Background & Etiology
The piriformis muscle is located within the gluteal muscles, it is used to abduct and laterally rotate the leg. It originates at the base of the spine (scrum) and attaches to the greater trochanter (top) of the femur (leg bone.) The sciatic nerve typically runs underneath the piriformis muscle, but in some patients may run through the muscle. Piriformis Syndrome occurs when the piriformis muscle irritates the sciatic nerve, causing pain and discomfort in the buttocks that runs along the course of the sciatic nerve. Pain along the sciatic nerve is referred to as sciatica.
The piriformis muscle typically affects the sciatic nerve when it experiences a spasm, shrinks or contracts. Common causes of piriformis syndrome include:
- Tight abductor muscles in the leg that transfer stress to the piriformis
- Malfunctioning gluteal muscles that transfer stress to the piriformis
- Repetitive strain through use of the legs in a sitting position like bicycling or rowing
- Changes in gait
- Traumatic injury such as a fall
- Pain directly in the center of the buttocks
- Tenderness in the area of the muscle
- Pain that radiates down the back of the leg along the path of the sciatic nerve
- Reduced range of motion of the hip and effected leg
If an individual suspects they have Piriformis Syndrome, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation.
If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the nerve irritation.
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Piriformis Syndrome include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the hip and leg.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the hip and effected muscles.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running or kicking activities) in daily use of the involved lower extremity.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the hip and nerve site.
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy that include:
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Surgery to correct underlying pathology or the cause of the nerve pain
Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of Piriformis Syndrome.