Piriformis Syndrome
Treatment in Perth
Pain deep in the buttock or travelling down the back of the leg is often labelled Piriformis Syndrome. But the piriformis isn't always the only structure involved and getting the diagnosis right matters.
BOOK AN ASSESSMENT →Understanding Piriformis Syndrome
Piriformis Syndrome is a common problem that, in my view, may be over-diagnosed.
It is often mistaken for pain originating not from the piriformis muscle but rather from one of several nerves in the gluteal region, including the Sciatic Nerve, Posterior Femoral Cutaneous Nerve, and Cluneal Nerves.
Understand the piriformis and why it can cause buttock and leg pain.
Sitting, muscle weakness and training can all play a role.
Several nerves and the lumbar spine can produce similar symptoms.
Treatment depends on which structure is actually causing the problem.
What Is Piriformis Syndrome?
The piriformis is a muscle located deep in the buttock region. When the piriformis becomes painful or irritated, it can produce buttock pain. Because of its close relationship with the sciatic nerve, symptoms can also include pain, numbness or tingling extending into the leg.
Piriformis Syndrome is also sometimes called ‘deep gluteal syndrome’, ‘extra-spinal sciatica’ or ‘wallet neuritis’.
What Causes Piriformis Syndrome?
There are many ways to acquire a problem with the piriformis muscle. Some of the most common are:
Excessive Sitting
Spending long periods sitting keeps muscles at a relatively static length. Over time, the piriformis can become tight and may irritate the sciatic nerve.
Muscle Weakness
The piriformis is involved in hip external rotation, abduction and extension. Weakness in the gluteus maximus, medius and minimus can cause you to overuse the piriformis to compensate.
Poor Gym Training
Muscles that don't show in the mirror can easily be overlooked. Training in a narrow range of straight movements while neglecting rotation may leave important hip movements under-trained.
How Is Piriformis Syndrome Diagnosed?
Diagnosis of Piriformis Syndrome is usually a clinical one.
Typically, a thorough history and physical examination of the muscles around the hip will be enough to make the diagnosis.
If we are still uncertain, we use several tests to help understand whether the piriformis is involved.
These tests help us understand whether the piriformis is involved. The more of these tests that are positive, the more confident the diagnosis.
How Can I Self-Manage It?
The key to getting better is correct diagnosis.
With that said, if you do have a diagnosed problem with your piriformis, you may benefit from exercises aimed at improving how the muscle moves and tolerates load.
Lengthen the Piriformis
Relax the Piriformis
Modified Pigeon Pose
This exercise is recommended as part of the ATG System by Ben Patrick (Kneesovertoes Guy).
In my view, you do not need a gym bench to get started if you can get your knee and ankle onto a flat surface like a couch or mattress.
If you struggle getting into this position, put pillows under your knee to raise it up and start there instead.
What Else Could It Be?
In a clinical setting, Piriformis Syndrome is a diagnosis of elimination.
In many cases, examination findings that suggest Piriformis Syndrome can also be positive in other conditions.
When I am asked what else it could be, I usually suggest the three structures I treat most often when I find Piriformis Syndrome symptoms.
Sciatic Nerve
The sciatic nerve can become adhered to the piriformis or another group of muscles collectively known as the ‘deep rotators of the hip’.
When this happens, the sciatic nerve can experience compression or stretching during some movements and may become inflamed or symptomatic.
The sciatic nerve can also be painful if pathology of the lumbo-sacral spine is suspected.
Posterior Femoral Cutaneous Nerve
The posterior femoral cutaneous nerve (PFCN) is another nerve located at the back of the hip and can be symptomatic.
Pain is usually limited to the back of the thigh and doesn't typically give pain in the lower leg or lumbar spine.
Lumbar Spine
When the pain comes from the lumbar spine, it may involve the discs, nerve roots, joint capsules or muscles.
If these structures are involved, it can be more concerning and should be evaluated by a professional.
Find the structure.
Treat it directly.
Retest the movement.
The important question isn't simply whether your pain is near the piriformis.
We want to determine whether the problem appears to involve the piriformis itself, one of the nearby nerves, the lumbar spine, or a combination of structures.
That assessment guides what we treat.
Can Treatment Help?
In my opinion, yes absolutely.
Our treatment plans for Piriformis Syndrome can involve Shockwave Therapy, Soft Tissue Therapy and Chiropractic Adjustments for the lumbar spine and pelvis.
Soft Tissue Therapy
The Soft Tissue Therapies we use at Southside are unique treatment techniques that directly target the sciatic nerve, posterior femoral cutaneous nerve and piriformis.
We use a combination of pressure applied by hand and movement to break up fibrous adhesions between structures in the body to promote movement and reduce pain.
Shockwave Therapy
Shockwave Therapy can be used to treat these adhesions as well as the piriformis muscle and some surrounding ligaments.
Chiropractic Adjustments
Adjustments to the lumbar spine and pelvis promote free and easy movement.
How We Approach Piriformis-Type Pain
Assess the Cause
We start by working out whether your symptoms are most consistent with the piriformis, a nearby nerve, the lumbar spine or another structure around the hip.
Treat the Relevant Tissue
Depending on what we find, treatment may involve targeted soft tissue therapy, Shockwave Therapy, spinal or pelvic adjustments, or a combination of approaches.
Retest & Progress
We reassess the movements and symptoms that brought you in and use that response to guide what we do next.
Sources
I draw heavily on my own personal, professional and clinical experience to write these articles, but in researching this topic I consulted the below websites.
Not sure what's causing your glute or leg pain?
We can assess what's contributing to the problem and determine whether the piriformis, nearby nerves or lumbar spine may be involved.