What is Piriformis Syndrome?

By Declan Wise

Piriformis syndrome is an entrapment of the sciatic nerve underneath the piriformis muscle. Anatomically the sciatic nerve passes underneath the piriformis muscle as it travels from the lumbar/sacrum down into the bottom of the foot. The sciatic nerve is responsible for providing sensation and muscle control to the posterior (or back) of the lower limb. When the piriformis muscle is irritated or inflamed it can also affect the sciatic nerve resulting in sciatic-like symptoms.

How does it present?

Patients typically describe a deep aching sensation in the gluts or buttock region. This can also be associated with tingling sensations that travel from the glut to the hamstring and even as far down as the bottom of the foot. Commonly pain will be aggravated by sitting for prolonged periods of time, pain in the buttock worsened by hip movements, any pressure applied over the glut muscles and internal hip rotation.

How does it occur?

Common causes of piriformis syndrome include:

• Trauma to the hip or buttock area
• Piriformis muscle hypertrophy
• Sitting for prolonged periods (taxi driver, office workers, bicycle riders)
• Poor hip bio-mechanics that place stress on the piriformis muscle
• Anatomical Anomalies
• Bipartite piriformis muscle (where the piriformis muscle is divided into two muscles instead of one singular muscle)

Piriformis syndrome in most circumstances is diagnosis of exclusion whereby other more common causes of sciatic-type pain need to be ruled out initially. Other common causes are (but not limited to) lumbar disc herniations, lumbar stenosis, sacrum irritations, hamstring injuries or space occupying lesions. Hence your practitioner will need to rule out these causes through history and examination.

How can we help?

Piriformis syndromes can pose as a challenge from a management perspective as successful treatment can widely vary depending on each individual. Management strategies that we use (typically a combination of some) include:

• Soft tissue releases
• Adjustments/mobilisations
• Stretching exercises
• Strengthening exercises
• Dry Needling
• Taping

If you are suffering from a Piriformis syndrome or looking for more information book an appointment today.