The piriformis muscle lies underneath the gluteus muscle. A tight or inflamed piriformis is what is known as piriformis syndrome.
When your piriformis muscle becomes tight or fatigued, it can cause you to have a very sore lower back and buttocks. The pain can travel to other lower body parts if your piriformis muscle goes into chronic spasm.
The piriformis muscle is one of the external rotator muscles, so-called because they allow you to rotate your thigh outwards (externally) at the hip.
What are the signs of piriformis syndrome?
Piriformis syndrome is a rare neuromuscular disorder that impacts the sciatic nerve and the piriformis muscle. Spasms by the piriformis muscle can irritate the nearby sciatic nerve which can cause certain symptoms, such as:
- Pain that can go from the back to the foot
- Intermittent pain
- Severe pain when attempting certain movements (for example climbing stairs, walking and running)
Health care professionals make their diagnosis based upon the patient’s history and physical exam; other more common, similar problems are diagnosed or ruled out by CT scan, MRI, electromyography, and injection tests.
What are the causes of piriformis syndrome?
Piriformis syndrome is most often caused by macro trauma to the buttocks, leading to inflammation of soft tissue, muscle spasm, or both, resulting in nerve compression.
Microtrauma may result from overuse of the piriformis muscle, such as in long-distance walking or running.
Recognized causes of piriformis syndrome include:
- Abnormal development or location of the piriformis muscle or sciatic nerve
- Abnormal spine alignment (such as scoliosis)
- Leg-length discrepancy (when the legs are of different lengths)
- Prolonged sitting, especially if carrying a thick wallet in a pocket directly behind the piriformis muscle
- Prior hip surgery
- Unusually vigorous exercise
- Foot problems, including Morton’s neuroma
In many cases the cause cannot be identified.
How can you treat piriformis syndrome?
The pain and numbness associated with piriformis syndrome may go away without any further treatment. However, if you can only feel the symptoms going from bad to worse, then you should try the following ways to find relief.
- Lay face-up, and cross your right foot over the outside of your left knee. Use your right hand to pull down on the right front of your pelvis. Use your left hand to pull down on the right knee toward the floor to assist in a stretch. Inhale and exhale deeply, focusing on relaxing the muscle on the exhale.
- Dry Needling is one of the beneficial forms of treatment that your physical therapist can utilize to reduce pain.
- Application of heat.
- At the onset of pain, lie in a comfortable position on the stomach and place an ice pack on the painful area for approximately 20 minutes. Repeat as needed every 2 to 4 hours.
- If pain is caused by sitting or certain activities, try to avoid positions that trigger pain.
- No single treatment option works for everyone, but massage therapy is a little-known treatment for piriformis syndrome that may bring you significant relief from your symptoms.
- Doing exercises such as lunges and squats will help strengthen your muscles and support the piriformis.
- Surgery — Although an option of last resort, removing a portion of the piriformis muscle or its tendon has been reported to provide relief in refractory cases.
- Injections of a local anaesthetic (similar to Novocain), botulinum toxin, and/or a corticosteroid agent (after consulting with a professional).
What is the best sleeping position for sufferers of piriformis syndrome?
To reduce the potential for chronicity, people with piriformis syndromes should sleep on their side with a pillow folded between their knees. They should also sit with their knees straight.
Another sleeping position would be best for you. Lie flat on your back—keep your heels and buttocks in contact with the bed and bend your knees slightly towards the ceiling.
Don’t despair if you don’t find relief after a few days; no single sleep position works for everyone.
Keep in mind, it is absolutely essential to consult your doctor or trainer before you decide to follow a certain treatment plan for piriformis syndrome. Only once it is diagnosed, you can start a treatment process with medical advice.
The weakness of the glutes can lead to faulty movements at the hip, which can potentially lead to over-lengthening of the Piriformis muscle. If your physical therapist determines this to be the case for you, strengthening the glutes would be a good idea.