buttock and/or back of leg
Pain or difficulty with walking
Abdominal, pelvic, and/or inguinal pain
PIRIFORMIS SYNDROME TREATMENT
Once properly diagnosed, there are several non-drug treatment options for piriformis syndrome. A treatment approach that focuses on reducing the spasm and inflammation of the muscle, as well as addressing the underlying cause of the condition will give the greatest chance for success. Below is a list of possible treatment options.
Treatments for spinal and pelvic alignment
Deep tissue massage
Orthotics (if needed)
Hip and low back exercises
Electric Muscle Stimulation or TENS
In the 25 years that I have been practicing chiropractic, I have found that a holistic approach using multiple modalities (including core stabilization exercises) has given my patients the best results. If you have hip/buttock pain and/or sciatica that isn't getting better, piriformis syndrome should be considered as a possible cause.
Wishing you good health,