The piriformis muscle is located deep beneath the fat of the buttocks near the gluteus maximus region, and is responsible for making the leg rotate outward on command. Piriformis syndrome is the result of tightness in this muscle, which places force on the sciatic nerve causing pain, tenderness, and numbness in the buttocks that might also radiate down the leg all the way to the calf. The cause is often relating to the spine or sacroiliac joints, or from overuse. This can be a very painful condition and for some people is very disabling. Fortunately, for the majority, chiropractic treatment is very effective! An accurate diagnosis is always the key to successful treatment.
What is piriformis syndrome?
The piriformis’ origin is on the pelvic surface of the sacrum and the sacrotuberous ligament, it extends through the greater sciatic foramen to its insertion point on the upper end of the greater trochanter.
When the muscle contracts it rotates the thigh outwards (external rotation). As with all muscles sitting close to a joint, its main function is to provide stability for the thigh and hip through a static or isometric contraction. It works in conjunction with several other muscles in the buttock area such as the Quadratus femoris, Obturator internus, Superior- and Inferior gemellus. It is almost impossible to isolate in muscle testing because of it, but it is easy to find and palpate if you know how.
In the majority the sciatic nerve passes immediately below the piriformis muscle, but in a small proportion of people (approximately 15% of the population) part of the sciatic nerve goes through the piriformis muscle.If the muscle is in spasm this can cause neurological symptoms such as pain, numbness, pins and needles, tingling and weakness due to compression of the nerve. This is called piriformis syndrome.
It is also important to know that the referred pain pattern from the piriformis muscle itself is felt down the leg in a path along the sciatic nerve. It is therefore often mistaken for a piriformis syndrome when it is not.Quite often it is not even considered as a diagnosis when somebody has sciatica or leg pain. And the cause of sciatica is often thought to be due to a disc injury. It is, of course, imperative to have an accurate diagnosis to give the right treatment.
So, sciatica can have many causes and it has been shown in many studies that disc herniations can be non-symptomatic. This is where it is easy to get into a muddle.
Imagine if a disc herniation is visible on a MRI scan and the piriformis syndrome and referred pain has not been considered as a diagnosis. You have surgery for the disc and low and behold there is no improvement after surgery.
Symptoms of piriformis syndrome
Piriformis syndrome can cause pain in the lower back, groin, perineum, buttock and hip, and can also cause dyspareunia (painful intercourse) and pain in the rectum during defecation. But the most common symptoms are pain in the lower back and/or pain that radiates to the buttocks and down the leg. Often when people talk about the piriformis syndrome they mistake the referred pain from the muscle to be a piriformis syndrome. The difference is that the true piriformis syndrome has neurological symptoms associated with it, such as pain, numbness, pins and needles, tingling and weakness.
As with all orthopaedic problems rest and exercise modification is important to ensure a quick recovery.The chiropractic treatment is aimed at restoring the function of the pelvic and spinal joints, which is often the cause.A pronated foot (fallen arch) may cause rotation of the leg, which can put extra strain on the muscle, this is also addressed through foot orthotics and specific exercises for the feet. This is followed by trigger point therapy, massage, stretching and strengthening exercises.
What should you do?
These are all risk factors for developing recurrent and chronic back pain:
Poor fitness levels and spinal stability (core muscle strength)
Previous episodes of back pain
Pain for more than 8 days
So, the longer you have put up with the pain the more likely you are to become a chronic and recurrent sufferer.The general recommendation is to make sure you get the problem diagnosed properly, have a chiropractor evaluating your core stability, have treatment if necessary and do the right type of exercise to help your problem.