The piriformis is a flat muscle, pyramidal in shape and is one of six small muscles found deep to the gluteus maximus (the buttocks). The piriformis laterally rotates the hip and abducts the hip when the hip is flexed. It originates from the anterior (front) part of the sacrum and inserts on the greater trochanter of the femur.
Piriformis syndrome is condition in which the sciatic nerve is aggravated or compressed by the piriformis muscle, which has become tight and inflamed, resulting in pain, numbness and tingling in the buttocks and sometimes along the back of the leg and into the foot. This pain is sometimes referred to as sciatic pain (sciatica). The sciatic nerve starts in the lower back, runs through the buttock and hip and down the lower limb (hence the transference of pain and numbness from the buttock to the back of the lower leg).
Piriformis syndrome is more common in women (possibly due to the biomechanics associated with the wider Q angle in women), and among athletes engaging in forward moving activities, such as bicycling, running. It can be caused by inactive gluteal muscles and tight hip flexors, as a result of sitting too long. It can also can be caused by overuse, for example by activities performed in the sitting position, that involve strenuous use of the legs, such as rowing.
Pain and numbness is often felt in the buttocks, and can radiate down the back of the leg (following the sciatic nerve) into the hamstrings. It can sometimes be mistaken for hamstring strain or hamstring origin tendinopathy. However, no pain will be felt in the hamstrings, instead tenderness will be found in area of the piriformis.
Pain increases after prolonged sitting, and can be more noticeable when climbing stairs or walking up an incline.
It can result in reduced range of movement of the hip joint, in particular internal rotation of the hip.
Rest, avoid running, until symptoms have disappeared.
Ice, can massage area with Ice Up (portable ice massager) (5-10 minutes) every 2/3 hours for first 48 hours.
NSAIDS when appropriate for pain (because of side effects, it is best to seek medical advice first before taking).
Sub acute (3 days to 3 weeks):
Heat and massage to stimulate blood flow and healing. Massage should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
Long term (chronic):
Physiotherapy and massage: Strengthening and flexibility exercises for the hip abductors, hip adductors, and gluteal muscles (Piriformis stretch, Hip rotation stretch, The Bridge). Start with low intensity and short duration and then gradually increase. As flexibility and strength increases can start introducing Proprioceptive balance and agility exercises.
As piriformis syndrome can be caused by over pronation biomechanical assessments should be performed to eliminate misalignment issues, and the necessity for orthotics and the replacement of running shoes.
Published: October 31, 2011Author: Sophia Cross, BA (Hons) MA
Piriformis Syndrome Treatments